Medicine and Health Sciences Commons^™

The Impact Of Advance Directives On The Intensity Of Care Received In The Acute Care Setting In Older Adults, Marsha Helen Tyacke

Dissertations (1934 -)

The proportion of older adults in the U.S. is rapidly increasing. One-third of Medicare expenditures occur in the final year of life, with nearly half resulting from acute exacerbations of chronic, progressive diseases(Riley & Lubitz, 2010). Older adults prefer comfort over life-sustaining care, and decreased intensity of care is associated with improved quality of life at the end-of-life (EOL). Advance directives (ADs) have been proposed as mechanisms to improve congruence between patient wishes and EOL care; however, the impact of ADs on care delivered in the acute care setting at the EOL for this population is unclear. A retrospective, correlation …

The Effect Of Training And Recognition On Nursing Assistant Retention In Acute Care Settings, Rachael Austin Swann

Nursing Theses and Capstone Projects

Nursing assistants are being hired in acute care settings to alleviate staffing issues associated with the nursing shortage. This has been a great economical solution to ensure adequate staff because of the large number of trained individuals in this vocation. Turnover and retention with nursing assistants in all settings including acute care is an expensive and reoccurring problem. Although several strategies have been implemented to prevent this, few provide a sustainable positive outcome. This situation requires an approach to look at the causes of turnover and provide interventions to reverse the negative impact. The intent of this research looked at …

Evidence-Based Interventions: Improving Influenza Vaccination Rate Among Health Care Workers (Hcws) Targeting Direct Care-Givers, Jennelyn Fraser-Johnson

Doctor of Nursing Practice (DNP) Projects

Background: Influenza is a contagious disease affecting over three million people every year. It is associated with yearly seasonal outbreaks which increases the risk of mortality among immune-compromised, hospitalized clients, clients in long-term care facilities and also enhances the risk of infection in healthcare workers (HCWs). Nosocomial infections and employees’ absenteeism are often associated with the flu. A high influenza vaccination rate in health care professionals reduces the risk of influenza infection as well as being a cost- effective strategy to reduce lost work hours. A Joint Commission criterion for accreditation for healthcare facilities is to achieve a 90% …

A Clinical Practice Guideline For Pain Management In The Post Anesthesia Care Unit, Susan Mogan

Walden Dissertations and Doctoral Studies

Ineffective pain management in the post anesthesia care unit (PACU) increases patients' risk of adverse effects including decreased mobility, infection, chronic pain, depression, cardiopulmonary complications, increased length of stay, insomnia, fatigue, and overall decrease in quality of life. The PACU in a community hospital did not provide an evidence-based pain management guideline for nurses treating postoperative patients, resulting in nurses' concerns about providing pain management. The purpose of this project was to translate evidence on pain management into an evidence-based guideline for improved nursing practice in a PACU. Evidence was obtained from a detailed literature search using multiple databases and …

Baseline Prevalence Study Of Hendrich Ii Fall-Risk Assessment Tool At A Local Community Hospital, Emanuelle Vasconcelos Barbosa Borba Pontual

Master's Projects and Capstones

Each year, 700,000 to 1,000,000 people in the United States fall in hospitals; 30%–35% of those sustain injuries, and 20% of falls will cause serious traumatic injuries. Yet, research shows that close to one-third of these falls could be prevented. This paper presents the analyses of two fall-risk tools, Hendrich II fall risk model (HFRM II) and PMAT, in a local community hospital. Extensive review of literature and statistical analysis of 106 patients’ assessments practices were used to determine the current assessment skills for falls and PMAT. The aim was to understand if RNs are using the tools appropriately and …

Development Of Evidence-Based Rapid Response Team Protocols For Treatment Of Deteriorating Adult Medical-Surgical Patients, Laura Pitts Darby

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

Acute care hospitals in the United States and across the world are experiencing substantial increases in acutely ill patient populations requiring multifaceted medical treatments and care. This increase in number of seriously ill patients is resulting in crowded critical care units and more acutely ill patients on general medical-surgical units. Several decades ago, Rapid Response Systems were introduced to help reduce the risk of adverse outcomes in patients presenting signs and symptoms of clinical deterioration on medical-surgical units. In patients displaying symptoms of rapid clinical deterioration, members of the Rapid Response Team are often required to begin immediate intervention and …

The Acute Care Pediatric Nurse Practitioner In Missouri: An Analysis Of Needs Assessment, Jessica L. Mann

Dissertations

Introduction: Due to an increasing number of acutely ill pediatric patients and changing healthcare demands, there is an even greater need for nurse practitioners (NPs) to work in the area of pediatric acute care (AC). There is a lack of alignment of education and certification with the scope of practice of the AC Pediatric Nurse Practitioner (PNP). The development and implementation of a graduate level AC PNP program in Missouri will support the alignment of education, clinical training, and certification with the scope of practice of the AC PNP and improve access to a quality program for nurses that currently …

Exploration Of Nurses' Experiences Transitioning To A Team-Nursing Model Of Care, Melissa E. Pestill

Walden Dissertations and Doctoral Studies

In response to the needs of patients, coupled with nursing workforce predictions and the pressure of cost containment, a shift to a new team nursing model of care has been seen in Canada and Australia. Today's patients require multiple resources, nurses with additional skillsets and vast amounts of experience during their hospital stays, and a team of nurses can meet these needs. This project explored the experiences and perspectives of nurses during the implementation of a team nursing model of care on a 32-bed, inpatient, cardiology floor in southern Ontario. The purposes of this project were to conduct a formative …

Evidence Based Protocol: Discharge Delays In The Acute Care Setting, Kylie C. Schaberg

Master's Projects

According to Batalden, Nelson, Godfrey and Lazar (2011, p, 25), the clinical microsystem is a “place where patients, families and health caregivers meet” and encompasses all interactions from the moment a patient enters the system up to and including when the patient leaves the system. In order to understand the complex and dynamic changes that occur at the microsystem level, a thorough assessment must be completed. The purpose of this chapter is to gain a greater understanding of the mechanism of the microsystem and the effects that this microsystem has on the process for discharging patients from the hospital setting …

Reducing Medication Errors In The Acute Care In-Patient Setting: An Integrative Review, Ronni T. Rothwell

Doctoral Dissertations and Scholarly Projects

Promoting a culture of safety in healthcare organizations has become a necessary goal to ensure that patients are safe, well cared for, and satisfied with the services they receive. One of the areas recognized as a major safety concern across hospitals in the United States and abroad are medication errors, which continue to occur at a staggering rate. This integrative review seeks to serve two purposes to combat this pandemic problem. First, the project will attempt to determine if an appropriate intervention or strategic initiative exists that can reduce medications errors for adult patients on an acute care patient unit …

Implementing Sbar Training With Acute Care Nurses, Maureen Murray

DNP Projects

Background In 1999, the Institute of Medicine reported 98,000 deaths in US hospitals due to medical errors. The Joint Commission posits 70% of sentinel events are rooted in communication errors. The US military and aviation industry had developed structured communication tools to reduce communication error and shared this with healthcare in the form of the Situation Background Assessment Recommendation (SBAR) tool. The Joint Commission recommends use of the SBAR tool.

Objective Formal training on SBAR was not present at one acute care facility, constituting a gap between evidence and practice. This practice improvement project aimed to close this evidence-practice gap. …

A Practice Improvement Project To Improve Knowledge And Perceptions Of Palliative Care Among Patients With Heart Failure And Cancer In The Acute Setting Using Video Enhanced Education, Crystal F. Spellman

DNP Projects

Background: Clear communication of the purpose and benefits of palliative care can reduce barriers to acceptance of such services for patients and families. The purpose of this practice improvement project was to assess and improve knowledge and perceptions of palliative care among patients with a diagnosis of heart failure and cancer in the acute setting using a video enhanced education intervention. Methods: This practice improvement project took place at a 555 bed teaching hospital. 18 patients referred to an inpatient palliative care consult service in the acute care setting with a diagnosis of either heart failure or cancer participated. …

How Substance Abuse Impacts Pain Management In Acute Care, Dawn Dunn, Janette Neuman

Janette S. Jones

Article includes a review of evidence-based interventions useful for assessing and managing pain in patients with histories of substance abuse.

Developing Capacity To Care For A Client At Risk For Delirium And For The Acutely Delirious Client, Sherida G. Ingram

Electronic Thesis and Dissertation Repository

ABSTRACT

The purpose of this mixed methods study was: (a) to assess nurses’ knowledge and self-efficacy of caring for clients experiencing delirium and those at risk of developing delirium in a hospital setting prior to and immediately after taking part in a clinical education session, and (b) to explore nurses’ experiences of applying knowledge from the education session to the practice setting. Objectives of the education session included reviewing risks, signs, symptoms, standardized screening tools, and management strategies for clients at risk for or experiencing delirium in a hospital setting.

For the quantitative methods portion of the study, participants completed …

Patient Experience Measurement Ignores Mental Health: Suggestions For Healthcare Organizations, Mona Shattell Phd, Rn, Faan, Andrew Gallan Phd

Mona Shattell

No abstract provided.

Is There An Economic Case For Investing In Nursing Care – What Does The Literature Tell Us?, Diane E. Twigg, Helen Myers, Christine Duffield, Margaret Giles, Gemma Evans

Research outputs 2014 to 2021

Aim

To determine the cost effectiveness of increasing nurse staffing or changing the nursing skill mix in adult medical and/or surgical patients?

Background

Research has demonstrated that nurse staffing levels and skill mix are associated with patient outcomes in acute care settings. If increased nurse staffing levels or richer skill mix can be shown to be cost-effective hospitals may be more likely to consider these aspects when making staffing decisions.

Design

A systematic review of the literature on economic evaluations of nurse staffing and patient outcomes was conducted to see whether there is consensus that increasing nursing hours/skill mix is …

Assessing Prevalence Of Known Risk Factors In A Regional Central Kentucky Medical Center Heart Failure Population As An Approach To Assessment Of Needs For Development Of A Program To Provide Targeted Services To Reduce 30 Day Readmissions, Christeen Ivy Broaddus

DNP Projects

Abstract

Objectives:

1. Determine demographic, physiologic, and laboratory characteristics at time of admission of the heart failure (HF) population in a regional acute care facility in Central Kentucky through review of patient electronic medical records.
2. Determine which HF population characteristics are significantly associated with readmissions to the hospital.
3. Provide identification of the statistically significant common characteristics of the HF population to this facility so that they may work towards development of an electronic risk for readmission predictive instrument.

Design: Retrospective chart review.

Setting: Regional acute care facility in Central Kentucky.

Participants: All patients (n = 175) with a diagnosis or history …

Floating Nurses To Specialty Areas, Deborah S. Hickman

Nursing Theses and Capstone Projects

As the largest group of health care providers, nurses play a vital role in the safety and satisfaction of patients. Despite this vital role, the nursing shortage continues to grow. As a result of this shortage and to fix staffing insufficiencies, nurses are frequently assigned to work in an area that they are not familiar with. This reassignment of a nurse to a different unit from their normally assigned unit is referred to as "floating." Nurses that are reassigned to a different unit from their normally assigned unit are referred to as "float nurses." Some healthcare professionals believe the use …

Improving The Diagnostic Accuracy Of Failure-To-Rescue, Amelia Marie Joseph

Theses and Dissertations

The ability to successfully rescue patients from complications has been shown to be a good measure of quality care processes in hospitals. Failure-to-rescue (FTR) has been defined using secondary International Classification of Disease (ICD-9 CM) codes. Studies of FTR using these codes have demonstrated satisfactory accuracy when compared to clinical events documented in the medical record. However, a subset of the original codes for FTR, thought to be sensitive to nursing care, have failed to show the same level of accuracy. This study examined the possibility of using clinica lpredictors to identify failure-to-rescue.

Secondary analysis of a previous dataset was …

Evaluating The Knowledge And Attitudes Regarding Pain Management Among Nurses In A Surgical Setting At An Acute Care Facility, Barbara Turner

Nursing Theses and Capstone Projects

It is estimated that seventy-three million patients undergo surgical procedures each year in the United States. Of these, 80% experience acute post-operative pain, and approximately 20% experience severe pain (Hutchinson, 2007). Benner's Theory from Novice to Expert was used to guide the study, "Evaluating the Knowledge and Attitudes Regarding Pain Management Among Nurses in a Surgical Setting at an Acute Care Facility". A convenience sample of twenty-one nurses in an acute care hospital in Southwestern North Carolina participated in the Knowledge and Attitudes Survey Regarding Pain. Results showed a weak correlation between knowledge and attitudes of pain management and years …

The Nurse's Knowledge Of Blood Conservation As A Part Of Blood Management, Lindsey Putnam Austin

Nursing Theses and Capstone Projects

Medicine has historically regarded blood transfusion as an integral component of major surgery or illness. However, clinical studies have shown that allogeneic blood transfusions are associated with increased morbidity and decreased survival. Knowledge of this research and the concepts of blood conservation so as to avoid unnecessary blood transfusions is needed in order to deliver holistic care and serve as patient advocate. This knowledge reaches every specialty of nursing care.

This study of the nurse's knowledge of blood conservation as a part of blood management utilizes The Conservation Model developed by Myra E. Levine in 1973. Levine's work is a …

Psychometric Properties Of Three Instruments To Measure Fatigue With Myocardial Infarction, Ann Eckhardt, Anne Fink, Michelle Fennessy, Jessica Jones, Donna Kruse, Kathryn Vanderzwan, Catherine Ryan, Julie Zerwic

Scholarship

The purpose of this study was to evaluate the psychometric properties of three questionnaires to measure fatigue with myocardial infarction. The Fatigue Symptom Inventory Interference Scale, Profile of Moods States Fatigue subscale (POMS-F), and Short Form 36 (SF-36) Vitality Scale were completed during hospitalization (n = 116) and 30 days after hospital admission (n = 49). Moderate to strong correlations were found among each of these fatigue scales and between each fatigue scale and measures of other variables to include vigor, depressed mood, anxiety, and physical functioning. POMS-F scores decreased significantly at Time 2, but this decline in fatigue was …

Psychometric Properties Of Three Instruments To Measure Fatigue With Myocardial Infarction, Ann L. Eckhardt, Anne M. Fink, Michelle M. Fennessy, Jessica Jones, Donna Kruse, Kathryn J. Vanderzwan, Catherine J. Ryan, Julie J. Zerwic

Ann L. Eckhardt

Reducing Inpatient Falls And Fall Related Injuries In Acute Care Settings, Channing Williams, Nikita Lewis, Victoria Thomas

McCabe Thesis Collection

Falls are a continually rising issue in today's healthcare. In acute care settings, patient falls make up 38% of all adverse events in which include physical injury, undesirable emotional and financial outcomes for the client (Angn, Mordiffi, Wong, Devi, & Evans, 2007). Falls in the hospitals lead to fear, pain, decreased healing, longer in-patient stays, further health-related complications. Falls may also cause patient discomfort and affect quality of life. Prevention of falls is an important goal of hospitals world-wide. Research has been conducted to determine the clinical effectiveness and implementation of a fall prevention. Although falls in hospitals cannot always …

Transitioning From Acute Care To Ambulatory Care, Beth Ann Swan

College of Nursing Faculty Papers & Presentations

Trends in health care financing and changes in care delivery from the hospital to outpatient settings have caused an unprecedented demand for registered nurses in ambulatory care.

Nurses transition to ambulatory care expecting to use the same knowledge base and skill set used in their acute care practice.

While some knowledge and skills may be transferable, competencies (and additional knowledge and skills) needed by acute care nurses and ambulatory care nurses are not the same.

The purpose of this article to is describe and dispel myths associated with ambulatory care nursing practice and discuss the knowledge, skills, and competencies that …

“It’S The People That Make The Environment Good Or Bad:” The Patient’S Experience Of The Acute Care Hospital Environment, Mona Shattell, Beverly Hogan, Sandra Thomas

Mona Shattell

A review of contemporary nursing research reveals a tendency to focus on select aspects of the hospital environment such as noise, light, and music. Although studies such as these shed light on discrete aspects of the hospital environment, this body of literature contributes little to an understanding of the entirety of that world as the patient in the sickbed experiences it. The purpose of the study detailed in this article was to describe the patient’s experience of the acute care hospital environment. Nondirective, in-depth phenomenological interviews were conducted, then transcribed verbatim, and analyzed for themes. Against the backdrop of “I …