Medicine and Health Sciences Commons^™

Safer Together: One Purpose, One Future, Tara Haines

HCA Healthcare Journal of Medicine

This art quilt is based on the theme that working together creates a safer future for our patients. The patient is at the center and is surrounded by the care team to help them navigate towards health and better outcomes. Our student nurse is on the left with angel wings, supported by their professor, the patient, the care team, and their nurse, all guided by Florence Nightingale's lamp over the often uneven path towards a safer future

From Hired To Hands-On-Deck Status: Solving Delays In Health Care Hiring Processes And Supporting Workforce Safety Across A Large For-Profit Health System, Cynthia Skeens

HCA Healthcare Journal of Medicine

Background

During and after the COVID-19 pandemic, health care staffing shortages and onboarding inefficiencies, specifically delays in employee health clearance, prolonged time to hire, and threatened workplace and patient safety.

Methods

An employee health onboarding workflow at a large health care organization was redesigned across 3 domains: people, process, and technology. Interventions included workflow standardization, elimination of non–value-added steps, optimized tuberculosis screening, increased appointment capacity, and technology integration (electronic health record [EHR]documentation, centralized scheduling and communication, and completion of pre-visit forms). Following a pilot from May to December 2022, the workflow was expanded organization-wide with a structured rollout and ongoing …

Promoting Safety In Alcohol Withdrawal Syndrome: A Proactive Nursing Process Framework, Julie Anne C. Comia, Elizabeth Card

HCA Healthcare Journal of Medicine

Background

Alcohol withdrawal syndrome (AWS) is a potentially life-threatening response to the abrupt cessation or reduction of heavy, prolonged alcohol use. Untreated, it can progress to delirium tremens (DT), a medical emergency historically associated with mortality as high as 40%. Agitation and hallucinations during withdrawal also pose safety risks to the health care team in addition to the patient. Because deterioration follows a predictable course, timely nursing recognition and intervention are central to protecting both the patient and the care team from avoidable harm. The evidence-based framework is intended as an educational tool to help nurses anticipate and avoid harm; …

The Use Of Infra-Red Spectroscopy To Assess Intact Skin Of Various Skin Tones, Mary Lee A. Potter, Stacie Sosa, Charlott Polm, Sherry Campton, Wisam Salameh, Ronnie Klein, Yaniv Cohen

HCA Healthcare Journal of Medicine

Background

Pressure injuries (PI) continue to be a serious medical complication in the acute care setting. Industry leaders advocate for the use of objective technologies to provide accurate and quantifiable skin assessments for all patients across diverse skin tones. The Infra-Red Spectroscopy Scanner (IRSS) is a novel non-invasive decision support system (DSS) electro-optic technology that uses near infra-red spectroscopy to examine and assess physical and chemical changes prior to visual skin breakdown in real-time.

Methods

A 2-phase prospective open-label pilot device study was launched under protocol IRM-02-1123 (USA version 3.0, November 1, 2023). In both Phase 1 and Phase 2, …

Building A Culture Of Safety Through Faculty Mentorship: The Peer Pairing Framework For Clinical Nurse Educators, Clare A. Chambers

HCA Healthcare Journal of Medicine

Background

Clinical nurse educators often transition from bedside practice to clinical education in high-risk settings without structured support. Limited or absent mentorship during this transition may affect educator confidence, student learning outcomes, patient outcomes, and the ability to sustain a culture of safety. Although mentorship is widely recommended in nursing education, implementation strategies remain limited. The Peer Pairing Framework was developed as a staged mentorship approach to support clinical nurse educators and inform a comprehensive mentorship model.

Methods

The Peer Pairing Framework was informed by a voluntary onboarding survey of 914 clinical faculty, of whom 73.52% expressed interest in having …

Critical Care Catalyst: The Impact Of Trauma Nurse Leads On Mortality, Patient Outcomes, And Throughput, Danielle Brady, Jessica L. Brady, Hannah Dice, Parker Hu

HCA Healthcare Journal of Medicine

Background

Trauma is the leading cause of years of life lost in the United States. Dedicated trauma nurse leaders (TNLs) coordinate resuscitation and streamline care, but data evaluating their clinical impact at level I trauma centers are limited. We evaluated the association between a newly implemented dedicated TNL program and patient outcomes.

Methods

This single-center, preimplementation and postimplementation observational study at an urban level I trauma center compared adult tier 1 and tier 2 trauma activations from the pre-TNL period (January 1, 2017, through April 30, 2020) with the post-TNL period (May 1, 2020, through December 31, 2023; 8 dedicated …

Time Is Brain: A Nurse-Informed Multicenter Analysis Of Hospital-Based Mechanical Thrombectomy Pathway Efficiency (Haste), Gina M. Remington, Gita Nadimpalli, Michael Rolli, Nicki Roderman, Rebecca Cain, Sarah Pieprzyca, Debra Philpot, Elizabeth Wiggins, Edward C. Jauch, Shanna Arnold-Egloff

HCA Healthcare Journal of Medicine

Background

Swift response and successful reperfusion are major determinants of outcome in acute ischemic stroke due to large vessel occlusion. Quality initiatives in stroke care have shown that organized, protocol-driven practice can shorten treatment times and improve safety-sensitive clinical outcomes, yet thrombectomy workflow variation persists across health systems, and few studies have translated workflow findings into operational recommendations.

Methods

This retrospective, multicenter study evaluated mechanical thrombectomy workflow performance across 16 facilities in a large United States health system from August 2020 through December 2021. Elastic net regularization was applied to patient-level characteristics to generate residual durations for door-to-imaging, door-to-puncture, imaging-to-puncture, …

Retrospective Exploratory Pre And Post Evaluation Of Waste Anesthetic Gas Scavenging System And Association With Post Anesthesia Care Unit (Pacu) Nurse Health, Jessica Garibay, Dina A. Krenzischek, Ryan Macdonald, Elizabeth Card

HCA Healthcare Journal of Medicine

Background

The Occupational Safety and Health Administration (OSHA) recognizes the negative health impact of occupational exposure to anesthetic gases in the operating room. As a result, OSHA has implemented regulations, engineering controls, and regular air quality surveillance programs to protect surgical staff. However, immediate postoperative patients exhale waste anesthetic gases (WAGs) into the Post Anesthesia Care Unit (PACU) environment, exposing nurses to occupational health risks, including headaches, fatigue, organ damage, cancer, and reproductive complications. The PACU lacks any regulations or even recognition of this safety issue; in fact, most nurses and leadership are unaware. One potential solution, a scavenging oxygen …

Laboratory Study Of A Waste Anesthetic Gas Mask Scavenging System To Reduce Airborne Pathogen Exposure For Health Care Workers In Post Anesthesia Care Units, Josh Horton, Trevor Lim, Andrew Kanach, John Moenning, James Mcglothlin, Bruce M. Applegate Sr.

HCA Healthcare Journal of Medicine

Introduction

A scavenging oxygen mask system (SOMS) utilizing house vacuum has been demonstrated to significantly reduce exposure of post anesthesia care unit (PACU) health care workers (HCWs) to waste anesthetic gases (WAGs). Therefore, it was proposed that the same system could also be used to protect HCWs in the PACU by reducing Infectious Respiratory Particles (IRPs) spread from patients who may harbor airborne infective pathogens, such as Mycobacterium tuberculosis, certain strains of influenza, and SARS-CoV-2.

Methods

A life-like adult manikin head equipped with a bio-aerosol Collison nebulizer was set up to simulate patients exhausting pathogenic droplets. Further evaluation of …

A Nurse-Driven Escalation In Trauma Team Activation Reduces Mortality Of Injured Patients, Darrell L. Hunt, Yingxian Liu, Jordan S. Rahm, Bailey Segura, Mercedes Huens, Emily Lopez, Esther Krinsky, Joe Spinell, Andrea Palmer

HCA Healthcare Journal of Medicine

Background

There is a dearth of literature examining the clinical outcomes of injured patients who experience physiological deterioration in the emergency department (ED). At our trauma center, injured patients who develop hemodynamic, respiratory, or mental status instability after arrival are retriaged and upgraded to a full trauma team activation (fTA). The purpose of this study was to compare the clinical outcomes of patients with fTA based on prehospital signs and symptoms (initial) versus upgraded fTA patients.

Methods

This was a single-center, retrospective cohort study of injured patients presenting to a tertiary trauma center between June 1, 2022, and June 30, …

Bathrooms As A Patient Safety Blind Spot In Emergency Departments: A Narrative Review And Nursing Practice Framework, Carmelo Villani

HCA Healthcare Journal of Medicine

Background

Emergency department (ED) bathrooms preserve privacy and dignity but interrupt direct observation. Risks described across clinical publications and professional guidance include falls, unrecognized deterioration, overdose, hazardous ingestion, infection, inaccessible environments, and unmet elimination needs. This review integrated those risks and translated them into a nursing practice framework.

Methods

For the structured narrative review, PubMed/MEDLINE, CINAHL Plus, and Scopus were searched on July 30, 2026, without date, language, age, or publication-type filters. Backward and forward citation chasing and a targeted search for professional documents supplemented database searching. Publications were categorized by ED relevance and synthesized thematically. Professional guidance was analyzed …

From Restraint To Calm: A Narrative Review Of Nonpharmacologic Alternatives To Physical Restraints In Adult Acute Care And Introduction Of The Calm Bedside Restraint Alternatives Framework, Elizabeth Card, Brandi Puet

HCA Healthcare Journal of Medicine

Background

Nurses and health care workers are dedicated to creating a therapeutic environment for healing. Sometimes, physical restraints may be used to ensure safety in patients exhibiting violence, confusion, or agitation, or in patients with life-saving medical devices. While the regulatory requirements for use of physical restraints are well developed, this is not the case with alternatives to using restraints, and many nurses may lack clarity on the best practice for identification and application of alternatives to physical restraint use.

Methods

Two trained reviewers searched PubMed, Google Scholar, and professional health care organizations’ websites guided by a search strategy and …

Unheard Voices: Reducing Psychological Barriers To Publication In Nursing Research, Caryn R. Alper

HCA Healthcare Journal of Medicine

Despite their interest in clinical inquiry, many nurses face psychological barriers, including imposter syndrome (IS), that prevent them from engaging in research and disseminating their findings. This editorial explores how psychologically safe work environments can help counter these barriers through supportive leadership, respect, and mentorship to strengthen skills and confidence and reduce vulnerability in scholarly work. Normalizing self-doubt and creating environments where nurses feel safe asking questions and testing ideas can help more nurses recognize the value of their expertise and contribute their voice to the base of evidence.

Psychological Safety Is Everyone’S Work: A Call To Practice, Education, And Leadership In Nursing, Gina Rivera

HCA Healthcare Journal of Medicine

Psychological safety is essential to nursing practice, education, and leadership because it enables individuals to speak up, ask questions, report concerns, and learn from mistakes without fear of humiliation or blame. In health care settings, psychological safety supports patient safety by encouraging error reporting, timely escalation, and interprofessional collaboration. For nurses, it strengthens teamwork, accountability, well-being, and retention in complex, high-pressure environments. In nursing education, psychological safety allows students to admit uncertainty, engage in feedback, and develop clinical judgment across simulation, clinical, didactic, and online learning spaces. This article argues that psychological safety is often discussed separately across practice, academia, …

Safer Together: A Special Nursing Issue Focusing On Safety In Health Care, Tracy A. Ortelli, Lori M. Brodie

HCA Healthcare Journal of Medicine

Safety is a shared responsibility dependent upon the collective efforts of health care professionals, educators, leaders, organizations, and systems. This special nurse-led issue of the HCA Healthcare Journal of Medicine highlights scholarly works addressing education, clinical practice, and health care workforces. We are informed about safety through research, clinical reviews, case-based learning, and education. This issue was created to inspire the entire health care workforce to pursue continuous improvement to make health care safer together.

Beyond Language: Bilingualism, Biculturalism, And Professional Identity Among Bsn Students In South Texas, Nancy Nadeau, Eleftherios Gkioulekas, Margaret Rubi, Luz Maria Silva

Bilingualism in Higher Ed Summit

No abstract provided.

Sedation Minimization And Early Mobility To Prevent Intensive Care Unit Delirium, Alana M. Kugelard

Lynchburg Journal of Medical Science

The purpose of this paper is to synthesize current evidence on sedation minimization, early mobility, and multicomponent care bundles for the prevention of intensive care unit (ICU) delirium in critically ill adults. ICU delirium is a common and serious complication associated with increased mortality, prolonged mechanical ventilation, extended ICU and hospital length of stay, and long-term cognitive impairment, making it a significant safety and quality-of-care concern. A literature review was conducted using PubMed and the Cochrane Library, with search terms including “ICU delirium,” “sedation minimization,” “light sedation,” “early mobilization,” and “ABCDEF bundle.” Filters included adult populations, peer-reviewed studies, randomized controlled …

Use Of The Well-Star Model And Well-Star Graphic In Healthcare, Fidan Korkut-Owen, Zubeyde Akpakir, Dean W. Owen

Journal of Wellness

No abstract provided.

Synthesizing Evidence Of Stress, Anxiety, Burnout, And Health Habits In Nursing Students Compared To Non-Nursing Students, Brooklyn Watson, Julie Harrison, Mariah Leopold, Nantz Kerry Fleurant

Best Integrated Writing

Nursing school is widely recognized as a demanding and stressful academic program, characterized by rigorous clinical and academic expectations. Elevated levels of stress among nursing students can contribute to negative academic, emotional, and professional outcomes. Through this project, the student team conducted an in-depth examination of nursing student stress and burnout to better understand its prevalence, contributing factors, and potential interventions. The team employed comprehensive search strategies to identify and evaluate relevant evidence. Multiple Johns Hopkins Evidence-Based Practice appraisal tools were used to critically assess the literature, synthesize findings, and determine the significance of the evidence in relation to the …

Best Integrated Writing Fall 2026 - Complete Edition, Wright State University School Of Humanities And Cultural Studies, Kristie Mckiernan

Best Integrated Writing

Best Integrated Writing includes excellent student writing from Integrated Writing courses taught at Wright State University.

How Does Nurse-To-Patient Ratio Impact Patient Satisfaction?, Kathryn G. Courtney, Alexa Nicholson

Scholars Week

This evidence-based practice project examined the relationship between nurse-to-patient ratios and patient satisfaction. A review of current literature, guided by Jean Watson's Theory of Human Caring and the Plan-Do-Study-Act (PDSA) quality improvement framework, found that lower nurse-to-patient ratios are associated with improved communication, higher patient satisfaction, better patient outcomes, and increased patient safety. Based on these findings, recommendations and a Safe Nurse-to-Patient Staffing Policy were proposed to support acuity-based staffing, enhance quality of care, and improve both patient and nursing outcomes.

Implementation Of A Standardized, Multimodal Safe Sleep Education Policy For Newborns, Emma C. Cook, Anisa E. Toliver

Scholars Week

This evidence-based practice project proposes updating a regional hospital’s infant sleep policy to include standardized, multimodal safe sleep education. The goal is to improve adherence to safe sleep practices and reduce the risk of sleep-related infant death using interventions such as multiple forms of standardized parent education, consistent staff modeling of safe sleep practices, environmental modifications, and routine bassinet audits. This project uses Dorothea Orem’s Self-Care Deficit Nursing Theory to strengthen parental understanding and promote safe sleep environments during hospitalization and at home.

Developing An Emergency Department-Specific C. Difficile Infection-Prevention Policy, Katelyn M. Wuest, Chris Bray

Scholars Week

Our evidence-based practice project focuses on the need for an Emergency Department (ED)- specific Clostridioides difficile (C. difficile) infection-prevention policy that adapts the existing facility-wide guidelines to the unique workflow and environment of the ED. Using infection-prevention literature and environmental disinfection recommendations as a foundation, the project proposes the need for clearer guidance regarding applying precautions, managing shared equipment, and maintaining environmental cleanliness. Implementation and evaluation using a Plan-Do-Study-Act approach can help assess staff adherence and identify opportunities to improve consistency in infection-prevention practices.

Improving Fall Risk Assessment In Inpatient Rehabilitation, Sarah B. Flick, Aaliyah Garcia, Trista Hamblin

Scholars Week

This evidence-based practice project examines how fall-risk assessment can be improved for patients in inpatient rehabilitation by incorporating rehabilitation-specific functional factors into the existing assessment process. A review of four research studies identified toileting, transfers, ambulation, cognition, previous falls, and functional limitations as important considerations for fall-risk identification. The project proposes a structured functional review to supplement current assessment tools, with a phased implementation plan using staff education, a pilot program, and ongoing evaluation to support patient safety and individualized fall-prevention interventions.

Validating A Predictive Model Of Nurse Burnout Using Integrated Data Sources, Shahin Davoudpour, Mahesh Vaidyanathan, Rinad S. Beidas, Hannah Mulroe, Elliott Brandon, Matthew Lloyd, Gabrielle M. Olson, Mallika Pandey, Daniel Blumenthal, Baljash Cheema, Gaurava Agarwal

Advances in Cancer Education and Quality Improvement

Objective: To evaluate an integrated machine learning model using routinely collected organizational data to identify nurses at increased risk for burnout.

Background: Health care worker burnout directly threatens patient safety, quality of care, and workforce stability. Although nurses experience significantly higher burnout rates than physicians and face distinct operational stressors (eg, staffing shortages, continuous bedside care demands), most predictive modeling efforts have focused on physicians. Current approaches to identifying burnout typically rely on voluntary surveys, but advances in data science and machine learning have created new opportunities to move beyond self-reported measures.

Methods: This retrospective observational study included 1,177 nurses …

Individual, Social, Economic, And Health System Determinants Of Cervical Cancer Screening Uptake Among Women In Rubanda District, Uganda, Gervase Centinary, Sebastian Baine Olikira, Sezalio Masembe, Ronald Kibonire Arineitwe

School of Nursing & Midwifery, East Africa

Background: Cervical cancer screening uptake in Sub-Saharan Africa is shaped by individual, social, economic, and health system factors, yet few studies test all four domains simultaneously within a single rural district. This study examined individual, social, economic, and health system determinants of screening uptake among women aged 18 years and above in Rubanda District, Uganda, a district with critically low screening coverage.

Methods: A community-based cross-sectional study was conducted among 418 women aged 18 years and above across four sub-counties of Rubanda District, selected through multi-stage sampling. Individual, social, economic, and health system characteristics were collected via structured questionnaire. …

Use Of Standard Visual Education Tools To Improve Npo Compliance In Pediatric Day Surgery, Alma Rivera

EBP Fellowship

Practice Problem Non-compliance with perioperative fasting (NPO) instructions is an ongoing safety and operational challenge in pediatric day surgery. Day-of-surgery cancellations result in financial losses, with unproductive OR time costing $1,430-$2,025 per hour. NPO violations cause 4.5% - 13.6% of lost OR time in children's hospitals and are the third leading cause of elective surgery cancellations. At our pediatric hospital, NPO violations contribute to same-day surgical delays and cancellations, particularly in the high-volume Otolaryngology (ENT) service line. This Evidence-Based Practice (EBP) project sought to answer whether, among caregivers of pediatric patients scheduled for ENT Day surgery (P), implementing a health …

Pulse (Ox) Check! Smarter Monitoring, Stronger Outcomes, Christina Reyna

EBP Fellowship

Practice Problem: Infants and children are a vulnerable patient population at an inherently higher risk of detrimental effects of hypoxia or hypoxemia. Literature shows that early detection of hypoxemia can facilitate timely interventions which in turn can reduce morbidity and mortality. On an inpatient pediatric pulmonary unit, there have been multiple instances of staff concern for inaccurate pulse oximetry readings, leading to evaluation of potential technological interventions to improve early detection of hypoxia. In one year, there were 3 code/MET events, in which uncertainty of device accuracy delayed response time and interventions. To address this problem, an evidence-based practice project …

Trust But Verify: Testing A Framework For Ai Interrogation In Nursing Education, Michael Chamberlain

AI in the Classroom: A Virtual Summit

Generative AI produces fluent, confident output that is sometimes fabricated. Nursing students increasingly submit work built on sources that do not exist, or that exist and do not support the claims drawn from them. This session reports two semesters of classroom observation testing whether prompt design can address that problem.   The hypothesis was that structuring student prompts to require the AI to validate its own sources would improve detection of hallucinated citations. It did not. Across two sections, students who used the structured format caught fabricated citations at the same rate as students given an open prompt. Structure did change …

Moving To Adult Care: The Impact Of Transition Readiness Assessments In The Hct Of Yas With Epilepsy, Tanika A. Middleton, Shley Mccool

EBP Fellowship

Practice Problem: Health Care Transition (HCT), the process of planning, preparing, transferring from pediatric healthcare and integrating into adult healthcare, is increasingly necessary as more adolescents with complex and chronic health conditions reach adulthood. Assessing transition readiness is identified as a key component of HCT. At a large, academic pediatric healthcare system, there was an opportunity to more consistently incorporate readiness assessments in HCT services of specialty clinics and determine the impact of readiness assessments on HCT outcomes. To address this, an evidence-based practice project was implemented using the following PICOT question: In patients ages 18-22 seen in the outpatient …