Medicine and Health Sciences Commons^™

Why Did They Fail? Investigating The Eight Invalid Dimensions Of Patient Safety Culture: Mixed Method Research, Felicia Setiawan, Ferdi Antonio

Jurnal Keperawatan Indonesia

Resistance to adopting patient safety culture practices or technologies can hinder improvements in patient safety. This study contributes to enhancing the understanding of patient safety culture (PSC) assessment by identifying the specific factors that render some PSC dimensions invalid and offering actionable recommendations for improvement in healthcare settings. Primary data were gathered using a mixed method of explanatory sequential design, with quantitative data collection and analysis followed by qualitative data collection and analysis. The study was conducted in the leading Private Hospital XYZ, one of the private hospital groups internationally accredited with Joint Commission International with a 110-patient bed capacity. …

A Systematic Review Of The Use Of Routine Versus Selective Episiotomy For Vaginal Birth, Nour A. Alrida, Amal Ababneh, Khawla Al-Sharif, Diana Arabiat, Jafar Alshraidah, Basheer Al-Zu'bi

Research outputs 2022 to 2026

Episiotomy is a common obstetric surgical procedure involving an incision to enlarge the vaginal opening, facilitating the delivery of the fetus during the second stage of labor. Hence, the current review was conducted to assess the impact of using selective versus routine episiotomy during vaginal birth on birth outcomes. This systematic review used the Joanna Briggs Institute (JBI) methodology for systematic reviews and research syntheses. PubMed, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and SCOPUS were searched for relevant studies. Two reviewers independently screened and extracted data from relevant studies. Four studies met the eligibility …

Implementing A Patient Education Bundle To Improve Patient Satisfaction, Madison Tyler

Student Scholarly Projects

Practice Problem: Patients on the intervention unit reported via HCAHPS surveys a lack of understanding of the nurse provided education on their medications’ side effects and purpose after discharge home from the hospital. Nurses at the intervention unit’s organization do not use any formal or standardized method of patient education to ensure patient comprehension.

PICOT: Among adult inpatients (18 years or older) on a step-down unit in an acute care facility (P), does implementing an education bundle related to patient medication education (I), compared to current practice of no formal education process (C), increase patient satisfaction as measured by HCAHPS …

Quality Improvement Project: Evaluating The Impact Of An Intrapreneurial Skill Enhancement Program On Enhancing Innovation Perspectives And Overcoming Obstacles Among Nurse Practitioners At A Midwestern Academic Medical Center, Michael Thorn

Doctor of Nursing Practice Projects

Nurse practitioners (NPs) face barriers to being innovative in healthcare because of a need for more resources, education, and cultural inclusion compared to physicians and researchers (Joseph et al., 2019). NPs are often disregarded from involvement in the innovation ecosystem and seen as solely end-users of new products and services (Davis & Glasgow, 2020). This Doctor of Nursing Practice project aimed to assess the impact of a 5-week innovation and intrapreneurship course on NPs' perceptions of their ability to innovate at a Midwest academic hospital. The aim was to address the known innovation education gap that NPs rarely receive. Using …

Nursing Shortage Crisis: Can Implementing Supplemental Instruction Impact Nursing Students' Success In Nursing Programs?, Lauren Smith

Doctor of Nursing Practice Projects

This quality improvement project (QI) aimed to provide nursing students in the traditional Bachelor of Science in Nursing (BSN) program with different forms of supplemental instruction (SI). The problem identified considered that nursing students' success rates have been dwindling for years, decreasing the number of nurses available. The purpose was to evaluate the effectiveness of SI in promoting student success throughout the semester. SI was first introduced at the University of Missouri-Kansas City in 1973 and is utilized primarily to improve student success in courses that are often considered "high-risk" for failure (Bowman et al., 2021). When SI is appropriately …

Evaluation Of A Peer Mentoring Program In Baccalaureate Nursing Students: A Quality Improvement Project, Leigh E. Swartzendruber

Doctor of Nursing Practice Projects

Nursing school can be rigorous, stressful, and anxiety-producing for students trying to progress to graduation, with students leaving the program if they encounter barriers. Academia must consider strategies to support students; peer mentoring is an evidence-based approach. The project evaluated an existing peer mentoring program to understand the benefits and barriers entry-level sophomore students experience with the program, comparing survey results from 2022 and 2024 cohorts—a mixed-methods descriptive statistical study was conducted with the spring 2024 peer mentoring program. Using a PDSA cycle, the program was transformed from an in-person to a hybrid format. At the end of the program, …

A Quality Improvement Project: Implementing A Mental Health Screening Program For International Business Travelers., Joyce Ighedosa

Doctor of Nursing Practice Final Project Abstract

A Quality Improvement Project: Implementing a Mental Health Screening Program for International Business Travelers.

PURPOSE The purpose of the Quality Improvement project was to implement a mental health screening program for international business travelers in an oil and gas organization. The Patient Health Questionnaire (PHQ-2) was implemented

BACKGROUND The project was implemented in a global oil and gas organization. The original medical screening for pre-travel preparation was on identification of physiological disorders, proper management of identified disease processes; infectious disease prevention; vaccine review and update; malaria chemoprophylaxis and vector control. Mental Health was not reviewed.

METHODOLOGY The PHQ-2 was …

Empowering Patient Care Technicians To Reduce Non-Ventilated Hospital-Acquired Pneumonia In An Acute Care Hospital In Northern California, Barbra Pacatang

Master's Projects and Capstones

Abstract

Problem: Non-ventilator hospital-acquired pneumonia (nv-HAP) is increasingly becoming a significant concern in healthcare settings. Studies have indicated that nv-HAP accounts for a substantial portion of hospital-acquired pneumonia cases, with a high associated mortality rate. The prevalence of nv-HAP underscores the importance of implementing robust HAP prevention bundles. Prevention, early recognition, and appropriate management of nv-HAP are essential to improve patient outcomes and reduce the burden on healthcare facilities.

Context: A 28-bed capacity Stroke Telemetry Unit incurred six nv-HAP incidents in 2023. Patients needed to be more compliant with the nv-HAP prevention bundles. Patient care technicians (PCTs) are instrumental nurses’ …

Improving First Case On-Time Starts In The Operating Room, Lojy Koshy

Master's Projects and Capstones

Problem: A timely first-case start in the operating room (OR) is critical for optimizing departmental efficiency and resource utilization. Persistent delays in first-case start times disrupt the surgical schedule, leading to suboptimal OR use, diminished patient and staff satisfaction, reduced operational efficiency, and decreased overall productivity. Addressing these delays is essential to enhance the quality and efficiency of surgical services.

Context: The microsystem for this project is a Northern California operating room that handles a high volume of surgical procedures. There are 10 operating rooms, and the goal is to have 70% of first cases in the operating room on …

Quality Improvement Project Integrating Telemedicine To Reduce Patient No-Shows, Ferdinand Akoko

Doctor of Nursing Practice Projects

No-show among psychiatric outpatient clinic patients is a major problem due to disrupted clinical flow, reduced productivity, and financial losses. This quality improvement project implemented telehealth services to decrease the no-show rates in an outpatient psychiatric clinic in Texas. This project employed quantitative methods to compare the no-show rates pre- and post-intervention for 90 days. The quantitative data were analyzed by paired t-tests. A total of 1,790 appointments were sampled during the implementation period. The obtained results are statistically significant in decreasing the rates of no-shows for all adult appointments from 18% to 13% (p ≈ 0.0067). New appointment no-shows …

Development And Implementation Of An Emergency Preparedness Policy And Procedure, Educational Intervention, And In-Situ Simulation In A Pediatric Primary Care Office: A Quality Improvement Project, Kaitlin Patel

Doctor of Nursing Practice Scholarly Projects

Background. Pediatric primary care offices are frequently unprepared to respond to clinical emergencies that may present to or occur at their site. The purpose of this project was to improve office emergency preparedness at a pediatric primary care office to align with the American Academy of Pediatrics policy statement for pediatric office emergency preparedness.

Methods. A PRISMA-guided literature review found support for both educational interventions and in-situ simulation to improve aspects of emergency preparedness. The aim of this project was to develop a practice-specific emergency preparedness policy and procedure and implement a training and in-situ simulation to increase medical and …

Obstetric Education For Critical Care Nurses, Anna Forberg

DNP Projects

Background The purpose of this study was to educate ICU nurses on the care of obstetric women in critical care through the use of a toolkit with intentions to increase knowledge and confidence.

Method The toolkit was created via the platform WordPress™ and topics were chosen based on the most common admission diagnoses found during the literature review. Data were collected via forms manager and voluntary participation among ICU nursing staff was obtained.

Results Mean scores from the pretest to the post-test showed improvement from 7.08 to 8.50 and the minimum and maximum scores increased from pretest to post-test supporting …

The Impact Of The Covid-19 Pandemic On The Incidence Of Sexual Assaults And Victim Services, Jessica Hunter

Student Works

The Impact of the Covid-19 Pandemic on the Incidence of Sexual Assaults and Victim Services

Purpose: The purpose of this literature review is to discuss incidents/rates of sexual assaults (SA), access to or accessibility of SA victim services, and the utilization of SA services during the COVID-19 pandemic.

Background: In the U.S., 1 in 5 women experience rape or attempted rape, while 1 in 4 men experience some form of sexual violence in their lifetime. Additionally, SAs affect roughly one-third of the world's population, making SA a prominent problem worldwide.

Methods: Electronic searches in CINHAL and MEDLINE were performed using …

Improving Patient Awareness And Compliance With Telephone Follow-Up Calls Post Visit, Ajibola Kutti

Student Scholarly Projects

Practice Problem: In a high-volume clinic without current follow up practices post visit, a telephone follow-up (TFU) intervention was implemented within three days of patient outpatient appointments.

PICOT: The PICOT question that guided this project was: In adult patients in a high-volume clinic (P), does the implementation of telephone follow-up calls by nurses (I) compared to current practices (C) improve patient compliance and post-office follow-up visits (O) over 10-weeks (T)?

Evidence: The literature provided recommendations and evidence that supported the effectiveness of following up with patients within three days of leaving the healthcare clinic. TFU’s are a cost-effective intervention that …

Nurse Leaders Promoting Well-Being Through Mindfulness, Laura G. Cockrell

Walden Dissertations and Doctoral Studies

Becoming a nurse is not just a career but a calling. With this calling comes an ethical duty to the patient, but the duty remains to provide care for oneself. During the COVID-19 pandemic, a strained nursing profession felt the effects of a self-care deficiency. Mindfulness is one self-care tool that can allow nurses to maintain a state of well-being. This project followed Orem’s self-care deficit theory, in which people can use self-care to maintain wellness. The purpose of this project was to develop, deliver, and evaluate an education program for registered nurse leaders on mindfulness activities to address whether …

Barriers To Implementation Of Practice Guidelines In Heart Failure, Mary Geisenhof

DNP Projects

In 2022, the most recent guidelines for care of the patient with heart failure (HF) were released by the American Heart Association (AHA), the American College of Cardiology (ACC), and the Heart Failure Society of America (HFSA). In summary, this group did not recommend fluid restriction for patients with heart failure, unless they are in the end stages of heart failure, and only if fluid restriction may be beneficial (Heidenreich et al., 2022). Despite this recommendation, some providers and nurses continue to restrict fluids. The aim of this DNP project, therefore, was to analyze barriers to implementation of best practices …

Student Nurse Experiences Of Retention Strategies And The Perceived Contribution To Academic Progress, Jessica Dugas

Walden Dissertations and Doctoral Studies

There is a worldwide nursing shortage that has been heightened by the COVID-19 pandemic. Several factors have contributed to the worsening shortage, including high attrition rates in nursing programs. Retention strategies have been suggested to support nursing students during their education to have success and graduate. The purpose of this descriptive qualitative study was to explore how nursing students experience retention strategies and their perceived contributions to academic progress. Bandura’s social cognitive theory was the theoretical framework used to guide the study. Data were collected from one-on-one interviews with 12 nursing students recruited using purposeful and snowball sampling. Data were …

Using Home Telehealth To Reduce Hospital Readmission Rates In Heart Failure Patients In The Emergency Room, Margaret Ashby

Student Scholarly Projects

Practice Problem: In one hospital, the readmission rates and emergency room visit for patients who are diagnosed with heart failure (HF) was increasing.

PICOT: Among veterans who are hospitalized for HF (P) does the enrollment into a care coordination program for these veterans (I) compared to current practices (C), reduce the hospital readmission rates and emergency department visits (O) within 10-weeks (T)?

Evidence: The literature supports the idea that home telehealth as a home monitoring program for patients who have chronic diseases such as heart failure (HF) and has had success in patients with hypertension amongst patients. Transition strategies from …

Quality Improvement Project: Incivility In Nursing Education: Utilizing An Educational Module And Professionalism Guide To Address Incivility In A Nursing Students, Jennifer Schadler

Doctor of Nursing Practice Projects

Incivility is a well-documented issue in the nursing profession that begins in nursing education and follows graduates into nursing practice. Nursing academia has a responsibility to address incivility to prevent inappropriate behaviors from becoming embedded into the culture. The problem addressed in this quality improvement project is incivility among nursing students at a private college. The purpose of this project was to apply evidence-based incivility interventions to address uncivil behaviors of nursing students. The hypothesis was that the implementation of a civility mentor module and professionalism guide would impact perceived incivility among nursing students. The project was conducted using the …

Reducing Rates Of Blood Culture Contamination In The Emergency Room, Erika Goldberg

Student Scholarly Projects

Practice Problem: In one emergency room (ER) blood cultures (BC) drawn by nurses had a high contamination rate due to lack of collection standards, which lead to poor patient outcomes.

PICOT: The PICOT question that guided this project was; In adult emergency room patients where blood cultures are drawn (P), how does implementation of an evidence-based practice method (I), compared to the standard method of obtaining blood cultures (C), affect blood culture contamination rates (O), within ten weeks. (T)?

Evidence: Based on multiple sources within the literature; best evidence for lowering blood culture contamination rates (BCC) is done using EBP …

The Impact Of Hourly Safety Rounding On Pediatric Fall Rates, Natalie Doskal-Poe

Dissertations

The Impact of Hourly Safety Rounding on Pediatric Fall Rates

Abstract

Problem: Falls are a common adverse event in the inpatient pediatric setting and are a significant risk to patient safety. Environmental factors, such as unclear pathways, bed rails down, beds in high position, and call lights out of reach, are considered avoidable causes of patient falls. The site’s fall data in a 12-month period from January 2023 to January 2024 showed (n=9) patient falls occurred with (n=5, 55.6%) due to environmental factors. The purpose of this Quality Improvement (QI) pilot project was to assess the …

Self-Harm In Female Youth With Undiagnosed Adhd: Implementing American Academy Of Pediatrics Screening Guidelines, Roselie M. Woodard

Dissertations

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. If undiagnosed or untreated, ADHD can lead to severe psychosocial issues such as academic failure, substance abuse, unplanned pregnancy, and incarceration. The financial burden in the U.S. from diagnostic errors creates an immense, rising fiscal impact. Early diagnosis and management are crucial to prevent these complications.

Females with ADHD, particularly those with the inattentive subtype, often face diagnostic challenges due to symptom masking and over-compensation. This results in poorer cognitive functioning and self-esteem compared to males with ADHD. ADHD is linked to autonomic nervous …

Transformative Learning: Changing Nurses’ Perceptions About People In Poverty, Jacqueline Debrew

Journal of Social, Behavioral, and Health Sciences

Background: Meaningful learning experiences with clients in poverty may help nursing students change their perceptions towards those experiencing poverty and, thus, provide unbiased, nonjudgmental care when they become nurses.

Purpose: The purpose of this research was to understand what learning activities and experiences nursing students found meaningful and led to a change in prior perceptions of people in poverty.

Methods: Guided by Mezirow’s Theory of Transformative Learning, accelerated BSN students enrolled in a mental health nursing course (n = 14) were assigned reflective journals throughout the semester on their assigned clinical experiences, which were analyzed for emergent themes.

Results: …

Using An Evidence-Based Practice Nurse Recognition Practice To Improve Job Satisfaction, Hali Bianchi

Student Scholarly Projects

Practice Problem: The project targeted low job satisfaction and high nurse turnover in a Central Florida bone marrow transplant unit, impacting patient care and costs.

PICOT: (P) For registered nurses (RNs) on the bone marrow transplant unit, (I) does implementing an evidence-based practice employee recognition program (C) compared to no employee recognition program, (O) lead to an increase in job satisfaction (T) over 10 weeks?

Evidence: The evidence supported the effectiveness of meaningful recognition programs, such as personalized verbal acknowledgment from leadership, in boosting job satisfaction among nurses.

Intervention: The intervention involved nurse managers using a weekly employee recognition …

Nurse Retention Amid Workplace Adversity: Examining Strategies And Outcomes, Horace Smith

Student Scholarly Projects

Practice Problem: This project aimed to evaluate the effectiveness of nurse retention strategies in enhancing job satisfaction, focusing primarily on Emergency Department (ED) Registered Nurses (RNs). A comprehensive approach was adopted within the ED of a veteran hospital in the Southeast, aimed at promoting staff retention.

PICOT: The PICOT question guiding this project is as follows: In a veteran hospital's Emergency Room (ER) located in the southeast (P), how does the implementation of nurse retention strategies (I) compared to current standards (C) increase their job satisfaction (O) over a period of ten weeks (T)?

Evidence: This project …

Implementation Of A Standardized Acute Care Plan For Complex Care Medicine Service Patients: A Quality Improvement Initiative, Tracy Markwell

Doctor of Nursing Practice Scholarly Projects

Abstract

BACKGROUND: Care transition plans, locally called Acute Care Plans (ACPs), are created specifically for super utilizers of the Complex Care Medicine Service (CCMS) and are a target for improvement. The purpose of this project was to improve care for CCMS patients by developing, implementing, and evaluating a standardized CCMS ACP. A multidisciplinary approach was chosen to facilitate the transitions of care process during an admission or discharge from the hospital.

LOCAL PROBLEM: The purpose of the ACP is to get a quick summary of how to treat a patient when they come to the hospital. The ACPs are …

Implementing Pain Screening In A Parkinson’S Disease Clinic: A Quality Improvement Initiative, Anne Marie Desmond

Doctor of Nursing Practice Scholarly Projects

Background: Pain is a multifaceted, non-motor symptom often unnoticed and undertreated in Parkinson's disease (PD). PD pain is associated with decreased quality of life (QOL) and is found in 30-85% of PD patients. The effective diagnosis and treatment of PD pain could improve patient QOL. Barriers to appropriate diagnosis and treatment include a valid and reliable PD pain assessment tool. There was an opportunity to improve the assessment of PD-related pain at the movement disorder clinic in this suburban clinic of a tertiary safety net hospital. The local movement disorder clinic did not have a standardized PD-specific tool to assess …

Assessing Medical Adherence In A Volunteer Community Health Clinic, Jessica Clark, Matthew Anderson, Janelle L. B. Macintosh, Corinna Trujillo Tanner, Kristen Erekson

Student Works

Purpose: The purpose of this project was to identify the rates of and reasons for nonadherence in medical follow-up care among patients who utilize the Volunteer Care Clinic (VCC).

Background: The VCC is a free outpatient care center for acute medical conditions. The VCC serves uninsured, low socioeconomic residents of Utah County, and many of the patients who come to the clinic primarily speak Spanish. The director of the VCC expressed concern that patients who were assigned medical follow-up care to complete after their visit were not completing these assignments. Nonadherence is associated with increased costs, more hospitalizations, and worse …

Non-Cognitive Factors Influencing The Development Of Clinical Judgment In Undergraduate Nursing Students, Kathryn Robinson

Graduate Theses, Dissertations, and Capstones

A nurse’s ability to form sound clinical judgments is directly related to safe patient outcomes. Pre-licensure nursing programs are focused on developing students’ clinical judgment ability; however, an academic-practice gap continues to exist. The Implicit Theory of Intelligence and Achievement Goal Theory provide insight into how mindset beliefs and goal orientation impact the teaching and learning environment. The performance goal orientation, ineffective learning strategies, and avoidance of challenging tasks associated with a fixed mindset may negatively impact the development of clinical judgment. This exploratory study sought to determine if there is a relationship between the non-cognitive factors, mindset beliefs and …

“We Rely On Each Other”: A Qualitative Exploration Of Rural Eastern Region Native American Experiences During The Covid-19 Pandemic, Robin M. Dawson Phd, Rn, Cpnp-Pc, Hunter M. Boehme, Stephen Criswell Ph.D., Julia Dunham-Thornton, Melissa S. Nolan Ph.D., Mph

Publications

Background: Native American communities suffered disproportionately negative effects during the COVID-19 pandemic, yet no research has explored the experiences of rural Eastern Region Native Americans. Methods: Informed by the Native Reliance Model and Indigenous Standpoint Theory, we conducted a qualitative descriptive project in the Spring and Summer of 2022; data included semi-structured interviews and focus groups with 24 individuals representing five South Carolina tribal groups. Findings: Thematic analysis yielded four emergent themes: 1) “Let's just finish the Indians off”: Pandemic distrust rooted in historical and contemporary Native American experiences; 2) “We have been misled”: Making sense of conflicting public health …