Medicine and Health Sciences Commons^™

Determining Nurse Practitioner Core Competencies Utilizing A Delphi Approach, Tracey Chan

Electronic Theses and Dissertations

Background: Competency-based education (CBE) has been recommended for nurse practitioner (NP) education. To implement CBE, existing NP core competencies need to be reduced in number and refined.

Purpose: This study refined and reduced redundancy in the National Organization of Nurse Practitioner Faculties (NONPF) and American Association of Colleges of Nursing (AACN) NP core competencies through the consensus of experts in NP practice. This study used the current NP Core Competencies (NONPF, 2017), the Essentials of Doctoral Education for Advanced Nursing Practice (AACN, 2006), and the Common Advanced Practice Registered Nurse Doctoral-Level Competencies,(AACN, 2017a) …

Implementing A Fall Prevention Program: A Quality Improvement Project To Promote Patient Mobility On The Medical-Surgical Unit, Alba Araiza

Master's Projects and Capstones

Implementing a fall prevention program is imperative in acute healthcare settings. Falls are one of the top reported events that occur in hospitals and it is a patient safety concern that requires the implementation of evidence-based practices to reduce falls. This quality improvement project will be developed by a master’s prepared clinical nurse leader (CNL) on a medical-surgical unit to improve patient safety.

Problem

Maintaining patient safety is the most important priority in health care. Health care organizations implement protocols, policies and procedures to ensure that care is provided in a safe manner to minimize preventable harms. However, falls are …

Implementing A Fall Prevention Program: A Quality Improvement Project To Promote Patient Mobility On The Medical-Surgical Unit, Alba Araiza

Master's Projects and Capstones

Abstract

Implementing a fall prevention program is imperative in acute healthcare settings. Falls are one of the top reported events that occur in hospitals and it is a patient safety concern that requires the implementation of evidence-based practices to reduce falls. This quality improvement project will be developed by a master’s prepared clinical nurse leader (CNL) on a medical-surgical unit to improve patient safety.

Problem

Maintaining patient safety is the most important priority in health care. Health care organizations implement protocols, policies and procedures to ensure that care is provided in a safe manner to minimize preventable harms. However, falls …

Reducing Pressure Ulcers In Emergency Department Boarding Patients, Youa Yang

Nursing and Health Professions Faculty Research and Publications

CRMC is a level one trauma and teaching hospital in Fresno, California. CRMC’s emergency department (ED) is licensed for 84 beds. When hall beds are added this ED can go up to 110 beds. CRMC sees over 9,000 patients a month. Due to an increase in hospital census and length of stay, this ED has a daily average of 30 inpatients boarding. In December of 2018, this ED had one hospital acquired pressure ulcers (HAPU). Barriers to preventing HAPU’s in the ED are rooms that are not big enough to accommodate hospital beds, inexperienced new nurses who are unaware of …

Nurse-Driven Protocol To Reduce Urinary Catheter Infections: A Quality Improvement Project, Sara Burrington

Master's Projects and Capstones

Costs of healthcare are astronomical, not only in the financial sense, but in many aspects of life for both patients and healthcare providers. Costs include those accompanying healthcare associated infections (HAI), where as a result of environmental factors, a patient acquires an infection during their admission. Since 2008, Medicare and Medicaid no longer reimburse hospitals for infections deemed ‘reasonably preventable.’ The biggest offender of this type of HAI is overwhelmingly, catheter associated urinary tract infections (CAUTI) (Kennedy, Greene & Saint, 2013). With approximately 31% of the inpatient population requiring an indwelling catheter at some point throughout their stay, risk of …

Compounding Effects Of Reducing Nurse Burnout And How It Can Produce An Increase In Patient Safety And Satisfaction, Alexander Mua

Master's Projects and Capstones

The reduction of nurse burnout has shown to have an increase in patient satisfaction and quality of care. It also has shown a decrease in patient-related or sentinel events. Accordingly, with the reduction of nurse burnout, there has also been a reduction of compassion fatigue. This project has illuminated the benefits of acuity-based caseload at the micro-level, including the cost-effective nature of overtime pay, including HCHAPS benefit score. The method of obtaining, planning, and implementing was based on the Plan, Do, Study, Act (PDSA), which required collaboration amongst multiple disciplines, groups, departments, and executives. The process and goals concluded to …

Expanding Magnetic Resonance Imaging Access For Patients With Cardiovascular Implantable Electronic Devices, Rosalie Geronimo

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem. Patients with non-conditional cardiovascular implantable electronic devices (CIEDs), which lack magnetic resonance imaging (MRI) components, are unable to undergo MRI.

Context. The Heart Rhythm Society guidelines for patient device management and Centers for Medicare and Medicaid Services requirements for persons with specific expertise in implanted permanent devices to manage CIEDs during MRI spurred policy, procedure and staffing changes.

Interventions. The evidence-based change-of-practice project comprised of workflow development, policy and procedure changes, implementation of required staffing support to manage the CIED during an MRI.

Measures: The outcome measure was to improve access to MRI for patients with CIEDs, measured …

Adopting Complex Case Management Competencies, Phyllis Stark

Doctor of Nursing Practice (DNP) Projects

Improving disposition management of complex hospitalized patients is crucial to the success of acute care facilities. Most hospital patients discharge in less than 5 days, but there is a cohort of complex patients whose length of stay far-exceeds the norm (Centers for Medicare and Medicaid Service Website, n.d.). Today’s case managers are focused on patients who are discharging today or tomorrow in order to keep hospital census cycling through. This phenomenon known as “throughput” drives daily operations and is a measure of success. When case managers are faced with complex patients whose length of stay measured in weeks, months, or …

Preparing Healthcare Staff For Cardiac Arrest Codes In The Outpatient Clinical Setting: Code Drill Training Improves Patient Outcomes, Rowan Edwards, Rn

Master's Projects and Capstones

Preparing Healthcare Staff for Cardiac Arrest Codes in the Outpatient Clinical Setting: Code Drill Training Improves Patient Outcomes

The acuity of care provided in outpatient clinical settings across the United States continues to rise. It is estimated that more than 350,000 cardiac arrests occur outside of a hospital each year (AHA, 2019). For the purpose of this clinical nurse leader (CNL)-lead quality improvement project, the relevant focus is directed towards improving the knowledge, physical skills and perceptions of healthcare staff within an urgent care center (UCC) regarding the application of advanced rescue skills. It is important to note that the …

Assessment Of Structural Competency In Baccalaureate Nursing Students: A Descriptive Study, Elle J. Del Gallo

Senior Honors Projects, 2010-2019

Cultural competence has been investigated extensively in nursing education to better prepare nurses to care for individuals of diverse backgrounds. While developing cultural competence is important to address individual care needs, it may not address the social and structural factors that influence health. Structural competency describes the ability to assess not only cultural factors that affect health disparities, but also structural inequalities and stigmas that can alter a patient’s presenting symptoms and risk for certain diseases.

Improving Identification Of Ssi In Snf, Jennifer Teng Yuan Yu

Master's Projects and Capstones

Educational deficit in basic wound assessment can lead to failure to recognize early signs of infection or wound deterioration. Despite many challenges towards wound care, there are potential opportunities to reduce patient injury and clinical outcomes through continuing education. The purpose of this paper is to review literature on current wound care knowledge in nurses and assess existing wound care knowledge in nurses at a skilled nursing facility. A 10-question pre-test wound assessment quiz based on the Bates-Jensen Wound Assessment Tool (BWAT) selected by the Wound Care Coordinator (WCC)/Wound Care Specialist (WCS) was given to 22 nurses: 5 Registered Nurses …

Reducing Vascular Access Complications Through Precise Cannulation Plan Implementation, Rosemarie Quicho

Master's Projects and Capstones

Abstract

Aneurysm, which is the dilatation of the arteriovenous fistula (AVF), and pseudo-aneurysm, which is caused by leaking of blood outside the arteriovenous graft (AVG), pose a threat to the vascular access (VA) and the patient (Mudoni et al., 2015). Uneven vein penetration by dialysis needles and subsequent skin scarring lead to the development of inflammatory changes in the VA area. Scab formation masks the signs of ongoing inflammation. Damage to and tearing of the scab can then lead to lethal exsanguination from the VA (Handlos, Marecová, Smatanová, Dvořáček, & Dobiáš, 2018). Dialysis staff members are trained to use the …

Nurse Manager Succession Planning: Building A Leadership Pipeline For The Future, Katie Stephens

Doctor of Nursing Practice (DNP) Projects

Problem. This academic medical center was increasing bed-capacity and needed to hire 12 additional nurse managers (NM) to meet these new requirements. Promoting assistant nurse managers (ANM) to the NM role saves time and money, supports leadership and cultural continuity, and demonstrates a strong organizational commitment to internal human capital.

Context. Formal nurse manager succession planning (NMSP) programs have been shown to increase nurse manager competency and retention rates, while also helping to identify and develop new generations of nurse leaders. To mitigate the recent loss of ANMs and strengthen the remaining leadership bench strength, the organization is developing, implementing, …

A Formal Hcahps Teaching Program Targeting Communication Improves Hcahps Scores, Bobbie Davis

Master's Projects and Capstones

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey given to patients after discharge from an inpatient unit is a validate tool used to determine the level of patient experience. Organizations across the country, including the Northern California Academic Medical Center, have implemented many initiatives aimed at improving these scores. HCAHPS scores for the hematology/oncology unit at this medical center remain low even after previous education efforts. The aim of this quality improvement project was to improve the patient experience, as evidenced by HCAHPS scores, with the implementation of an HCAHPS teaching program for nursing staff, focusing on …

Relationship Between Stress And Performance In Skills Competencies In An Undergraduate Nursing Program, Erin Ababiy

Master of Science in Nursing Final Projects

This research study describes the potential relationship between perceived high stress levels and failure in high-stakes performance testing in a baccalaureate undergraduate nursing environment. In addition, it determines if there is a marked difference between perceived stress levels in accelerated and traditional students. To answer these questions, the researcher administered the Cohen’s self-report Perceived Stress Scale (PSS) to baccalaureate nursing students fifteen minutes before high-stakes performance skills competency testing. Of 102 voluntary participants, 33 were of the accelerated nursing track and 69 were of the traditional track. Encompassing both groups, nine students failed the skills competency test.

The results showed …

Women With Type 2 Diabetes Mellitus: Diabetes Self-Care, Diabetes Time Management, And Diabetes Distress, Lisa Summers-Gibson

Seton Hall University Dissertations and Theses (ETDs)

This descriptive correlational study examined the relationships between and among diabetes self-care, diabetes time management, and diabetes distress in women with type 2 (T2DM). A gap of knowledge exists between these variables and this study, guided by Orem’s self-care theory, aimed to identify these relationships and predictors of diabetes self-care. The sample (N = 188) was comprised of predominately White (81.4%) women recruited from multiple office locations, community hospitals, and diabetes support groups predominately from the Mid-Atlantic Region (64.04%). Participants voluntarily participated by responding to flyers posted in data collection locations or by electronic survey disseminated by diabetes support group …

The Relationship Between Emotional Intelligence, Perceived Stress And Coping Mechanisms In The Undergraduate Nursing Student, Marissa Rebello

Master of Science in Nursing Final Projects

Purpose:The aim of this study was to evaluate the relationship between emotional intelligence (EI), coping mechanisms and perceived stress in undergraduate nursing students.

Design:A quantitative non-experimental descriptive design was followed.

Method:The data was collected through a convenience sample. The sample was collected during an undergraduate nursing class where the students in the classroom were asked to participate in the study. The students that chose to participate took a survey that included data collection on demographics, EI scores, perceived stress and coping mechanisms. The Perceived Stress Scale (PSS) (Cohen et al., 1983), the Brief COPE (Carver, 1997), and …

Local Anesthesia Before Intravenous Cannula Insertion: Recommendations For Registered Nurses In Practice, Vera Campbell-Jones

Electronic Theses and Dissertations

Abstract

Administering local anesthetics, such as intradermal, should become standard practice for RNs in pretreatments for pain control prior to intravenous insertion. Peripheral venous cannulation has provoked the most fear and anxiety in adult patients about everyday practice in hospitals. Adult patients often state that this procedure causes considerable discomfort. Local anesthesia for cannulation is usually not offered to adult patients who are on general medical units. Evidence has indicated inconsistency in the use of pain management strategies during these procedures. The researcher’s goal in this project was to educate RNs about the intradermal pretreatment procedure, provide education on the …

The Impact Of Direct Nursing On Patient Engagement To Improve Medication Adherence, Shelley Moore

Electronic Theses and Dissertations

This study examined the impact of direct nursing care on patient engagement and medication adherence within the practice setting of specialty pharmacy. It investigated the problem statement, “Among patients with specialty pharmacy dispensed medications, will direct interaction with nurses impact patient engagement and improve medication adherence?” Patient engagement in healthcare is a growing area of knowledge for the effectiveness of care. The research uncovered patient engagement as a predictor of improved medication adherence through effective direct nursing involvement. Methods to measure engagement were the utilization of the ACE™ Altarum Consumer Engagement (ACE) Measure™. By using a proven, researched tool to …

Development Of A Text Message Stress Management Intervention And Its Impact On Perceived Stress And Coping Self-Efficacy Among Student Nurses, Kristin Jaye Henderson

Graduate Theses and Dissertations

Purpose: The purpose of the two studies was to develop a text message intervention and examine its effects on lowering perceived stress and increasing coping self-efficacy among nursing students. We also explored stress perceptions and investigated student satisfaction with the text message stress management program. Methods: For the first study, twenty three students participated in the focus groups for intervention development. Sample messages were presented to participants and feedback was requested. The messages were modified based on student feedback. The second study utilized an experimental pre/post design with a convenience sample (N=101) to examine the effects of the text message …

Millennial Perceptions Of Leadership As An Influential Factor In Nursing Retention: A Phenomenological Study, M'Lyn Spinks

Doctorate of Nursing Science Dissertations

For years, stakeholders in nursing have anticipated the retirement of the baby-boomer nursing workforce while heralding it as a major factor in a persistent global nursing shortage (American Association of Colleges of Nursing [AACN], 2017). Nursing shortages, known to have a negative impact on patient safety and outcomes, call for strategies to alleviate, if not resolve, issues of retention (Aiken et al., 2017). Authentic leadership, an identified retention factor among professional nurses and associated with improved patient outcomes, has the potential to provide the theoretical support needed to better inform millennial nursing leadership training and development. This phenomenological study explored …

Improving Access To Mental Health Care With Nurse Practitioners, Jessica Whelan

Dissertations

Problem: Over 40% of those with mental illness are untreated since the supply of psychiatrists does not meet the demand. The psychiatric mental health nurse practitioner (PMHNP) may be an adjunct in providing those services. The purpose of this quality assurance study was to evaluate outcomes of care between a PMHNP and a psychiatrist (medical doctor [MD]).

Methods: An observational, descriptive design with a retrospective medical record review of adult patients over a six-month period in a suburban, Midwestern, privately owned psychiatric practice.

Results: A total of 787 individual patients encountered at least one visit (N=787) although 3,679 …

Refugees' Perceptions Of Primary Care: What Makes A Good Doctor's Visit?, Anne Mutitu, Bev Zabler, Jeana M. Holt

Patient Experience Journal

Redesigning primary care is a national priority, as the United States (US) struggles with issues of poor access, high cost, and suboptimal quality. Refugees are among the populations who suffer from America’s disjointed health care system, resulting in disproportionate health disparities. Although there are many studies on refugee health, few share refugees' perceptions of primary care. We asked local refugees who were seen for primary care services at a midwestern academic nurse-led clinic, what makes a good doctor's visit?  The clinic served as the hub of a federally funded refugee Community Centered Health Home (CCHH) pilot project. This qualitative study …

Factors Related To 30-Day Readmission Among Hispanics With Type 2 Diabetes, Athena Mohebbi

Dissertations

Background: Medicare spends $17 billion yearly on 30-day readmissions. Hispanic adults have a higher prevalence of diabetes (12.6%) compared to non-Hispanic whites (9.4%). Those with a diagnosis of diabetes have the 17% higher rate (14-23%) for 30-day readmission. Little research has been conducted on Hispanics with diabetes relative to 30-day readmissions. Aims: Among Hispanics with type 2 diabetes: 1) measure the incidence of 30-day readmission by sociodemographic, behavioral and clinical factors;2) identify independent factors associated with 30-day readmission among Hispanic adults with type 2 diabetes accounting for potential covariates; 3) compare the ability of the Hispanic Diabetic Study Model plus …

Un Modèle De Développement Et De Déploiement De Compétences Pour Les Enseignants Et Les Formateurs Cliniques En Sciences Infirmières / A Model Of Competency Development And Deployment For Nurse Academics And Clinical Educators, Martin Charette, Johanne Goudreau, Anne Bourbonnais

Quality Advancement in Nursing Education - Avancées en formation infirmière

La communication entre les milieux d’enseignement en sciences infirmières et les milieux cliniques ne se fait pas de façon optimale. L’utilisation d’un langage commun partagé par les enseignants et les formateurs cliniques, en particulier en ce qui concerne les notions de développement et de déploiement de compétences, permettrait de situer les attentes envers les étudiants et les nouveaux diplômés sur un continuum débutant lors de la formation initiale et se poursuivant dans le milieu clinique. Cet article présente un modèle de développement et de déploiement de compétences en pratique infirmière, construit théoriquement par l’intégration des travaux de Patricia Benner sur …

Is University Nursing Education In Canada Taking The Lead In A World Focused On Sustainable Development? / La Formation Universitaire Au Canada Est-Elle À L’Avant-Plan Dans Un Monde Centré Sur Le Développment Durable?, Ginger Sullivan, Jennifer Bell Ms, Mona Haimour, Solina Richter Dr.

Quality Advancement in Nursing Education - Avancées en formation infirmière

Global Health is widely being adopted by universities and higher education institutions in Canada and around the world. The current global climate has given rise to an emphasis on the necessity of global health education for nurses. Nursing educators as well as nursing students are seeking guidance as they integrate global health as part of their learning, teaching, research and practice. In September 2015, the member states of the United Nations adopted the Sustainable Development Goals (SDGs): seventeen goals to end poverty, protect the environment, and ensure health and well-being for all. These seventeen goals will guide the world’s development …

Using Complex, Multi-Sectoral Data In A Needs Assessment To Inform Future Strategies In Childhood Asthma Management, Loren Raun, David Persse, Gwendolyn Johnson, Katherine Ensor, Elizabeth Stevenson, Melissa A. Valerio, Erin K. Caton, Laura Campos, Harold J. Farber

Health Behavior Research

The purpose of this needs assessment was to study the current state of asthma management in high-risk children in Houston, Texas to inform a theory-based approach to improving asthma management. The mixed-method assessment included multi-sectoral survey, quantitative, and geospatial data that address a range of social and community factors in family, community, home, and medical contexts. Houston Emergency Medical Services (EMS) provided ambulance-treated asthma data mapped by geographic area to identify where childhood asthma management was weakest. Texas Children’s Health Plan (TCHP) provided medication compliance rates and counts of children by zip code that TCHP considered high-risk according to claims …

Loma Linda Nurse - Vol. 27, Loma Linda University School Of Nursing

Loma Linda Nurse

Contents

FEATURES

4 | A Seat at the Table—Discussing the Spectrum of Nursing Care

10 | Andrea Jyn Dizon— The Other Classroom

12 | Justin Bobila— When Nursing Takes Flight

LLUSN HIGHLIGHTS

14-19 | ALUMNI NEWS

20-27 | ACADEMICS

28-31 | COMMENCEMENT

32-36 | HOMECOMING

37-39 | FACULTY UPDATES

Impact Of Best Practice Guideline Statement On Anesthesia Practice In Rural Mississippi Hospitals With Obese Patients Undergoing Total Knee Arthroplasty, Steven Hodnett

Doctoral Projects

The aim of this best practice guideline (BPG) was to be a resource for anesthesia providers practicing with obese patients undergoing total knee arthroplasty (TKA) and to measure the knowledge of these providers. After dissemination of an executive summary to anesthesia providers in two hospitals in rural Mississippi, an anonymous online survey was provided via Qualtrics software for voluntary participation. The survey consisted of 10 questions. The data collection period was five weeks. Respondents are noted at N=2, and the data was reviewed and categorized into one of three domains (i.e., knowledge, practice, and safety). In the domain of knowledge, …

A Market Analysis Of Pay Rates For New Graduate Certified Registered Nurse Anesthetists, Zachary Halliwell

Doctoral Projects

The profession of Certified Registered Nurse Anesthetists (CRNA) is a thriving occupation. In their national Occupational Outlook Handbook, the Bureau of Labor Statistics (U.S. Department of Labor, 2018), reported the national market for CRNAs is predicted to continue its steady growth through 2026. The Bureau of Labor Statistics (BLS) provides numerous statistics, as previously mentioned, on their website. However, the stats available include CRNAs of varying experience levels. The Mississippi Department of Employment Security (MDES) has a few statistics, online, regarding the market for CRNAs. The data provided by MDES, while appreciated, is lacking in numerical significance, given the minuscule …