Medicine and Health Sciences Commons^™

A Simulated Learning Experience In Advanced Care Planning Conversations, Brandy Ellis

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

Background: The CDC (2012) reports that 1/3 of Americans have no advance care planning (ACP), which is essential for maintaining autonomy when people are no longer able to communicate wishes directly. IOM (2014) reports that providers have limited training in communication techniques and low confidence in holding advanced care planning conversations. Nursing simulation is an effective method of teaching clinical skills in a safe environment. The development of a high fidelity (HF) standardized patient simulation, using the Jeffries Simulation Framework, combined with evidence-based practice classroom curriculum, may increase knowledge and confidence in holding ACP conversations for nurse practitioner students.

Methods: …

Can The Implementation Of Interprofessional Rounds Improve Hospital Throughput Efficiency?, Rebecca Howdyshell

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Abstract

Efficient throughput processes are a vital part of providing cost effective, safe, quality patient care. Research has shown interprofessional rounds can have success at improving throughput processes. A rural, not-for-profit, 255 bed hospital in a Mid-Atlantic State was experiencing issues with throughput/patient flow. The aims of this quality improvement project were 1). to implement Interprofessional Rounds on the Progressive Care Unit (PCU); 2). To design and build a working Interprofessional Rounds template into meditech to guide Interprofessional Rounds and streamline discharge documentation; 3). to increase the amount of discharge orders entered between 0700 and 1300 by ten percent; and …

Student Perspectives On Working In Interdisciplinary Teams To Implement Mhealth, Elina Chun

Undergraduate Honors Theses

Interprofessional education of students in healthcare professions can lead to positive outcomes for students that are unique in a university setting. The purpose of this thesis is to describe benefits and challenges students encounter when working with students of other majors. This study used a convenience sample of students working on a university project to implement mHealth. Participants responded to two surveys with quantitative and qualitative questions. Students reported greater appreciation for diversity, the necessity of communication skills, and self-awareness of their own responsibilities in a team.

"Improving Nursing Communication Outcomes Through The Tell-Us Card", Jillian Cule, Jeffrey Salao, Nina Park, Laura Le, Brittney Pilker, Maricarmen Reyes

Master's Projects and Capstones

Nursing communication plays a pivotal role in patient-centered care. However, statistics have shown that failures in communication exist in more than 20% of all hospital settings (Sethi & Rani, 2017). Within the explored microsystem, a gap in patient communication was identified through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Reports revealed that the microsystem was performing at 69%, which is 11% below the national average for nursing communication (Centers for Medicare and Medicaid Services [CMS], 2018). After performing a microsystem assessment, there was a measurable communication opportunity between the patients and nurses. It was determined that …

Improving Nursing Communication Outcomes Through The Tell-Us Card, Nina Park, Laura Le, Brittney Pilker, Jillian Cule, Maricarmen Reyes, Jeffrey Salao

Master's Projects and Capstones

Nursing communication plays a pivotal role in patient-centered care. However, statistics have shown that failures in communication exist in more than 20% of all hospital settings (Sethi & Rani, 2017). Within the explored microsystem, a gap in patient communication was identified through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Reports revealed that the microsystem was performing at 69%, which is 11% below the national average for nursing communication (Centers for Medicare and Medicaid Services [CMS], 2018). After performing a microsystem assessment, there was a measurable communication opportunity between the patients and nurses. It was determined that …

Nursing Partnership With Patients, Parents And Families For Safety Through Simulation, Courtnay Caufield

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: The importance of communication between nurses, patients, and their family members with respect to treating each other as partners in safety cannot be overstated. It is imperative that families and patients feel empowered to speak up and report clinical errors at any time and be able to communicate effectively to prevent harm and encourage communication.

Context: This is especially important in the acute care setting, where patients may be in contact with multiple people and processes daily. Attention to this safety partnership can be established through improvements in patient satisfaction scores, which are usually collected from patients and …

Improving Nursing Communication Outcomes Through The Tell-Us Card, Jeffrey Salao, Nina Park, Laura Le, Brittney Pilker, Jillian Cule, Maricarmen Reyes

Master's Projects and Capstones

Abstract

Nursing communication plays a pivotal role in patient-centered care. However, statistics have shown that failures in communication exist in more than 20% of all hospital settings (Sethi & Rani, 2017). Within the explored microsystem, a gap in patient communication was identified through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Reports revealed that the microsystem was performing at 69%, which is 11% below the national average for nursing communication (Centers for Medicare and Medicaid Services [CMS], 2018). After performing a microsystem assessment, there was a measurable communication opportunity between the patients and nurses. It was determined …

Improving Nursing Communication Outcomes Through The Tell-Us Card, Brittney Pilker, Jillian Cule, Laura Le, Nina Park, Jeffrey Salao, Maricarmen Reyes

Master's Projects and Capstones

Nursing communication plays a pivotal role in patient-centered care. However, statistics have shown that failures in communication exist in more than 20% of all hospital settings (Sethi & Rani, 2017). Within the explored microsystem, a gap in patient communication was identified through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Reports revealed that the microsystem was performing at 69%, which is 11% below the national average for nursing communication (Centers for Medicare and Medicaid Services [CMS], 2018). After performing a microsystem assessment, there was a measurable communication opportunity between the patients and nurses. It was determined that …

Millenial Nurses Connecting With Patients In The 21st Century: A Phenomenological Studyh, Heather Caramanzana

Theses & Dissertations

Problem: Millennial nurses are the largest portion of the profession reporting burnout and compassion fatigue. The millennial generation was impacted by the explosion of technology in the late twentieth century. Constant technological stimulation heavily impacted developmental milestones. Early adolescence is a critical time for the abstract development of empathy and compassion. The millennial generation communicates through technology while performing more than one task in a short amount of time, known as multi-tasking. With less time spent at the bedside due to increases in administrative tasks, deficits in the development of empathy and expression of compassion may impact the development of …

Interprofessional Education: How Curriculum Influences And Develops Future Healthcare Professionals, Karen Keune

CUP Ed.D. Dissertations

The value of higher education is a topic of great consideration and discussion, not only for current and future students, but also for legislators, educators, and employers. A college degree is more than a pathway toward advanced knowledge in a given subject; it is a component of a larger outcome beyond a diploma, it's a job. While the scale of employment opportunities appears to rise for those with a college degree, it is not enough to guarantee security for new graduates, no matter their topic of study. More than a competency in the field of study is required to prove …

Improving Communication: Huddling For Change, Harnoor Chahal

Master's Theses

The purpose of this communication improvement project is to incorporate huddles between interdisciplinary departments within a microsystem in order to improve customer satisfaction by decreasing the number of grievances. Based on the increasing number of grievances due to delayed hospital discharge, which results from a lack of communication between team members, there is an increased need for communication between the microsystem. By implementing weekly huddles between the Inpatient and Outpatient nurses, not only will there be increased care-coordination, but there will also be a decreased delay in discharge from the hospital caused by missed or no communication. Evidence-based practice indicates …

Improving Pediatric Oral-Systemic Health Through Motivational Interviewing: An Interprofessional Training Intervention, Oksana Prodan

Doctor of Nursing Practice (DNP) Projects

Introduction: In response to the prevalence of early childhood carries (ECC) in the United States, recommendations were established for pediatric primary care providers to routinely incorporate oral-systemic health promotion services into clinical practice. An interprofessional education project was developed between Advanced Practice Registered Nurses (APRNs) and dentistry students in San Francisco to assist trainees in the effective delivery of oral systemic health promotion services. Improving health promotion communication skills was identified as an area of need for both sets of learners. Therefore, the IPE activity was designed to incorporate Motivational Interviewing (MI) into the training along with pediatric oral …

Introduction Of Communication Strategies To Decrease Patient Falls In An Acute Rehabilitation Setting, Alicia Joachim

Master's Projects and Capstones

Background: Due to the lack of appropriate fall prevention measures in an acute rehabilitation unit, there has been a notable increase of patient fall occurrences within a 6 month period. The purpose of this practice improvement project was to reduce patient falls within a 36-bed unit, using visual aids and effective communication among nursing staff. The multi-disciplinary members involved licensed nurses, nursing assistants, nursing supervisors, director of nursing, and executive administrator. Methods: The method used to implement this project included a literature search, informational interviews and staff surveys, and prioritization of interventions by the team. Project implementation was guided by …

The Interactive Patient Careboard: A Technological Innovation To Improve Patient Safety, Perla Q. Baldugo

Master's Projects and Capstones

Problem: An innovative method to communicate with the patient and between interdisciplinary team members is the use of the interactive patient careboard (IPC) which has declined since its implementation. Concurrently, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores for the med surg unit need improvement. The low HCAHPS scores in communication suggested to nursing leadership that revitalizing use of the IPC could lead to improvements in the scores. The ideal shift handoff includes IPC as a focal point of communication. The RN is expected to display the careboard during handoff and identify for the patient the healthcare …

Improving Communication In A Virtual Team: A Quality Improvement Project, Deepali Addagarla

Master's Projects and Capstones

Problem: Data analysis based on two surveys revealed team communication, interdependence, technology interfaces, and integration as the quality gaps in the Virtual Surveillance Team. When compared with traditional in-person teams, a virtual working team faces different types of communication challenges.

Context: The virtual surveillance team in the regional quality department at Oakland monitors both Advance Alert Monitor (AAM), a statistical model developed by the Kaiser Permanente (KP) Division of Research (DOR) that is used to predict an individual’s likelihood of deterioration, and eHospital care gaps for Kaiser Foundation Hospitals in Northern California (KFH, NCAL). The latest evaluation from DOR of …

Understanding The Factors Influencing The Perception Of Organizational Sustainability Among Healthcare Professionals (Hcps) Post The Patient Protection And Affordable Care Act, Funso A. Olufade

Seton Hall University Dissertations and Theses (ETDs)

Background and Purpose of the Study: Healthcare costs in the United States has continued to increase annually, and new policy's attempt at protocol changes in healthcare practices does not ensure quality care delivery. An example of these policies include provisions and new guidelines under the 2010 healthcare legislation, - The Patient Protection and Affordable Care Act (ACA). The premise with the Affordable Care Act (ACA) is increased healthcare access for patients. However, not responsibly balancing the increased demand with the escalating cost of care creates an unsustainable system (Department of Health & Human Services, 2015). Healthcare organizations, including hospitals …

Creating A Healthy Work Environment Using Communication And Recognition, Rachel A. Coicou

Doctor of Nursing Practice (DNP) Projects

Working in a healthy environment is of interest to nurses at every level of employment. Whether a frontline nurse or a nurse executive, it just feels better to wake up each morning and go to work in a place that respects clear communication and recognizes the great work that is being done. Working in such an environment is engaging and encourages employees to thrive (Shirey, 2006). Teamwork, camaraderie, and work satisfaction will increase in a healthy environment (Hall, Doran, & Pink, 2008). Thus, nurse leaders’ imperative is to meet the obligation of creating a healthy work environment (HWE) for the …

Improving The Use Of The Integrative Healing Approach, Kristina Horak

Master's Projects and Capstones

The Integrative Healing Approach (IHA) is an initiative that promotes holistic healing and includes the use of essential oils, deep breathing techniques, and therapeutic touch. Its purpose is to relieve pain, anxiety, insomnia, and depression among patients, and stress among staff. The IHA pilot initiative was implemented on the Acute Rehabilitation Unit (ARU) and faced barriers to implementation after the first round of staff education. By rounding with staff and conducting surveys, it was identified that the staff are not using IHA interventions as often due to time constraints. Additionally, there is an identifiable rift between Registered Nurses (RNs) and …

Multifarious Interventions To Reduce Falls On The Medical-Surgical Units, Wenjie Ying

Master's Projects and Capstones

The CNL project was conducted on the 56-bed adult medical-surgical units in a trauma center. There were total eight fall incidences from January to February. The SWOT analysis, stakeholder analysis, pre-educational survey, cost-effective analysis and root-cause analysis suggested in-depth training on multifaceted fall prevention. The objectives include reducing falls by 50%, increasing staff’s adherence to fall prevention protocols, boosting staff’s confidence in patient mobility, improving staff responsiveness and communication with meds in HCAHPS, and enhancing knowledge of medications’ side effects by May 14, 2018. The literature reviews indicated that the multicomponent preventative measures to prevent falls along with leadership supports …

Standardized Patient Handoff Tool, Matthew Marten

Doctor of Nursing Practice Projects

Patient handoffs are defined as the transmission of information and accountability between teams and individuals. These handoffs can be periods of increased risk for the patient and increased errors among anesthesia providers and PACU nurses (Segall et al., 2012). The Joint Commission recommends healthcare providers improve patient handoff as a national goal (Robins & Dai, 2015). The purpose of this nursing doctoral project was to determine if using a standardized patient handoff tool could improve communication and satisfaction between anesthesiologists, CRNAs, and PACU nurses. A review of the current literature supported the need for a standardized patient handoff tool for …

Effects Of Transitional Care Management On Hospital Readmissions, Samantha Dunkirk

Doctor of Nursing Practice Projects

Primary care providers are challenged to identify strategies to decrease hospital readmissions. Transitional care management (TCM) services can improve communication and allow primary care providers (PCP) an opportunity to meet with patients just after discharge to assess needs and prevent readmissions. A TCM protocol was evaluated at a large Midwestern clinic to determine if communication improved and readmissions decreased. The protocol consisted of notifying the PCP upon admission and discharge to the hospital, communicating with the patient or family within 48 hours of discharge, and facilitating a follow up visit with the primary care provider within 14 days of hospital …

“We Make Death Look Pretty”: A Qualitative Study Analyzing Reported Effects Of Compassion Fatigue On Hospice Nurse-Patient Communication, Katherine Harville

Masters Theses, 2010-2019

Rationale: Compassion fatigue is present in multiple nursing fields, but hospice poses a significant threat to nurses working within that specific environment. This is due to their consistent proximity with patient suffering, death and dying, and constant communication with patients regarding their death. The hospice nurse-patient relationship requires a deeper connection between nurse and patient which often results in consistent emotional labor for hospice nurses, further amplifying the threat of compassion fatigue. While the effects of compassion fatigue can manifest in many forms, it is typically characterized by a nurses’ decline in job satisfaction, which they do not tend to …

Patients’ Perceptions Of Patient-Centered Care And The Hospital Experience Pre- And Post-Discharge, Cheryl Smith

Electronic Theses and Dissertations

Florence Nightingale used the principles of patient-centered care as the foundation for nursing practice. Today, patient-centered care delivery is part of the healthcare reform process that extends interprofessionally throughout all settings of healthcare in the United States (U.S.). Patient satisfaction measurement is one primary determinant of effective patient-centered care. The standardized Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and methods is a nation-wide tool used to measure patient satisfaction. However, this method of patient satisfaction assessment relies on recollections of patients’ hospital experiences and requires accurate memory and recall. This study sought to examine the effect of …

Improving Teen And Pediatric Provider Communication Through Education And Technology, Kathy A. Connor-Prows

Doctoral Projects

Navigating healthcare can be daunting as an adult, but doing so as a teenager can seem virtually impossible. Until the age of eighteen, parents of children of all ages initiate, schedule, and accompany their children to see their pediatrician for virtually all appointments. Over time, children and their parents develop a special bond with their pediatrician and too frequently, this relationship becomes abruptly severed as their teen turns eighteen years old and is thrust into adult medicine. As healthcare providers, we expect healthcare consumers (including teens) to know how and when to initiate, schedule, and get themselves to an appointment. …

Improving Nurse-Patient Communication Using The Teach-Back Method, Sheila Revis Smallwood

Nursing Theses and Capstone Projects

Effective nursing communication considers health literacy, the person’s ability to understand and make health decisions based on the information given. Health professionals often overestimate the health literacy of patients, thereby affecting patient outcomes. In a hospital environment, patients rate the ability of the nurse to explain things in a way patients understand by completing the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) after discharge. The HCAHPS results are converted to a score which is used in a formula to determine hospital reimbursement; the lower the score, the lower the reimbursement. The purpose of this project was to improve …

Relationships Of Moral Distress Among Interprofessional Icu Teams, Heather Vincent

Dissertations & Theses (Open Access)

Background: Moral distress is the psychological response to knowing the right action required by a healthcare professional but being unable to act upon the right course of action due to internal, external, and institutional constraints.

Purpose: The study investigated: 1. the level of moral distress among interprofessional healthcare providers working in four ICUs of a single academic hospital as measured by the 21-item Moral Distress Scale-Revised (MDS-R), 2. the differences in moral distress among interprofessional healthcare providers based on demographic characteristics and rankings of clinical scenario on the MDS-R.

Method: Descriptive, cross-sectional design using survey methodology.

Outcomes: Significant differences in …

Try To See It My Way: Patient Perspective Video Capture Debriefing In Simulation, Terri Hendry

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

Video capture of simulation provides observation from a wide-angle view. This study introduced a new technique, “patient-perspective” video capture, using a camera mounted into eyeglasses allowing learners to view their nonverbal and verbal communication through the patient’s eyes and to compare this to the wide-angle view. The participants (n = 29) were Nurse Practitioner students. The majority were female (93.2%), with a mean age of 36.8, SD = 12.31. The sample consisted of Millennials (65.6%), Generation Xers (13.8%), and Baby Boomers (20.7%). The average number of years of nursing practice was 9.89. Instruments measured demographics, five domains of patient-centered care …

Improving Communication Competency In Perioperative Nurse Managers, Philomena Whelan

Doctor of Nursing Practice (DNP) Projects

Abstract

Aim: This paper outlines the project planning, implementation and evaluation of a project aimed at improving the communication competency of perioperative nurse managers. Leadership development consisted of providing education and simulation practice to managers of the operating room (OR), pre and post anesthesia recovery (PACU) area and sterile processing (SPD). The goal was to improve the OR turnover time, cost per OR hour, patient access and the perception of the participants in their ability and willingness to speak up.

Background: The literature shows that training is needed to improve the ability of teams to understand the factors influencing the …

Using Safety Checklists Outside Of The Operating Room, Annabelle Gerhardt

Doctor of Nursing Practice Scholarly Projects

Abstract

The use of a Time Out checklist for patient safety in non-operating room procedural areas is equally important for positive patient outcomes as in the operating room (OR). In this busy southwestern United States hospital, the procedural teams in the non-operating room areas were reported to not be fully engaged during the performance of the Time Out pre-procedural pause prior to gastroenterological (GI) procedures. This study was conducted to improve compliance with the scripted Time Out checklist and promote full engagement of the GI procedural team during the Time Out thus reducing risks of wrong site surgery. Literature has …

Does Family Communication Matter? Exploring Knowledge Of Breast Cancer Genetics In Cancer Families, Sarah Harmon Davis

Theses and Dissertations

Purpose: Knowledge of breast cancer genetics is critical for those at increased risk whomust make decisions about breast cancer screening options. The purpose of this study was toexplore cognitive and emotional variables that might influence knowledge of breast cancergenetics.Methods: This descriptive, exploratory study analyzed theory-based relationships amongvariables related to knowledge of breast cancer genetics in cancer families. Participants includedfirst-degree relatives of women with breast cancer who had received genetic counseling andtesting; participants themselves did not have breast cancer and had not received geneticcounseling or testing. Data were collected by telephone interview and survey. Variables analyzedinclude numeracy, health literacy, cancer-related distress, …