Medicine and Health Sciences Commons^™

A Clinico-Pathological Study Of The Structural And Functional Changes In The Retina And Optic Nerve Following Diabetic Retinopathy Treatments, Richard Filek

Electronic Thesis and Dissertation Repository

Diabetic retinopathy (DR) is the result of microvascular changes in the retina due to hyperglycemia which alter the blood-retinal barrier (BRB). The increased permeability of BRB results in the accumulation of extracellular fluid, the development of diabetic macular edema (DME) and capillary occlusion. Capillary occlusion results in retinal ischemia which increases vascular endothelial growth factor (VEGF) levels, increases vascular permeability and results in neovascularization in proliferative diabetic retinopathy (PDR) patients. The treatments clinically used for DR are panretinal photocoagulation (PRP) for PDR and injectable vascular endothelial growth factor inhibitors (anti-VEGFs) for DME.

The safety of PRP and anti-VEGF therapy on …

Monitoring Patient Safety In The Recovery Room, Gail Davis

Dissertations

Respiratory depression is a serious complication after surgery. Early detection is a major patient safety concern for recovery room personnel as patients recover from anesthesia and experience pain. The opioids used for pain management may contribute to over-sedation effects and respiratory depression. Vital signs and pulse oximetry are standard postoperative monitoring procedures. End-tidal capnography and arterial blood gases may augment the standard-of-care procedures but may not be effective at detecting early respiratory depression. The purpose of this study was to generate baseline data trending patient safety variables and outcomes for postoperative patients using standard monitoring with standard-of-care plus transcutaneous capnography …

Improving The Quality Of Bedside Shift Report Behavior: Implementing A Standardized Bedside Report Tool On The Medical-Surgical Floor At Woodland Healthcare, Amanda Waggoner

Master's Projects and Capstones

Abstract

Nursing handoff communication at change-of-shift is a frequent, yet highly essential nursing responsibility that lays the foundation for providing care that is safe and consistent (Grimshaw, Hatch, Willard, & Abraham, 2016). A microsystem assessment conducted on the medical-surgical unit at Woodland Healthcare (WHC) utilizing the 5P’s (Purpose, Patients, Professionals, Processes, Patterns) revealed that only 6% of twelve hour night shift nurses were performing a quality BSR and 40% of twelve hour day shift nurses reported feeling satisfied with shift report. Additionally, three reportable events occurred as a result communication related errors which led to increased spending on behalf of …

Readiness For Improving Safe Care Delivery Through Web-Based Hospital Nurse Scheduling & Staffing Technology: A Multi-Hospital Approach, Lisa Massarweh

Doctor of Nursing Practice (DNP) Projects

Hospital scheduling and staffing practices are linked to patient safety, nurse satisfaction, and cost outcomes (Steege & Rainbow, 2017). Staffing, while complex, is ultimately central to the overall success of the hospital. Demands to eliminate events that cause death or serious harm, produce high patient satisfaction scores while maximizing workforce productivity, test any administrator’s skillset. Providing qualified staff in the right place at the right time can be challenged by restrictive union contracts, variable patient acuities, staff attendance, and mandated staffing ratios. These demands may lead to overtime utilization. There is a growing understanding of the negative effects of healthcare …

Combating Workplace Violence: An Evidence Based Initiative, Diana L. Giordano

Evidence-Based Practice Project Reports

Patient/visitor violence against healthcare (HC) employees is a type of workplace violence (WPV) and considered a dangerous hazard within HC occupations (Bureau of Labor Statistics, 2015). Lack of recognition of the true incidence and underreporting of WPV may contribute to a false sense of security within a HC facility (HCF). Therefore, fully addressing the problem may be met with administrative resistance, resulting in poor employee perceptions of support and commitment for a zero-violence environment. A retrospective analysis was conducted on the HCF’s online incident reports, security request calls, and data from a previously deployed WPV employee survey. The emergency department …

Application Of The Patient Checklist Tool In Anesthesia Handoffs, Theresa Durley

DNP Scholarly Projects

Accurate and essential communication is required during the transfer of patient care from one health care provider to another. Communication errors during the handoff process have been identified as contributing factors in sentinel events. There is a plethora of literature supporting a standardized transfer of care process as well as several accepted handoff communication tools for the various units within a healthcare institution. However, in the anesthesia domain, there is currently only one protocol specifically created for the transfer of patient care between certified registered nurse anesthetists (CRNAs). The PATIENT protocol, created by Dr. Suzanne M. Wright, CRNA, PhD (2013) …

Effective Communication And Teamwork Improve Patient Safety, Helene M. Anderson

Walden Dissertations and Doctoral Studies

Work environment influences the effectiveness of care for patients in any healthcare setting. It is even more important in settings such as the neonatal ICU (NICU) where this project took place. When the environment is not healthy, communication may suffer and result in poor patient outcomes and, family, patient, and staff dissatisfaction. The purpose of this quality improvement project was to understand how the implementation of the TeamSTEPPS program, for nurses in the NICU, could impact the safety culture as measured by the AACN Healthy Work Environment (HWE) tool. Lewin's professional practice change theory and the AHRQ change model were …

Leadership Practices That Improve The Workplace Safety Environment, Nathan Nomore Chikono

Walden Dissertations and Doctoral Studies

Inadequate leadership is the reason workplace accidents in the mining industry remain high, making the industry one of the most hazardous operational activities in the world. Unsafe leadership practices may result in death or injury to workers. A group of 30 mining company leaders from 3 gold mines in Zimbabwe revealed an exception to these hazardous practices, however, notable through their outstanding safety improvement records. To better understand what these practitioners were doing, this multicase study research design explored their strategies to improve the workplace safety environment in the mines. Data were collected using audio-recorded semistructured interviews and document analyses. …

Fall Prevention In A Neurological Care Unit, Claudeth Jeffrey

Walden Dissertations and Doctoral Studies

Patient falls are an ongoing concern for health systems in the US and in the setting where this project took place. Inpatient falls affect consumers and health providers because falls often result in patient morbidity and mortality, legal risk, increased length of stay, and increased costs. The purpose of this project was to evaluate the existing fall prevention protocol at the site where this project took place and to make recommendations for an evidenced-based fall prevention protocol. The professional practice model was the conceptual model that guided the exploratory descriptive project. A review of the site's fall prevention policies and …

Influence Of Psychological Empowerment, Leadership, And Climate On Safety Outcomes, Christine Healy

Walden Dissertations and Doctoral Studies

Research has demonstrated that safety outcomes are impacted by workplace risk factors, but also supervisory practices and employee actions. An area that has not been explored is the impact of employee cognitions on safety outcomes defined as work-related injuries. Based on the conceptual framework of psychological empowerment (PE), the purpose of this study was to examine the relationship of employee cognitions as measured by PE as related to leadership and safety climate and the occurrence of work-related injury. The research examined the mediating effect of (PE) on the factors of leadership and safety climate and their relationship to work-related injury. …

Use Of Physician Credentialing Standards By U.S. Medical Services Professionals, James Allen Reeder

Walden Dissertations and Doctoral Studies

Credentialing in hospitals is the first line of defense for improving patient safety and reducing medical errors by verifying a physician's medical knowledge and skills. There is no single set of standards for physician credentialing followed by all hospitals in the United States. Using May's normalization process theory, the purpose of this quantitative study was to survey medical services professionals (MSPs) to determine which physician credentialing standards were being used, the sources being used, and the frequency of standards used. The dependent variables in this study were the 13 ideal credentialing standards developed by the National Association of Medical Staff …

Workers' Perceptions Of The Effect Of Three-Tier Shift Schedules On Community Functioning, Jillian Leigh Wallace

Walden Dissertations and Doctoral Studies

Shift work is commonplace in many fields that require around-the-clock employee coverage. There is ample evidence that two-tier shift work can detrimentally affect health and functioning. The purpose of this study was to understand the impact of three-tier shift schedules on physical and mental health and community functioning, a concept which refers to activities and behaviors performed by individuals or groups within a system. This study used a qualitative phenomenological design, and community functioning and recovery theory were central to the conceptual framework. In-depth interviews were used to explore the perceptions of three-tier shift workers on their functioning, relationships, mental …

An Assessment Of The Effectiveness Of Unannounced Safety Inspections Versus Announced Inspections In Academic Research Laboratories That Utilize Biological Hazards, Holley M. Trucks

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Inspections are integral to comprehensive biosafety programs at academic research institutions that use a wide variety of infectious agents. However, there is no standardization of biosafety inspection procedures from institution to institution. This study analyzed results of 2,098 documented inspections conducted from January 2012 through December of 2016 performed by biosafety staff at a large Research I land grant institution in order to evaluate the effectiveness of an unannounced versus the more traditional announced approach to inspection procedure. Results demonstrated that: a) more findings were noted during unannounced inspections, therefore more accurately informing biosafety staff of the true day to …

The Heinrich Model: Determining Contemporary Relevance, Bryan P. Basford

Online Theses and Dissertations

For as long as his work has been at the core of the safety profession, Herbert William Heinrich has been a staple of debate. His 1931 work Industrial Accident Prevention: A Scientific Approach has sparked worldwide debate on the effectiveness or ineffectiveness of his safety theories, as well as the accuracy or inaccuracy of his research and methods.

Heinrich's work is undoubtedly cited time and again as the foundational teaching for behavior-based safety, as well as countless other teachings in the safety profession as a whole. Despite the continued challenges to the validity of his work, there has been little …

Appraising The Current Status Of The National Institute For Occupational Safety And Health's Fatality Assessment Control Evaluation Program, Douglas Schwindt

Online Theses and Dissertations

Today, generally 13 U.S. workers die from workplace injuries. In 1970 on average, there were as many as 38 workplace fatalities on each day (DOL 2016). As a response to this alarming reality, the government enacted the Occupational Safety and Health Act in 1970. This governmental legislation created the Occupational Safety and Health Administration to regulate safety in the workplace; as well as, The National Institute of Occupational Safety and Health who was charged with "developing new knowledge in the field of occupational safety and health and to transfer that knowledge into practice" (CDC NIOSH 2017).

In order to understand …

Analysis Of Union Safety: Determining Relationships Between Union Membership And Injury And Fatality Rates, Madelyn K. Street

Online Theses and Dissertations

In under two centuries the labor union transformed the American workplace, improving wages, benefits, employee engagement, and safety. In more recent years, the government and other organizations have caught up in focusing on safety. Countless studies have been conducted and determined that unions have a significant positive impact on safety compared to work environments absent of a union. Using Bureau of Labor Statistics data for 2006-2015, an investigation into the trends of union membership and injuries and fatalities reported in the United States was conducted. It was determined that there was not significant correlation between increased union membership and improved …