Medicine and Health Sciences Commons^™

Lived Experience In Patients With Recurrent Glioblastoma In Japan: A Narrative Study, Ai Chikada, Asako Takekuma Katsumata, Mariko Asase, Sayaka Takenouchi, Yoshiki Arakawa, Kazuko Nin

Asian/Pacific Island Nursing Journal

Glioblastoma (GBM) is well known to have one of the poorest prognoses among all cancers. Patients with GBM in progression-free survival (PFS) may be relatively stable and can often maintain their quality of life. Thus, PFS is a desirable goal. In Japan, the median PFS is 11 months. It is difficult to grasp a patient's thoughts and hopes when, after PFS, they are readmitted due to recurrence or acute deterioration. Therefore, this study aimed to describe the lived experience of illness in patients with recurrent GBM, focusing on PFS. We enrolled five patients into the study; however, only four patients …

Using Social Narratives To Improve The Healthcare Experiences Of Children Diagnosed With Autism Spectrum Disorder, Margaret Spindel

Senior Honors Projects, 2010-2019

Children with Autism Spectrum Disorder (ASD) often experience significant emotional stress when they visit a healthcare provider. The focus of this research project was to explore the use of social narratives to help reduce stress associated with this environment. Social narratives are short stories designed to walk a child through a potential situation that they will encounter, that they may not be familiar with, or that they are not currently handling properly. As part of an initial literature review, evidence for the need for additional intervention in the healthcare setting for children with ASD was established. Continuing literature review then …

Pilot Of A Randomized Trial Comparing Outcomes Of Three Types Of Peripheral Intravenous Catheters (Pivc): Utilizing The Plan, Do, Study, Act Cycle, Heather Galang

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

Peripheral intravenous catheters (PIVC) are used in high volume in acute and ambulatory settings. Due to high volume of use in patient care, complications from a PIVC can significantly impact patient experience. Literature indicates complications such as blood exposure, phlebitis, unplanned removal, infiltration, occlusion, dwell time, pain, and cost have serious consequences in patient care, leading to potential delays in treatment, patient discomfort, patient dissatisfaction, safety concerns, nursing interruptions, increased length of stay, and added costs. Gap analysis indicates additional research can prove beneficial for evidence-based care improvement. The authors propose using the plan, do, study, act to conduct a …

Self-Efficacy For Symptom Management In Adult Hematopoietic Stem Cell Transplant Patients, Lynn White

Theses & Dissertations

Hematopoietic stem cell transplant (HSCT) is a treatment for hematologic cancers and other hematologic conditions that causes severe treatment-related symptoms. The first 30 days after HSCT, or the acute phase, is when symptoms are most intense. During this time, the ability of patients to manage their symptoms, in collaboration with their health care providers, is crucial to reduce the distress caused by the symptoms. Self-efficacy is the person’s confidence in their ability to perform a behavior, such as symptom management. This body of work describes the concept of self-efficacy for symptom management (SESM), presents an integrated literature review on self-efficacy …

Improve Readmissions And Patient Satisfaction Scores With A Revised Discharge Education Plan, Michele M. Hughes

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

Problem: Payers of health insurance are tracking key performance measures and are limiting payments to hospitals. With this threat to financial reimbursement hospital systems have increased emphasis on tracking and improving outcomes. The purpose of this project is to reduce all-cause 30-day readmissions and improve patient satisfaction scores in the care transitions domain after a total hip or total knee replacement by revising the discharge materials and education.

Method: The total joint replacement discharge education materials were revised to address the common causes of readmissions. The documents were reformatted to improve literacy level, readability, and patient learning. Nurses were educated …

Fall Prevention In The Ed, Ninojoseph Lacap

Master's Projects and Capstones

This project focuses on the prevention of patient falls in the emergency department (ED). Kaiser Santa Clara Hospital is an academic medical facility in the heart of Silicon Valley. The facility has a 46 bed ED with an average daily census of 220, specializing in stroke, pediatrics, heart, and left-ventricular assist device (LVAD) patients. For the calendar year of 2016 there were thirty-reported patient falls in the ED. The global aim is to reduce the patient fall rate by 35% for the 2017 calendar year. The project’s objective is to continue the road to patient safety and to have less …

Lost In Translation, Daniel Pena

Master's Projects and Capstones

At the conclusion of a patient’s hospitalization the Registered Nurse (RN) will review all discharge instructions in the patients room in their preferred language. Plan time for the discharge and facilitate a calm quiet environment, such as the patient’s room with the door closed, if possible. Get the discharge instructions printed out in their preferred language and a set for yourself in English would be best so you are able to review the instructions line by line with them. When the patients medical team, such as but not limited to, medical doctors, pharmacists, physical therapists, and social work have completed …

Reducing Delays In Follow-Up Care Through Process Optimization, Liam Malpass

Master's Projects and Capstones

Primary care follow-up after an emergency department (ED) visit is an important component of comprehensive healthcare, contributing to both improved patient outcomes and reduced readmissions to emergency care. In alignment with the Clinical Nurse Leader (CNL) roles of risk anticipator and lateral integrator of care, this project aimed to support improvement in care continuity for patients at a large primary care clinic in London. At this clinic, a team of physicians, nurses, and support staff care for a diverse population of adult and pediatric patients who account for nearly 3,000 ED visits annually. Assessment of the clinical review process used …

Improving Oral Care Practices And Aspiration Risk Assessment To Mitigate Risk Of Hospital Acquired Pneumnia, Jeniffer Baker

Master's Projects and Capstones

Abstract

The aim of Improving Oral Care Practices and Aspiration Risk Assessment to Mitigate Risk of Hospital Acquired Pneumonia is to decrease rates of hospital acquired pneumonia (HAP) on a 16 bed Transitional Care Unit (TCU) with a mixed skill staff. The theme of the project is risk reduction with improved patient outcomes and cost reduction as reasons for implementation. Fourteen cases of HAP were reported in the last 5 quarters which accounts for 48% of all in-patient acquired infections. Through policy development, standardization of oral care technique, and improved risk factor assessment, the project goal is to decrease rates …

Mentor-Based Orientation Program, Sheryl Pinugu Bano

Master's Projects and Capstones

The intention of this quality improvement project is to improve the process of staff development in a 16-bed, acute rehabilitation unit by implementing a mentor-based orientation program. Rehabilitation nursing is a specialty that requires knowledge of the rehab philosophy and milieu. The lack of a rehab-specific educational component of the orientation process causes the new nurses anxiety and dissatisfaction which negatively impacts nurse retention. The project aims to improve the confidence and competence of new nurses, decrease nurse turnover rate, and increase nurse retention by providing a rehab-specific, orientation class. The MiRehab booklet and a PowerPoint presentation were …

Interdisciplinary Team Approach In Fall Prevention: Physician Perspective Focus, Anna Gryn

Master's Projects and Capstones

An in-hospital fall is a devastating event for patients and care providers resulting in injuries, physiological and psychological patient declines, and sometimes deaths. Furthermore, fall related costs greatly increase hospitals’ expenses and cause massive distress to caregivers and health providers. Many patient-specific, organizational, and seemingly erratic factors contribute to the occurrence of in-hospital falls. Despite this, hospitals must undertake consistent evidence-based measures to prevent fall occurrences as much as possible.

The traditional nursing approach to falls prevention is not sufficient to control fall rates because the issue is too complex and must be approached from multiple perspectives rather than just …

Increasing Patient Safety During Medication Administration, Vivien Tso

Master's Projects and Capstones

Medication administration error is one of the crucial medical errors that compromises patient safety in hospitals each day. Direct observations were conducted to assess medication administration (MA) accuracy and practices in order to determine the root cause(s) of errors at a community-based, non-profit hospital. Failure to scan patients’ wristbands, to verbally verify patients’ identity with two identifiers, and to verbally verify patients’ allergies, were some practices that were found to lead to medication administration errors. Implementation tools such as an informative video and reminder signage at bedside computers were piloted at the oncology unit of the hospital to improve nursing …

Assessment Of Fall Protocol Use On A Medical-Telemetry Unit, Ashia Mar

Master's Projects and Capstones

Purpose: This quality improvement project serves to implement a fall prevention plan to decrease patient falls on the medical-telemetry unit of a large metropolitan hospital.

Background: Patient falls are a persistent nationwide problem in the acute care setting. Between 700,000 and 1,000,000 falls occur in hospital every year and approximately 30-35% of these falls result in injury and 11,000 falls result in death (Health Research & Educational Trust, 2016). Falls always cause harm to the patient, whether it is emotional or physical; but, falls can also cause harm to the providers, family, and organization. Patient injury, additional hospital expenses, and …

Improving Early Sepsis Identification On Inpatient Units, Courtney Sumanqui

Master's Projects and Capstones

Sepsis is a medical emergency that if left untreated can rapidly cause death for many patients due to effects that this systemic infection has on the human body. Millions of Americans nationwide are affected by sepsis on an annual basis. To reduce the number of patients who decline to sepsis in the hospital, efficient sepsis protocols must be effectively implemented throughout the hospital. Healthcare organizations must dedicate themselves to providing high quality patient care from the time of admission to discharge. This quality improvement project focused on improving early sepsis identification on inpatient units.

Nurse practices, knowledge, understanding related to …

Fall Prevention Protocol In Acute Care Setting, Allie Di Angelo

Master's Projects and Capstones

Purpose:

Purpose: The purpose of this quality improvement project is to implement a falls intervention to improve falls on the Medical Telemetry unit in the large metropolitan hospital.

Background: Between 700,000 and 1,000,000 falls occur in hospitals every year. Furthermore, approximately 30-35% of these falls result in injury and 11,000 falls result in death (Health Research & Educational Trust, 2016). Falls harm patients, families, and providers. They are also a high cost, as many insurance companies will not reimburse care when a patient falls. As a hospital organization it is important to ensure funds are going to the appropriate places. …

Development Of A Formalized Mentorship Program, Rozlyn Bauer

Master's Projects and Capstones

The purpose of this project is to help increase retention of newly licensed registered nurses (NLRN) at a large community medical center. The medical center loses approximately 20 NLRNs per year which is costly for the medical center. The loss of NLRN can be attributed to decreased job satisfaction, poor nursing competence and lateral violence between the nursing staff. Evidence shows that mentorship is a proven, evidence-based approach to solving these issues and more (Hodgson & Scanlan, 2013).

Not only can mentorship help increase retention, address lateral violence, increase job satisfaction and nursing competence but, it can also help enhance …

Improving Early Sepsis Identification On Inpatient Units, Yee Yang

Master's Projects and Capstones

Sepsis is a serious complication caused by an overwhelming immune response to infection that affect millions of people worldwide each year. Sepsis is a time sensitive illness that requires early identification and quick interventions to improve patient outcomes. This quality improvement project includes a team of clinical nurse leader (CNL) students and gathering information on the nursing compliance of the sepsis protocol at a large metropolitan hospital. The observations on different inpatient units and chart review conducted at the large metropolitan hospital led to increased awareness of gaps that prolong the identification of sepsis among patients; also to the creation …

The Development Of A Cardiovascular Competency Checklist For Chinese Nurses, Amy B. Xiong

Doctor of Nursing Practice (DNP) Projects

Cardiovascular disease is a global issue affecting millions of lives around the world. Today, countries like the U.S. and China have joined forces to take on the global issue. In the U.S., the American Heart Association is the largest organization dedicated to reducing the mortality rate of cardiovascular disease by requiring healthcare services to uphold standard cardiovascular guidelines. Astonishingly, within the last 10 years, the U.S. has reduced their cardiovascular mortality rate by 30%.

This quality improvement project sought to determine the gap between the United States and China’s standard nursing education and practices and to help Chinese nurses achieve …

Pregnancy Loss In The Emergency Department, Gudrun Reiterhiltebrand

Master's Projects and Capstones

Abstract

The aim of this project is to improve the care for patients experiencing pregnancy loss in the emergency department (ED). Objectives are to enhance understanding of staff about the patients’ experience and their knowledge on how to best care for emotional needs, thus improving quality of patient care, work satisfaction, knowledge, confidence and comfort levels, while decreasing experienced stress. The project was implemented in a midsized community hospital with 117 beds, which discharged 74 patients with “interrupted pregnancies” over the previous year from the ED. The project was directed toward nurses, doctors, care partners, chaplains, and social workers. The …

Baseline Prevalence Study Of Hendrich Ii Fall-Risk Assessment Tool At A Local Community Hospital, Emanuelle Vasconcelos Barbosa Borba Pontual

Master's Projects and Capstones

Each year, 700,000 to 1,000,000 people in the United States fall in hospitals; 30%–35% of those sustain injuries, and 20% of falls will cause serious traumatic injuries. Yet, research shows that close to one-third of these falls could be prevented. This paper presents the analyses of two fall-risk tools, Hendrich II fall risk model (HFRM II) and PMAT, in a local community hospital. Extensive review of literature and statistical analysis of 106 patients’ assessments practices were used to determine the current assessment skills for falls and PMAT. The aim was to understand if RNs are using the tools appropriately and …

Improving Early Sepsis Identification On Inpatient Units, Monica Schurle

Master's Projects and Capstones

Sepsis is a serious complication, which is initiated by the body’s extreme response to an infection. If sepsis is not identified and treated promptly, it can rapidly lead to tissue damage, organ failure and death. In order to reduce the number of patients who decline to sepsis in hospital, an efficient sepsis protocol needs to be implemented. Nursing practices, knowledge, and early recognition of systemic inflammatory response syndrome (SIRS) were assessed and measured in order to implement effective interventions. A root cause analysis was conducted to identify any discrepancies with compliance performing the sepsis screening in a timely manner, identify …

Clinical Practice Update On A Temperature Guideline To Decrease Intraoperative Hypothermia In Patients Undergoing General Anesthesia, Ashley Rigdon

Doctoral Projects

Intraoperative hypothermia is a common problem within the operating room. Anesthesia inhibits the body’s normal thermoregulatory response to hypothermia, redistributing heat from the core to the periphery (Brandt et al., 2009). In the event of hypothermia, the incidence of infection triples as there is an increased risk for blood loss, increased risk for cardiac complications, and the thermal discomfort of patients (Brandt et al., 2009). Following a recent clinical practice guideline can help prevent hypothermia.

A descriptive project was organized utilizing current literature. The sample for this study is 45 CRNAs practicing at a multiple system healthcare facility in the …

Increasing The Adherence To Updated Clinical Practice Guidelines For Tb Screening Among Hiv Patients Entering A Congregate Setting Utilizing A Clinical Reminder, Domingo Lopez

Doctor of Nursing Practice

Purpose: The purpose of this Doctor of Nursing Practice project was to update an existing tuberculosis policy for screening HIV-positive individuals entering a south Texas jail to meet current evidence-based guidelines and increase the adherence of jail staff to the updated screening process.

Background and Significance: In 2015, over 700,000 people were jailed in the United States with over 20,000 being HIV-positive. Tuberculosis is highly contagious and spreads through the air. HIV is a virus that targets the immune system. HIV-positive people are 17-22 times more likely to contract tuberculosis. The current screening process at the jail showed a low …

Individualized Glycemic Targets For The Elderly Residing In Long Term Care Facilities, Abegail Hubberd

Doctor of Nursing Practice

Of people age 65 and older residing in a long-term care facility, 1 in 4 has Type 2 diabetes (Smide & Nygren, 2013). Care and management of this population is a challenge for nurses and other providers. Results of a needs assessment in a local long-term care facility identified deficiencies in the provision of evidence-based Type 2 diabetes care for this target population. American Diabetes Association Guidelines (2017) recommend application of individualized HbA1c targets for the elderly residing in long-term care facilities, especially for those with compromises in clinical and functional status. This two prong quality improvement project strove to …

A Clinical Nurse Leader Initiative: Promoting Mobility Among Long-Term Care Facility Residents, Ulyses Reamico

Master's Projects and Capstones

Maintenance of mobility during hospitalization or stay in long-term care facility result in improved patient outcomes including but not limited to decreased incidence of falls, non-pharmacological pain intervention, and prevention of further functional decline. In a 45-bed rehabilitation unit of a Veterans Affairs (VA) health care facility, a clinical nurse leader (CNL) initiative was done to promote mobility among the patients to mitigate functional decline. The patients, also referred to as clients or residents in long-term care facilities, were aged between 20s and 90s. The resident population consisted of patients admitted for physical rehabilitation after a stroke or surgical procedure, …

Nurse Perspectives On The Work Impacts Of Decentralized Nursing Unit Design, Susan Mcdevitt

Electronic Theses and Dissertations

This study investigated nurse perspectives on the work impacts of a decentralized inpatient unit model. The study involved two rural acute-care hospitals in rural Nebraska that moved from a centralized to a decentralized inpatient unit design. The researcher conducted focus group discussions with staff and nursing management at both facilities with a total of 28 participants. In addition, the participants completed a 12-item questionnaire using a five-point Likert scale for responding. Focus group discussion and questionnaire were designed to investigate the areas of quality of care, communication, documentation, stress and wellbeing, and transition. Data gathered revealed that on all survey …

Implementing Nerve Blocks For Patients Undergoing A Bilateral Mastectomy With Immediate Reconstruction: A Practice Change, Corey Beene Auerswald

Doctoral Projects

Breast cancer is one of the most commonly diagnosed cancers in women. A mastectomy is one of the first line treatments for breast cancer, but it is associated with considerable postoperative pain. Literature suggests current methods of pain management are ineffective and regional anesthesia can help reduce postoperative complications following a bilateral mastectomy with immediate reconstruction. Information from the literature review was used to inform five anesthesia providers at a rural hospital in Mississippi about the benefits of regional anesthesia for patients having a mastectomy. A presentation was given to anesthesia providers regarding the benefits of paravertebral blocks (PVB) for …

Impact Of A Mastectomy On Female Body Image And Sexuality, Hilary Tingley

Grace Peterson Nursing Research Colloquium

Impact of a Mastectomy on Female Sexual Expression: An Integrative Literature Review

Hilary Tingley

Nursing Student, DePaul University, School of Nursing

Background: Women diagnosed with breast cancer are often treated with a combination of therapies, one of which may be a mastectomy. There are an increasing number of women who are undergoing preventative mastectomies, many as a result of BRCA gene testing.

Objective: The purpose of this literature review was to examine the impact of a mastectomy on female sexual expression and body image.

Method: An integrative literature review design was used with research articles pulled from search engines such …

Organizational Learning In A College Of Nursing: A Learning History, Bret Lyman, Lisa A. Cowan, Hannah C. Hoyt

Faculty Publications

Background: College of nursing leaders can foster organizational learning as a means of achieving their desired organizational outcomes. Organizational learning has not previously been studied in colleges of nursing, leaving college administrators and faculty little guidance as they strive to improve outcomes in their own colleges.

Objectives: The purpose of this study was to discover new insights related to organizational learning in a college of nursing.

Design: The learning history method was used to document and describe organizational learning in a college of nursing.

Setting: This study was conducted with a college of nursing situated in a private, religious-based university …

Turning A Blind Eye: How Lack Of Communication With Er Nurses Nearly Cost A Patient Permanent Vision Loss, Kenneth Royal, April Kedrowicz

Patient Experience Journal

This narrative presents a case in which a patient was treated for conjunctivitis, but a breakdown in several layers of communication (between the hospital and the patient, and between hospital personnel) resulted in multiple medical errors that nearly costs the patient permanent vision loss. This real-life case underscores how simple communication errors may lead to life-altering consequences. Recommendations for improving communication to ensure similar errors do not happen to others are provided.