Medicine and Health Sciences Commons^™

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 …

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 …

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 …

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 …

Coaching Nurse Leaders In Conflict Management And Team Building To Improve Retention, Jeanette Black

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: Retention of assistant nurse managers (ANMs) was identified as a concern from interviews with executive leadership and ANMs employed at a large hospital within a Northern California integrated health system. The nurse leader orientation training was reviewed, with gaps identified in conflict management and team building.

Context: The attrition rate of U.S. nurse managers in 2010 was 8.3%, higher than executive nurse leaders, with replacement costs equal to 75% - 125% of a nurse manager’s salary (Loveridge, 2017). Employee turnover and dissatisfaction due to conflict can have detrimental effects on retention, productivity, morale, and quality of patient care. …

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 …

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, …

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 …

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 …

Burnout, Depression And Suicide Prevention For Nursing Staff In High-Intensity Settings, April Ritchie

Doctor of Nursing Practice (DNP) Projects

Nurses working in high-intensity settings experience burnout at higher rates than in other nursing areas. Burnout in healthcare is a problem estimated as high as 70% by the Agency for Healthcare Research and Quality. Burnout can lead to depressive symptoms, which can lead to suicidal ideation in affected healthcare providers, which makes early identification and treatment of utmost importance to the mental and physical wellbeing of these nurses.

The purpose of this project is to examine burnout in nursing staff working in high-intensity areas of the hospital in order to help identify burnout and/or depressive symptoms before they lead to …

Nursing Leadership Beyond 2020: A Succession Plan, Janet Gloriani Jule

DNP Qualifying Manuscripts

Background: The impending exit of the aging nursing workforce, especially nurse leaders, poses a great concern to healthcare executives. Organizations must take action to lessen the impact of nurse leader turnover.

Interventions: The author developed a mentoring plan and a curriculum for leader development, based on the Essentials of Nurse Manager Orientation adopted from the American Organization for Nursing Leadership (AONL) and American Association of Critical Care Nurses (AACN), for assistant nurse managers (ANM) who are new to the role. The curriculum was implemented for two cohorts of nurse leaders within the first two years of their hire date. Each …

Exploring Normalization Of Deviance And Examining Factors That Predict Culture Of Safety In The Operating Room., M. Imelda Wright

Electronic Theses and Dissertations

Patient safety in the operating room is a prodigious responsibility of OR nurses as the OR environment is complex and laden with risk, which increases surgical patients’ risk for adverse events. The dissertation presents the topic of patient safety in the operating room (OR), the concept of normalization of deviance, and a mixed-methods study with an exploratory sequential design that involved three phases. The dissertation comprises of five chapters. Chapter One presents an introductory overview of the salience of patient safety as well as its relevance to the unique environment of the OR. Chapter Two presents a concept analysis of …

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 …

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 …

The Effects Of Nurse-To-Patient Ratios On Patient Outcomes In A Variety Of Hospital Settings, Sydney Montgomery

Scholars Week

Nurse-to-patient ratios has been a topic of discussion that has gained momentum over the last several years. In the state of Kentucky, there is no policy mandating a maximum nurse to patient ratio. However, evidence-based practice suggests that lower nurse-to-patient ratios results in better patient outcomes and therefore, the majority of policies in place regarding nurse to patient ratios are not based on best evidence.

The Relationship Between Psychological Contract Breach, Organizational Identification, And Organizational Agility Among Nursing Faculty Members, Yaldez Zeineldin

Nursing

Psychological contract is defined as the unwritten or hidden agreement between both the employers and the employees to ensure reciprocity and safe productive work environment. The concept of the relationship between Psychological Contract Breach (PCB) as one of many recognized antecedents of organizational identification has been emphasises for years. Organizational Identification (OI) is defined as the extent to which both the organisation and the employee’s identities are overlapped. Organizational Identification (OI) has many benefits. For instance, it has a robust effect on the employees’ cognitive abilities, attitude, and behavior including their organizational agility and acceptance to the external and internal …

Development And Validation Of A Tool For Measuring The Professional Identity Of Nursing Students: The Q-Ipei / Le Développement Et La Validation D’Un Instrument De Mesure De L’Identité Professionnelle Chez Les Étudiantes Infirmières : Le Q-Ipei, Eric Tchouaket, Dominique Houle, Dominique Therrien, Catherine Larouche, Annie Denoncourt, Pascale Reny

Quality Advancement in Nursing Education - Avancées en formation infirmière

Background: The various pressures on nurses in their practice environment, given the complexity of care, have exposed the confusion around the role definition and level of professional identity (PI) of future nurses. To support them in their practice, it is important throughout their education to know their commitment, representations, and sense of identity with respect to their future profession. To our knowledge, there is no measurement tool in the literature that can be used to measure the PI of nursing students throughout their education, given its complex multidimensional nature.

Objective: Based on a framework that takes into account …

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 …

Identifying Pragmatic Aspects For Succession Planning Needs: Conversations With Nurse Managers And Nurse Directors, Tammy Whitney

2019 Sigma Region 15 Nursing Research Symposium

A severe nursing shortage is predicted by 2020, and just as alarming is the likely shortage of nurse managers and nurse directors. Effective succession planning for nurse leaders affects recruitment and retention, patient outcomes, staff engagement, and finances. Preparing successors for leadership is imperative for hospitals to surmount challenges today and in the future. The focus of this project was to discover first hand challenges of succession planning and opportunities for developments.

Impact Of Nurse Manager Peer Mentorship Program On Job Satisfaction And Intention To Stay, Tonya Roth, Diane Whitehead

Journal of Excellence in Nursing and Healthcare Practice

Nurse managers (NMs) play a vital role in patient outcomes by providing a stable work environment for teams. Numerous factors influence a NM’s job satisfaction and intent to remain in a job. The purpose of this project was to develop an evidence-based formal mentorship program for NMs in an effort to impact retention rates. A secondary purpose was to evaluate the impact that a formal mentorship program has on NMs’ job satisfaction and intent to stay. Across two hospitals in the Pacific Northwest, 15 NMs participated in a 6-month mentorship program. The program was guided by both the mentorship enactment …

Increasing Patient Satisfaction Survey Response Rate At An Ambulatory Surgery Center, Carlee Nicholson

Doctoral Projects

In an effort to increase distribution rate and response rate of the patient satisfaction survey at this ASC, adjustments were made to current processes. These interventions included accentuating the option of a paper or emailed survey, providing pre-operative and post-operative response prompts, as well as adding a cover letter to the existing survey. The purpose of these interventions was to ensure a 100% distribution rate of the survey as well as to increase the response rate by 20%.

Results were obtained by collecting forms to monitor distribution of the survey. The response rate was calculated by the number of responses …

The Effectiveness Of A Robotic Seal On Compassion Satisfaction In Acute Care Nurses: A Mixed Methods Approach, Jo S. Henson

Nursing Theses and Dissertations

Problem: Nurses face a variety of stressors that can result in decreased levels of compassion satisfaction. The purpose of this study was to investigate the efficacy of a computerized interactive social assist robot (PARO) to decrease stressors and increase compassion levels of acute care nurses in an inpatient setting.

Theory: The Professional Quality of Life Model posits that low Compassion Satisfaction, Burnout, and Secondary Traumatic Stress leads to Compassion Fatigue.

Hypotheses: It was hypothesized that interaction with a social assist robot with artificial intelligence will result in decreasing levels of stress therefore increasing levels of compassion satisfaction in nurses working …

Registered Nurses’ Perceptions Of The Electronic Canadian Triage And Acuity Scale In A Community Hospital, Andrea De Jong

Electronic Thesis and Dissertation Repository

In 2017, several hospitals in Ontario implemented the Electronic Canadian Triage and Acuity Scale (eCTAS). This new technology affects a critical area of the Emergency Department: triage. There is no research on Registered Nurses’ (RNs) perceptions of eCTAS. A quantitative non-experimental descriptive survey obtained and quantified RN perceptions of eCTAS at a hospital with a 23 bed Emergency Department. The Diffusion of Innovation Theory was used as the theoretical framework to help guide study development. Results indicate both positive and negative perceptions of eCTAS and that younger RNs are more likely to think eCTAS cues them to collect the relevant …

Treating Substance Use Disorders: Enhancing Attendance At The Weekly Inpatient Medication Assisted Treatment Group, Devon Gillis, Jayne Weisberg, Dena Whitesell, Amy Mcauliffe, Amy Sparks, Suneela Nayak, Ruth Hanselman, Stephen Tyzik

Operational Transformation

At a large academic tertiary medical center, an Integrated Medication Assisted Treatment (IMAT) program has been established for those medically stable inpatients with an addiction diagnosis. Over a four month period, this program had experienced a decline in attendance and a quality improvement project was initiated is to better understand the barriers to attendance and institute a process that would reverse the decline.

A goal was established to improve attendance by medically stable patients that have consented to participate to a minimum of 50%.

A root cause analysis outlined numerous causes for low attendance and several countermeasures were established to …

Implementation Of Trauma Service Guideline For The Use Of Phenobarbital In The Management Of The Non-Icu Trauma Patient At Risk Or Experiencing Severe Alcohol Withdrawal, Joseph Rappold, Julianne Ontengco, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operational Transformation

The trauma service in a large academic tertiary medical center admits a large proportion of patients with the secondary diagnosis of alcohol use disorder. Given the successful use of phenobarbital in the critical care unit for withdrawal prophylaxis and treatment of acute withdrawal, a quality improvement project was established to create and implement guidelines for the non ICU patient.

A root cause analysis demonstrated several issues to include inconsistent clinical decision documentation. As a result, several countermeasures were initiated to address the various issues.

Post implementation of countermeasures, a decrease in the amount of severe alcohol withdrawal as well as …

Reduction Of Catheter Associated Urinary Tract Infections (Cauti) In A Critical Care Setting, Deborah Jackson, Lindsey Lucas, Shawn Taylor, Jonathan Archibald, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operational Transformation

Urinary tract infections (UTIs) are the most common type of healthcare associated infections. Seventy five percent are related to indwelling urinary catheters. These infections come with increased morbidity and mortality risk. A team of intensive care providers at a large academic tertiary medical center initiated a quality improvement project to reduce the number of CAUTIs.

Baseline data established the total number of catheter days and CAUTIs by month. A subsequent root cause analysis was completed and several counter measures were developed to include a KPI implementation to track that all intensive care providers are educated in CAUTI and creation of …

Improving The Workflow And Partnership Between Registration And Clinical Staff In An Outpatient Urgent Care Center, Melissa Fairfield, Bailey Eells, Faye Collins, Joyce Cornish, Stephen Tyzik, Joy Moody, Wendy Osgood, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operational Transformation

An outpatient urgent care unit was experiencing challenges in balancing the need to register patients and delivering care in the timeliest manner as possible. Upon examination, it was found that delays were being experienced in patient triage and discharge that resulted in low patient satisfaction scores.

A team of providers was established to review all process steps and a quality improvement project was created to attain a goal of 100% of the time discharge would not be delayed due to incomplete registration.

Baseline metrics demonstrated current numbers of delayed discharges, median time from door to triage as well as door …

Visual Boards To Improve Compliance With Administration Of Glucose Gel, Bonnie Hibbs

Graduate Theses, Dissertations, and Capstones

The purpose of this quality improvement project is to increase staff compliance of administering glucose gel for the treatment of newborn hypoglycemia through use of a daily management board. Through improved compliance to gel administration, the project further seeks to decrease NICU admissions for hypoglycemia, decrease formula supplementation of breastfed newborns, and improve exclusive breastfeeding rates at discharge.

Nicotine Replacement Therapies To Decrease Withdrawal Symptoms And Improve Patient Experience, Cheryl Pawloski, Holly Stewart, Devon Gillis, Dena Whitesell, Maya Bulman, Christopher Racine, Raymond Serrano, Leslie Gatcombe-Hynes, Elizabeth Mullany, Amy Mcauliffe, Jayne Weisberg, Amy Sparks, Suneela Nayak, Stephen Tyzik, Ruth Hanselman

Operational Transformation

Smoking is one the leading causes of preventable death in the United States. Patient centered care revolves around encouraging patients to reduce their chances of preventable disease and death. To that end, nicotine replacement therapy (NRT) prescribed within 24 hours of hospital admission increases the chance of quitting and decreases the chance of nicotine withdrawal.

A pilot performance improvement project was initiated on two cardiac units at an academic tertiary medical center. The goal the project was to have NRT ordered within 24 hours of admission 100% of the time. Baseline metrics demonstrated admission NRT orders were below acceptable levels …

Intensive Care To Intermediate Care Bridge Program, Natasha Bartlett, Sally Langerak, Lindsey Lucas, Jonathan Archibald, Tayla Robbins, Miranda Thompson, Patrice Tetu, Calla Hastings, Megan Garland, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Amy Sparks

Operational Transformation

To deliver the highest quality of care across the continuum, a large academic tertiary medical center envisioned a project that would provide an internal source of cross trained nurses for their medical intensive care unit (SCU2) and their medical intermediate care unit (R4/IMC/AVU). The hope for this program was to improve communication and collaboration between nurses and enhance the care that they provide to patients and their families.

A highly qualified team of nurses was established to create a performance improvement project. The overall goal of this endeavor was to build a more collaborative relationship between the units and ultimately …