Health and Medical Administration Commons^™

Teamwork That Affects Outcomes: A Method To Enhance Team Ownership, Brian Carlson, Richelle Graham, Brad Stinson, Jordan Larocca

Patient Experience Journal

Healthcare is the ultimate team sport, and this case study explores how to build teamwork across teams. The ability for nursing, environmental services and food and nutrition services to work collaboratively to benefit patients is paramount to a patients experience and outcomes. The case study describes how the work was done to build teams and then improved outcomes in both patient and employee experiences. The learnings are applicable to any team setting not just those described in this case study.

Experience Framework

This article is associated with the Staff & Provider Engagement lens of The Beryl Institute Experience Framework ( …

Global Child And Family-Centered Care Fellowship, Education And Mentorship For Pediatric Healthcare Professionals: A Literature Review, Ashley Zheng, Bobbijo Pansier

Patient Experience Journal

Child- and family-centered care (FCC) is increasingly accepted and implemented to optimize the healthcare experience for patients, their families, and healthcare professionals. Standish Foundation for Children, a 501(c)(3) non-profit, has designed and piloted a fellowship to educate pediatric healthcare professionals in FCC & psychosocial care via an inquiry and mentorship model in Tbilisis, Georgia. This review aimed to evaluate and synthesize existing literature on psychosocial and FCC mentorship for pediatric healthcare professionals in four parts: ongoing need, effects on healthcare professionals, effects on children and their families and/or caregivers, and in cross-country healthcare settings. Reviewers searched open-source databases for articles …

Understanding Modern Drivers Of The Employee Experience In Healthcare, Antonio Pangallo, Tim Atwell, Kristi Roe, Adrienne Boissy

Patient Experience Journal

Employee engagement has been considered the guiding metric to convey the health, loyalty, and performance of the healthcare workforce. However, the pandemic created new challenges and stimulated deeper conversations around remote work, systemic racism, inclusivity, trust, well-being, and mental illness, which calls into question whether engagement alone is enough. Using an employee experience model deployed in other industries, we identified key drivers of six employee experience (EX) outcomes. We conducted a panel study with close to 5,000 nurses and physicians to identify and prioritize current key drivers specific to the healthcare employee experience. Relative weights analyses suggest that being treated …

Multicomponent Approach To Delirium Prevention In The Acute Care Setting: An Evidence-Based Quality Improvement Project., Kelley James

Doctor of Nursing Practice Papers

Background: Acutely ill, hospitalized individuals are at an increased likelihood of developing delirium. Between 30-35% of those patients admitted to the hospital will develop delirium, and as a result, these individuals will face an increased risk of mortality, adverse medical events, restraint usage, and incur a more extended hospitalization. The literature supports early screening utilizing the Confusion Assessment Method (CAM) tool and nurse-driven, multicomponent interventions to aid in preventing its development.

Environment: This project was implemented in a long-term, acute care facility specializing in patients requiring long-term mechanical ventilation, advanced wound care, pulmonary and respiratory care, and the rehabilitation of …

Neonatal Developmental Care Makes Sense: Implementation Of An Evidence-Based Guideline For Developmentally Appropriate Multi-Modal Positive Sensory Exposures., Nicole Moseley Jaeger

Doctor of Nursing Practice Papers

Background: There is increasing awareness of the contribution of the neonatal intensive care (NICU) environment and the importance of developmental care (DC) interventions to long-term outcomes in high-risk infants. Care at the project site reflected that given at many hospitals, where positive sensory experiences and negative sensory mitigation are done but inconsistently. There was not a guideline in place for DC interventions.

Setting: The project site housed a newly renovated single-family room (SFR) NICU with 12 licensed Level II beds and ability to flex to 19 beds. Neonates at gestational ages ≥28 weeks, requiring critical care for a …

Nursing Perspectives And Opinions On Early Or Delayed Sepsis Treatment: A Mixed Methods Approach, Pamela L. Harris

Theses and Dissertations (ETD)

Purpose. Each year at least 1.7 million adults in America develop sepsis. Sepsis can lead to life threatening organ dysfunction, severe hypotension, and death when severe sepsis or septic shock is involved. Sepsis is responsible for 50% of acute kidney injury (AKI), which is the most common form of organ dysfunction seen in critical care. Sepsis associated AKI results in loss of, or decreased renal function, is associated with adverse long-term outcomes, and carries a higher mortality rate than non-septic AKI, sepsis without AKI, or septic shock without AKI. Surviving sepsis guidelines suggests a 1-hour window from the time of …

Evaluating Burnout, Secondary Traumatic Stress, And Sleep Disturbances In Healthcare Professionals During A Global Pandemic, Laura K. Miller, Sarah Pehlke

Journal of Wellness

Introduction: For healthcare workers, the COVID-19 pandemic resulted in increased workload, work related stress and patient acuity potentially leading to burnout, secondary traumatic stress (STS), and sleep disruptions. This study aims to assess the prevalence of burnout and STS symptoms, as well as sleep disturbances among healthcare personnel working in the United States during the pandemic.

Methods: Healthcare workers from all disciplines and settings in the United States completed a cross-sectional survey about work and personal characteristics from January 20-March 1, 2021. Participants reported on symptoms of burnout, STS, and sleep disruptions.

Results: A total of 360 participants in the …

Asking The Question ‘What Matters To You?’ In A London Intensive Care Unit, Harriet Pittaway, Laura White, Karen Turner, Angelique Mcgillivary

Journal of Patient-Centered Research and Reviews

Purpose: At the heart of the paradigm shift in approach to patient care from paternalism toward shared decision-making lies the international “What Matters To You?” (WMTY) movement. However, WMTY principles are not frequently applied to the critical care setting. The aim of this quality improvement project work was to design and integrate a tool for all patients admitted to the intensive care unit (ICU) that helped answer WMTY.

Methods: Using Plan-Do-Study-Act (PDSA) methodology across 8 cycles, a multidisciplinary team designed and integrated a bedside poster into the ICU. Quantitative and qualitative data were collected via a bedside audit process on …

Visualizing Depressive Symptom Improvement: Implementing The 17-Item Hamilton Depression Rating Scale, Briana Raterman

Dissertations

Visualizing Depressive Symptom Improvement: Implementing the 17-Item Hamilton Depression Rating Scale

Abstract

Problem

Depression, a mental health diagnosis, has affected about 18.5% of adults (Villarroel & Terlizzi, 2020). Ketamine, a medication initially used as an anesthetic, has improved depressive symptoms in individuals struggling with treatment-resistant depression.

Method

This quality improvement (QI) project used the 17-item Hamilton Depression Rating Scale questionnaire to assess depressive symptom changes in patients receiving intramuscular ketamine for treatment-resistant depression. The questionnaire was administered to patients pre-and post-intramuscular ketamine administration. The data was collected on injections one, three, and six on each participant’s set schedule of injections …

Evaluation Of An Education Program Implementation For Adults With Stage 4 And 5 Chronic Kidney Disease, Dana Marie Carter

Dissertations

Abstract

Problem: Patients with long-term medical conditions represent a significant public health issue. Therefore, patients diagnosed with a chronic illness must have a high level of health literacy (HL) to manage their condition effectively. This Quality Improvement (QI) project evaluated the impact of an existing education-based program for stage 4 and 5 chronic kidney disease (CKD) patients and its effect on laboratory values compared before and after an NP-led education program that included vascular access, and modality choices.

Methods: A retrospective chart review was completed on 20 patients with an inclusive diagnosis of CKD stage 4 or 5 from …

Life Matters, Marina Fischer

Dissertations

Problem: One of the challenges facing many primary care providers is managing hypertension. Hypertension contributes to cardiovascular disease events. Consequently, the high occurrence of hypertension related visits signifies a clinical practice gap in hypertension management resulting in substandard blood pressure outcomes. The purpose of this clinical scholarship project was to assess the difference of pre and post Quality of Life Scale (QOLS) scores in a hypertensive population.

Methods: This quality improvement project used a longitudinal, observational design with prospective data collection. The sample included newly diagnosed hypertensive adults ages 21 to 64 years old. The sample was administered the World …

Doubling Down On Sepsis: A Quality Improvement Project To Improve Sepsis Bundle Compliance On An Inpatient Oncology Unit, Kayla Slay

Dissertations

Problem: Sepsis is a leading cause of death worldwide, and the second most common cause of death in cancer patients. Early management of sepsis through use of sepsis bundles have been shown to improve patient outcomes, yet bundle adherence is unfortunately inconsistent.

Methods: A two-nurse team, called the Sepsis Sidekicks, was a process improvement initiative to increase compliance with the center for Medicare and Medicaid Services (CMS) sepsis bundle and improve patient outcomes related to sepsis. The observational quality improvement project utilized a Plan-Do-Study-Act (PDSA) model over a six-week period where quantitative data was collected using a retrospective chart review. …

Evaluating The Extent Of Fall Prevention Knowledge Of Direct Care Clinicians In A Post-Acute Hospital Setting: A Quality Improvement Initiative, Joseph Henry Mitchell Jr

Doctor of Nursing Practice Projects

Background: Events, such as falls, continue to maintain permanence in countless public health settings and organizations, attributing to unnecessary resource utilization. Proven methods for mitigating fall occurrences transpire through reliable fall education and by creating programs that directly impact these incidents. These agendas are essential and can lessen undue stress, obligations, and associated fiscal liability.

Purpose: This DNP project aimed to ascertain and expand unit nurses' fall prevention strategy knowledge in a long-term acute care hospital, bringing awareness of evidence-based practices through a learning addendum.

Methods: This program, based on a descriptive, quasi-experimental, pre-, and post-analysis, strategically …

Implementing Antimicrobial Stewardship For Healthcare Providers In An Urgent Care Setting To Reduce Antibiotic Misuse For Respiratory Infections, Ashley Pauldin

Doctor of Nursing Practice Projects

Background: Antimicrobial resistance has been identified as a major threat by the World Health Organization (WHO), and antimicrobial stewardship is a key strategy to overcome resistance. A major contributing factor to this crisis is the inappropriate use of antibiotic prescriptions in outpatient settings. Although evidence-based guidelines on appropriate treatment for acute upper respiratory infections (URIs) have been developed, the need for improving provider and patient awareness and knowledge in the urgent care setting is critical.

Purpose: The purpose of the DNP project was to implement antimicrobial stewardship guidelines in the urgent care facility to decrease the misuse of antibiotic prescribing …

Utilizing Multimodal Communication Strategies To Improve Average Risk Women Veteran Patient Participation In Returning Colorectal Fecal Immunochemical Test Kits, Shuntae Hooten

Doctor of Nursing Practice Projects

Background: Cancer is one of the most dreadful diseases present in today’s world. It is responsible for millions of deaths worldwide. The disease is debilitating to one’s physical and emotional well-being. Cancer impacts not only the affected individual but also those close to them. When colorectal cancer is identified early via preventive screenings, it has a greater chance of responding to treatment, therefore, increasing the chances of survival. The fecal immunochemical test (FIT) kit plays a pivotal role in the early detection of colon cancer. Schreuders et al. (2016) revealed that FIT kits have better adherence, usability, and accuracy, citing …

Physician Assistant Global Advancement Through The Use Of Medical Relief Organizations, Kara Crafts Pa-C, Sarah Mistrot Pa-C, Mary Henningsgaard Pa-C, Kaley Morris Pa-C, Tamarrah Oliver Pa-C, Kevin Tran Pa-C, Trevor Crafts Md

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Objectives: The physician assistant (PA) model has been adopted by many nations to alleviate health care disparities. The objective of the project is to understand how medical relief organizations are utilizing physician assistants and contributing to the advancement of the career globally.

Methods: A search was conducted to create a list of all U.S. based medical relief organizations. An 18-question online survey was sent to 493 organizations that met inclusion criteria.

Results: Total response rate of the survey was 56.2%. 75.6% of organizations reported using PAs on their medical relief projects, and PAs were used in clinic/hospital/and operative settings.

Conclusions: …

Progresemos En Comunidad Apoyados En La Colaboración Social, Maria Nieves Avila Avila, Claudia Del Rocío Contreras Rodríguez, Sandra Patricia Carmona Urueña, Sindy Alejandro Cifuentes Guerrero

Ciencias de la Salud

La cartilla educativa Manejo de intoxicacionespor plaguicidas, y primeros auxilios proporcionar información a lostrabajadores agrícolas y sus familias, con el fin degenerar acciones de promoción y prevención quedisminuyan los riesgos de intoxicación por plaguicidasy contribuir a la creación de ambientes saludables.Los plaguicidas ocasionan riesgo para la salud delos agricultores y las personas que manipulan estassustancias, lo que lleva a la población en generala realizar una manipulación incorrecta que puedeocasionar intoxicaciones y la muerte. La mayoríade los casos de intoxicación por plaguicidas sepueden prevenir; esta cartilla brinda informaciónsobre la forma de reducir los riesgos para la saludy acciones prácticas sobre primeros …

Podium Presentation: Racial Inequities And Breastfeeding In A Nicu: A Quality Improvement Project, Emilia C. Garcia

2022 Providence Nurse Research Conference

No abstract provided.

High Reliability Through Charge Nurse Huddles: Improving Communication To Decrease Absenteeism, Audra Ellis Overman

2022 Providence Nurse Research Conference

Abstract:

It is important we show staff we as leaders are listening to their concerns and frustrations. Lack of communication with immediate supervisor is a cause of absenteeism among nurses, and that absenteeism leads to decreased quality of care, disrupted work routines, and increased workload for staff that are present. Communication is a proven tool to help develop teamwork, reduce absenteeism, and manage conflicts. Staff commitment to the workplace can be increased by management working toward a democratic style of supervision with increased open communication to decrease staff absenteeism. Absence of or poor communication creates a negative work environment and …

Optimization Of Transfusion Administration Process: A Quality Improvement Project, Nannette Berg, Jennifer Togioka

2022 Providence Nurse Research Conference

BACKGROUND:

Transfusion of blood products (transfusion) occurs infrequently for most nurses yet is a high-risk procedure for patients. To ensure patient safety, Centers for Medicare and Medicaid Services (CMS) and The Joint Commission (TJC) created regulatory standards for transfusion administration and documentation. To meet regulatory standards, transfusion events require documentation of all six critical steps and nurse leaders must monitor compliance with regulatory transfusion documentation, taking action when rates are suboptimal. Yet, transfusion documentation in the electronic health record (EHR) has been described as fragmented, confusing, and devoid of built-in prompts to facilitate completion. Checklists can organize tasks with multiple …

Employing Strategies To Increase Ebp Competency In Frontline Nurses While Aligning Nursing Skills With Current Evidence: A Quality Improvement Project, Stacey Spradling, Jamie Roney

2022 Providence Nurse Research Conference

Background: Clinical nurses are required to demonstrate expertise for diverse patient conditions while balancing efforts to improve both staff satisfaction and clinical outcomes. Nurse leaders must implement and measure the effectiveness of strategies to empower nurses to maintain clinical competence for themselves and their peers to ensure the highest quality of evidence-based care is delivered at the earliest patient touchpoints reliably and consistently.

Purpose: The purpose of this quality improvement project was to engage direct care nurses as skills “champions” to improve the clinical skills of nurses working in a resource pool in a large urban hospital.

Methods/Approach: Clinical …

Converting Clinical Orientation Materials From Paper To Electronic: A Quality Improvement Project, Megan Bowles, Abby Lust, Teresa Bigand

2022 Providence Nurse Research Conference

Background:

In one region including 4 hospitals, acute care nurses historically met with professional development practitioners (PDP) and received binders containing printed, specialty-specific policies and a competency checklist (required to be signed and returned to the nurse leader) upon new hire or transfer. Creating physical orientation packets is costly, time-consuming, and restricts the ability to share appropriate orientation materials in the event of a PDP sick call. Real-time communication between the orientee, preceptor, PDP, and nurse leader regarding status of the competency checklist cannot occur with a physical binder. Providing electronic onboarding materials is a potential solution.

Purpose:

To …

Assessing The Contribution Of Immigrants To Canada's Nursing And Health Care Support Occupations: A Multi-Scalar Analysis, Rafael Harun, Margaret Walton-Roberts

Social Work and Urban Studies Faculty Research

Background

The World Health Organization adopted the Global Strategy on Human Resources for Health Workforce 2030 in May 2016. It sets specific milestones for improving health workforce planning in member countries, such as developing a health workforce registry by 2020 and ensuring workforce self-sufficiency by halving dependency on foreign-trained health professionals. Canada falls short in achieving these milestones due to the absence of such a registry and a poor understanding of immigrants in the health workforce, particularly nursing and healthcare support occupations. This paper provides a multiscale (Canada, Ontario, and Ontario’s Local Health Integration Networks) overview of immigrant participation in …

Implementation Of Nola Pender’S “Clinical Assessment For Health Promotion Plan” To Increase Patient Self-Efficacy, Weight Loss And Health Promoting Behaviors Such As Improving Nutrition And Increased Physical Activity In Obese Women In A Weight Loss Clinic, Christine Ngwazini

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based practice Doctor of Nursing Practice (DNP) project was to review research-based studies on Nola Pender’s Health Promotion Model for weight loss and implement the evidence. The goal was to increase patient self-efficacy, weight-loss, and health promoting behaviors such as improved nutrition and increased physical activity among obese women in a weight loss clinic.

Background: Obesity leads to an increased risk of heart disease, stroke, type 2 diabetes, cancer, and premature death (CDC, 2020). From 2016 to 2017, 42.4% of people in the United States were obese (2020). Worldwide, over 650 million people were obese …

Skin Response: A Multidisciplinary Approach To Pressure Injury Prevention, Shannon E. Jagger Msn, Rn-Bc, Ne-Bc, Cpps, Deborah A. Saber Ph.D.. Rn, Ccrn-K, Patricia Poirier Ph.D., Rn

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Hospital acquired pressure injuries (HAPIs) are listed as serious reportable events and classified as “never events.” Nevertheless, more than 2.5 million people develop HAPIs in the United States every year with 60,000 dying from associated complications. HAPI rates at the site of this quality improvement initiative were high and required intervention. As a result, the Skin Response (SR) initiative was developed to bring a multidisciplinary team to the bedside within 20 minutes of an identified skin concern. This team consisted of the bedside registered nurse (RN), RN leader, physician, facilitator, nutritionist, and wound RN. Through a team approach, SR assisted …

Improving Quality Of Communication In Pediatric Perioperative Outpatient Setting Using Aidet And Commit To Sit, Hyo Ryung Kim

Master's Projects and Capstones

Abstract

Problem: Effective and therapeutic communication in the health care setting is multidisciplinary,

complex, and has unique challenges for each microsystem. The perioperative setting is an

especially challenging environment for healthcare workers to provide therapeutic

communication, as uniquely high-risk and time-sensitive information must be disseminated in a

language that is understandable for the patient(Osborne-Smith & Kyle Hodgen, 2017). A

microsystem assessment of an outpatient pediatric perioperative setting reflected some of the

challenges the healthcare workers were facing when communicating with their patients and

family members. Upon evaluation of the monthly NRC (National Research Corporation) score

prior to implementation of two …

Counting Every Drop: Preventing Maternal Mortality With Quantifying Blood Loss Through Triton Scale, Summer Le

Master's Projects and Capstones

Postpartum (PP) hemorrhage is one of the leading causes of maternal mortality (AWHONN, 2021). In each of the past three years, the percentage of PP hemorrhage has increased at Hospital X. The PP unit at Hospital X performs around 4,500 total deliveries each year. While the standard of care for PP blood loss is to specifically measure blood in milliliters as Quantifying Blood Loss (QBL) for Labor and Delivery (L&D), it is not yet the standard of care in the 24 hours postpartum after delivery (ACOG, 2019). This quality improvement project involved educating nurses about measuring blood loss – specifically …

Integrating Culturally Tailored Interventions To Increase Cervical Cancer Screening: A Quality Improvement Initiative In A Primary Care Clinic, Marife Centeno Solomon

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: While the incidence of cervical cancer in the US has significantly decreased due to the utilization of vaccination and screening tests, Asian, Native Hawaiian, and other Pacific Islander women consistently have the lowest rate of cervical cancer screening, making them at risk for undetected cervical cancer disease.

Problem: The low cervical cancer screening uptake can be attributed to a knowledge deficit about cervical cancer and its screening and the importance of early detection. Being an immigrant and with limited English proficiency can hinder women of Asian, Native Hawaiian, and other Pacific Islander from getting screened for cervical …

Utilizing Training And Educational Materials To Increase Hand Hygiene Compliance Of Healthcare Providers Participating In Cesarean Sections, Christopher Natividad

Master's Projects and Capstones

Surgical site infections (SSIs) are one of the most common complications of Cesarean section (C-section) procedures. The incidence of SSIs after C-section procedures at Hospital X has increased in each of the past three years. The Labor and Delivery (L&D) unit at Hospital X performs approximately 4,500 C-sections each year. Observation of these procedures illustrated a lack of adhesion to hand hygiene policies and protocols. This quality improvement project involved informing staff members of the poor hand hygiene compliance rates, and re-educating them regarding proper hand hygiene behavior using flyers, emails, and addressing them at shift change. Data collection focused …

Save Lives And Sanitize: Prevention Of Surgical Site Infections Post-Cesarean Section Through Increased Hand Hygiene Compliance, Lindsay N. Nance

Master's Projects and Capstones

Problem: Surgical site infections (SSIs) occur in 3-15% of cesarean sections, making SSIs one of the most common hospital-acquired infections (HAIs). Surgical site infections (SSIs) have increased within a Labor & Delivery (L&D) unit in a large California teaching hospital for the past three years, affecting reimbursement and creating a range of adverse outcomes for patients. Performance of consistent and thorough hand hygiene practices is key to preventing infection, yet the unit’s hand hygiene compliance of 66.7% is well below the facility’s target goal of 90%. Based on recommendations from the organization’s Infection Prevention & Control (IPC) specialist, the …