Health and Medical Administration Commons^™

Evaluating Nurses’ Turnover Intention And Organizational Commitment Following Stroke Unit Staffing Changes: An Evidence-Based Quality Initiative, Heather Tatusko

Doctor of Nursing Practice Scholarly Projects

Nurses are known to be overworked, overwhelmed, undervalued, and understaffed at dangerous levels throughout various inpatient hospital units across the United States (U.S.). Hospital registered nurse (RN) turnover is a significant issue that has accelerated since the COVID-19 pandemic, resulting in economic impacts and other burdens for organizations, individuals, and communities. Evidence suggests that evaluating Registered Nurses’ Turnover intention (NTI) and Organizational Commitment (OC) can help maintain a ready and capable team of skilled RNs; however, most healthcare organizations (HCOs) do not collect or analyze NTI and OC data and focus on staffing numbers and monetary incentives to get adequate …

Implementation Of A Standardized Suicide Screening Process In A University Student Health Clinic: A Quality Improvement Project, Addie Grace Strong, Kathryn Dambrino, R. David Phillippi, Linda Wofford

DNP Scholarly Projects

Background: Suicide is a leading cause of death among college age students, prompting the need for evidence-based screening tools like the Columbia Suicide Severity Rating Scale (C-SSRS) to enable early detection and timely intervention. Inconsistencies in suicide screening may pose a risk of missed intervention opportunities. This Doctor of Nursing Practice project specifically aimed to improve the quality and consistency of suicide screening in a university student health clinic by implementing the C-SSRS tool into the clinic workflow during mental health appointments. Methods: Employing a quality improvement framework, this scholarly project followed the Institute for Healthcare Improvement Model for Improvement …

Non-Clinical Perspectives On Sepsis: A Project For Enhanced Awareness, Anjali Kumari Singh

Master's Projects and Capstones

Problem: This project aimed to enhance non-clinical staff knowledge of sepsis through a targeted awareness campaign, while also seeking to uphold or enhance the organization's sepsis-related performance.

Context: Clinical Nurse Leader students conducted a microsystem assessment in five crucial non-clinical departments of an urban Bay Area hospital, each playing a vital role in the organization's efficiency at different levels.

Intervention: During Sepsis Awareness Month, a sepsis awareness campaign was implemented. This involved a concise presentation on sepsis, its consequences, and the significance of awareness in each department. Additionally, informational fliers detailing sepsis signs and symptoms were distributed.

Measures: A pre-and …

Improving Utilization Of Clinical Pharmacy Services In A Health Professional Shortage Area, Samantha E. Tallman

Culminating Experience Projects

Background: Integration of clinical pharmacy specialists (CPS) into primary care has increased over the last decade. CPS are highly educated advanced practice providers and specialize in chronic disease and medication management, and offer additional support to both patients and PCPs. Despite their extensive training and expertise, the role of CPS is often unknown or misunderstood amongst PCPs and results in the underutilization of CPS services. As a result, referrals to their service remain low. The purpose of this quality improvement project is to increase referrals to embedded CPS and identify encounter types by associated diagnoses.

Objectives: Develop and implement a …

Increasing Colorectal Cancer Screening Uptake Among Hispanic/Latino Patients: A Quality Improvement Initiative, Erick Hernandez Campos, Elizabeth Morse, David Phillippi

DNP Scholarly Projects

Background: In 2021, cancer (CRC) screening rates for Latino men (42%) and women (47.5%) remain well below the Health People 2020 target (70.5%). Extensive documentation of barriers for screening include language, insurance status, and other sociocultural barriers which contribute to delays in diagnosis and/or diagnosis at advanced stages of the disease, and worse health outcomes. Latinos need culturally and linguistically appropriate health promotion interventions aimed to increase CRC screening rates with any modality (FIT, Cologuard, or Colonoscopy).

Methods: The Donabedian Structure-Process-Outcome (S-P-O) Model for quality improvement was used to develop and target a provider-driven, language-concordant communication interventions for …

Improving Patient Access To Gastroenterology Through A Nurse-Practitioner-Led Clinic: A Quality Improvement Project, Kayla Northam

DNP Scholarly Projects

The United States has a critical healthcare access issue for gastroenterology patients. Delays in treatment can lead to expensive complications, including emergency room visits, hospitalization, and surgery. Creating a rapid-access clinic (RAC) for gastroenterology so that patients can obtain a quick and efficient evaluation of their symptoms in a shorter appointment time can help decrease the delay in care and generate more revenue for the hospital. Over 8 weeks in 2023, Dartmouth Hitchcock Medical Center Department of Gastroenterology used a telemedicine-only RAC to see patients for 20 minutes rather than the traditional 60-minute period. As a result, the RAC saw …

Organizational Characteristics As Predictors Of Hospital Accreditation, Rebecca B. Graystone

Walden Dissertations and Doctoral Studies

Abstract Hospital accreditation has had wide and longstanding acceptance as a key quality tool to drive efficient, effective healthcare. Researchers have more recently questioned factors commonly related with accreditation achievement given accreditation’s general association to better patient care, risk management, and cost reduction. Even less information was known about predictors of accreditation failure, which could be addressed by hospital administrators in advance of seeking application. Accordingly, the purpose of this cross-sectional study was to examine if hospital structures and processes were predictors of accreditation failure. The research questions explored hospital size, ownership status, geographic location, hospital leadership, empowerment, practice, and …

Sepsis Inservice And Video At An Urban Hospital In California, Angela T. Ho

Master's Projects and Capstones

The emergency department at an urban hospital in California was performing below institutional goals related to sepsis protocols over the past few months. This intervention was targeted at nurses and was composed of a PowerPoint in-service on compliance to SEP-1 protocols and follow-along video on using the correct sepsis order set and documentation in the electronic health record (EHR). Goals included increased compliance to the SEP-1 protocol and documentation, (2) reduced time between the onset of symptoms, recognition, and intervention, (3) decline in sepsis rates and mortality rates, and (4) lower cost of care. Data was collected from the EHR …

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 …

Bedside Shift Report And Patient Satisfaction, Kasandra R. Johnson

Electronic Theses and Dissertations

Each year, millions of deaths worldwide are caused by medication errors in hospitals. Some of these errors are accounted for through miscommunication during the change of the nurse shift report. One of the Joint Commission’s 2019 national patient safety goals for hospital programs was to improve communication effectiveness among caregivers since mistakes in a caregiver’s communication accounted for 37% of severe patient injuries. Safety is threatened by patients not being included. Therefore, adopting the bedside shift report allows patients to be actively engaged, reinforcing nurse-patient communication. The bedside shift report enables nurses to provide safe, high-quality, patient-centered care at the …

Implementation Of A Standardized Medication Reconciliation Protocol In A Psychiatric Stabilization Setting, Sara Robinson

DNP Scholarly Projects

BACKGROUND: Medication errors are a prevalent patient safety concern across healthcare settings. High-quality medication reconciliation is an intervention and expected standard of care that can help to prevent adverse drug events. This quality improvement project focused on implementing a standardized medication reconciliation protocol on a short-stay psychiatric unit.

INTERVENTION: An evidence-based toolkit supported by the Agency for Healthcare Research and Quality (AHRQ), Medications at Transitions and Clinical Handoffs (MATCH) was selected as the framework for developing and implementing this protocol.

Congruent with the evidence-based toolkit recommendations, baseline data collection and needs assessment provided context for tailoring the intervention to the …

Enhanced Recovery After Surgery: Necessity Of Real Time Tracking In Quality Measures And Outcomes, Emily Owens

Master's Projects and Capstones

Abstract

A High Reliability Organization (HRO), such as this Northern California Medical Center, holds itself to high standards of performance in the areas of recognition, ranking, and accreditation. The commonality between these high-scored and valuable acknowledgements is the pillars of Quality Outcomes. As benchmarking and reporting allow this facility to measure outcomes against self and other plans, it greatly strengthens the internal focus for continual improvement and goal setting in direct patient care and outcomes. A deeper layer of the Quality Department includes the bundle “ERAS – Enhanced Recovery After Surgery”, which is compiled of principles aiming to minimize opioid …

Technology-Based Advance Care Planning Education For Primary Care Patients, Taryn Achong

Doctor of Nursing Practice (DNP) Projects

Background: Advance Care Planning (ACP) encompasses a multidisciplinary, collaborative process that allows patients to understand their health and make informed decisions in their treatment plans. Considering the COVID-19 pandemic and recent research, ACP is considered imperative for all patients. Evidence-based approaches include supplemental group sessions, case manager interventions, and provision of at-home resources. Within the pandemic, there has also been a rapid shift to telemedicine, restricting most ACP efforts. Therefore, the utilization of technology-based ACP resources and telemedicine is highly supported.

Purpose: This DNP project serves to assist an internal medicine practice located in Hawaii’s metropolitan area. Although the …

Reach, Effectiveness, Adoption, And Maintenance Of Mobile Electronic Clinical Decision Support Tools Deployed As Part Of National Quality Improvement Projects, Ellen K. Kerns

Theses & Dissertations

Electronic clinical decision support (ECDS) tools are often developed within quality improvement (QI) projects to increase adherence with the latest clinical practice guidelines. However, the potential reach and maintenance of ECDS use beyond the time and location of their associated project are very limited. Deploying ECDS using a mobile app (mECDS) has shown the potential to be a viable method of overcoming these limitations. However, it is unclear what pattern the reach and adoption of such a tool might follow and what effect this use has on clinical practice. Our team developed an app which contained two different mECDS tools …

Improving Employee Engagement On An Inpatient Unit: A Quality Improvement Project, Holly Mccormack

DNP Scholarly Projects

BACKGROUND: Engaged employees are paramount to the success of an organization. They are more invested in their organization and the unit on which they work. This investment in the organization results in higher patient satisfaction and safety, less staff turnover, and improved quality. According to the literature, generational differences may be necessary to consider when improving employee engagement. To successfully lead a multigenerational workforce, nurse leaders should consider these differences and incorporate them into their strategic plan for employee engagement.

METHODS: A pilot survey was conducted on a medical-surgical unit to assess a perceived lack of engagement. Subsequently, work engagement …

Reducing Turnaround Time From Pathology Collection To Patient Awareness In Gastroenterology Practice, Adrianna Hyams

DNP Scholarly Projects

Background: Means of improving the turnaround time from specimen completion to the patient being notified of results are not well known or researched. The aim of this study is to decrease the turnaround time (TAT) from when the specimen is collected to the time the patient is notified from 4 weeks to 2 weeks. This quality improvement project took place in a privately owned gastroenterology office in southern Indiana.

Methods: An exhaustive literature review was completed to determine the best means of improving pathology TAT. The Plan Do Check Act (PDCA) method of quality improvement was used for this project. …

Comorbidity And Quality Of Life Of Hiv-Positive Adults Living In Supportive Housing, Rose Sharp

Dissertations

Problem: Life expectancy for people living with HIV significantly increased with widespread use of antiretroviral therapy, resulting in population increases in comorbidity prevalence. The increased burden of living with both HIV and comorbidities lowers health-related quality of life (HRQoL).

Methods: Using a descriptive, correlational, cross-sectional design, a convenience sample of HIV-positive adults was selected from seven supportive housing communities. Comorbidities were assessed using a modified Self-Administered Comorbidity Questionnaire, and HRQoL using the Patient-Reported Outcome Measurement Information System Scale v1.2 – Global Health.

Results: A sample of 17 (N = 17) adults reported a mean of 4.2 (SD = …

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 …

A Framework For Learning During An Honors Internship: Embold Health Inc., Haley Haldeman

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Embold Health Inc. is a health care analytics start-up company that identifies top performing providers using large data sets and clinically nuanced measurement. A comprehensive assessment of quality, appropriateness, and cost is what Embold Health delivers. Embold allows payers more control in choosing providers within their region. Being able to identify top provider behaviors through rigorous data driven measurement is significant both clinically and commercially; it provides the opportunity to increase value of care, decrease waste, and drive down cost.

Over the past year as an intern, I’ve had a first-hand look into the complexity that surrounds data driven health …

A Pilot Of Emergency Department-Initiated Buprenorphine For Opioid Withdrawal And Opioid Use Disorder: A Quality Improvement Project, Jason Lucey

DNP Scholarly Projects

Background: Emergency department (ED) visits for opioid related visits have increased dramatically during the opioid epidemic. Buprenorphine is an evidence-based therapy for treating opioid use disorder (OUD) and withdrawal. Unfortunately, lack of access to pharmacotherapy for OUD, including buprenorphine, remains a challenge. Research supports ED-initiated buprenorphine as a practical, cost-effective strategy which engages patients in treatment better than non-pharmacologic alternatives.

Purpose: The aims of this improvement project were to 1) develop a pilot process in an ED for providing buprenorphine to patients in opioid withdrawal or for OUD; 2) recruit and train a cohort of ED staff on the process; …

The Effectiveness Of Interventions And Bundles For Central Line-Associated Bloodstream Infections In The Neonatal Intensive Care Unit, Mohamad Alhamwi

Honors Undergraduate Theses

Introduction: Central Line-Associated Bloodstream Infections (CLABSIs) are a major cause of increased mortality, morbidity and healthcare costs in neonatal intensive care units (NICUs) patients. Despite CDC's efforts to reduce infection rates, patients often suffer consequences. The objective of this study is to perform a systematic review of strategies utilized in the neonatal population and evaluate them with the current CDC's guidelines to assess the effectiveness of bundles in preventing CLABSI in NICUs.

Methods: A systematic literature search was conducted using CINAHL Plus with Text, Cochrane Database of Systematic Reviews and MEDLINE from January 2008 up to 2018. There were multiple …

Increasing Medication Adherence In Hypertensive Patients With Million Hearts® Health Literacy Program, Tammy Ross

Walden Dissertations and Doctoral Studies

Healthy People 2020 identified hypertension (HTN) as a controllable risk factor to prevent cardiovascular disease and stroke. Adhering to regular antihypertensive (AHT) medications improves outcomes in patients diagnosed with HTN by controlling blood pressure, reducing hospital visits, and promoting patient wellness. Medication adherence occurs when prescribed medicine regimens are utilized by the patient as directed to manage illness or disease, as evidenced by patients receiving medications at their pharmacy. The practice-focused question for this quality improvement project asked whether implementation of health literacy tools from Million Hearts® HTN Control: Action Steps for Clinicians, increased medication adherence as evidenced by regular …

The Relationship Between Hospital Leadership Activities And Clinical Quality Outcomes In Iowa, Sarah Pavelka

Walden Dissertations and Doctoral Studies

The Centers for Medicare and Medicaid Services have been working with hospital networks across the United States to improve health care through education and training on clinical best practices and leadership frameworks. Some organizations have failed to reach the high-quality standards of care expected and have adverse patient care outcomes. The purpose of the study was to determine the relationship between leadership actions, funding type, and clinical care outcomes in participating Partners for Patients hospital programs in Iowa. The secondary variable data were provided from a Partnership for Patients contractor, through the Centers for Medicare and Medicaid Services Organizational Assessment …

The Design And Implementation Of A Relationship-Based Care Delivery Model On A Medical- Surgical Unit, Paula Ann Rodney

Walden Dissertations and Doctoral Studies

The Design and Implementation of a Relationship-Based Care Delivery Model on a Medical- Surgical Unit

by

Paula A. Rodney

MSN, California University of Pennsylvania, 2011

BSN, University of Virginia, 1979

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

April 2015

Patient satisfaction and clinical outcomes have become important issues in healthcare since the introduction of the Value Based Purchasing Program. Patient satisfaction, as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, was declining and hospital-acquired pressure ulcers (HAPU), falls, and catheter-associated urinary tract infections (CAUTI) were …

Shared Leadership In Six Sigma Teams From The North Shore-Lij Health System, Brian J. Galli

Engineering Management & Systems Engineering Theses & Dissertations

The main goal of the research was to identify the relationships that the internal research team environment and external coaching variables had with the degree of shared leadership in the context of Six Sigma teams from the North Shore LIJ Health System. Furthermore, the research ascertained the relationships that these variables had with two performance metrics: a team's ability to complete project deliverables and satisfy customer's requirements. This research also sought to understand additional factors that affected the five variables.

The research found that while shared leadership did not positively change as a team progressed through the phases of the …