Nursing Commons^™

Evaluating Controlled Substance Documentation In An Electronic Medical Record, Delora Brooks

Dissertations

The Centers for Disease Control and Prevention (CDC) directives issued in 2016 gave guidelines for safely prescribing opiates; however, primary source discussions about methods used for documenting opioid and controlled substance monitoring within an electronic medical record (EMR) are limited (Hussain, Nelson, Polston & Zheng, 2019). This leaves individual providers to determine the appropriate way to document. Inconsistent documentation may not protect providers or organizations from regulatory, civil or criminal liability. As stated by Raveesh, Nayak & Kumbar (2016), “The best way to handle medico-legal issues is by preventing them”. Even with the advent and widespread use of EMRs, documentation …

Seven Steps To Successful Change: How A Large Academic Medical Center Prepared Patients For Organizational Change, Brian Carlson, Madison Agee, Terrell Smith, Paul Sternberg Jr, Jason Morgan

Patient Experience Journal

Vanderbilt University Medical Center (VUMC) launched a new electronic health record (EHR) in a “big bang” implementation that saw the new software go live across multiple hospitals, clinics and geographic locations in a single morning. The organization rightly focused most of its energy on preparing its nearly 25,000 employees for the impacts of the transition, but it also considered the effects that would be felt by its patients and families. Survey data indicate that patient satisfaction scores demonstrably dip before, during and after an EHR implementation, and take approximately a year to recover. A team at DMC employed a seven-step …

The Implementation Of An Open Source Electronic Medical Record At A Faith-Based Community Clinic, Gabri Warren

Graduate Theses, Dissertations, and Capstones

Faith-based nursing and healthcare is increasingly gaining popularity as the industry looks to minimize costs and improve health outcomes. Historically, qualitative studies have not shown the extent to which individuals and communities are impacted by health initiatives initiated by faith institutions. Healthcare technology can help support the specialty by providing increased quantity and quality data to analyze. Traditional, proprietary EMRs are too costly; however, open source systems offer a low cost, and easily modifiable option to non-profit, or smaller organizations. The data collected by an open source system allows organizations to improve the care that patients receive, and helps guide …

Exploration Of The Experiences And Viewpoints Of Faculty Members On Continuing Education Webinars: A Qualitative Study, Fatemeh Jafarzadeh-Kenarsari, Kobra Abouzari-Gazafroodi, Fatemeh Zaersabet

The Qualitative Report

Continuing education is necessary to improve the professional knowledge and skills of graduates of medical sciences, which may be implemented via e-learning. This qualitative study aimed to explore the experiences and viewpoints of faculty members participating in continuing education webinars. The participants consisted of 15 faculty members selected purposefully and with maximal variation regarding their sex, age, the field of specialization, academic rank, and work experience. Data were collected through semi-structured individual face-to-face interviews. Data analysis of these transcripts using a qualitative content analysis approach revealed 3 themes and 9 sub-themes. The main themes included “Moving across the boundaries of …

Improving Patient Experience And Education By Leveraging Technology, Cathy Palleschi, Wendy Osgood, Mark Parker, Cecilia Inman, Alicia Russell, Eileen Shanahan, Erin Pappal

Operations Transformation

It is estimated that 65% of the population are visual learners. With that in mind, a team of cardiac nurses in a large academic tertiary hospital developed a quality improvement project to hopefully improve patient engagement as well the patients’ perception that the nurses explained things in a manner that they could understand.

Baseline patient survey scores for the question, “Nurses Explained Things In A Way That I Understand”, were under the 75^thpercentile for a period of 9 months. A root cause analysis was conducted and it demonstrated numerous reasons for this score.

Several countermeasures were instituted to …

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

Operations 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 …

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

Operations 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 …

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

Operations 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 …

A Coaching And Team Performance Evaluation Model To Build Capacity For High-Impact Lean Improvement, Ruth Hanselman, Mark Parker, Suneela Nayak, Stephen Tyzik, Amy Sparks

Operations Transformation

There is abundant evidence that links a strong culture of safety with improved patient and staff experience. However, there has been no clear avenue identified as to how to achieve this metric.

A team in a large academic tertiary teaching hospital set about leveraging their daily managing system (DMS) to attain improvement in their institution’s safety. The goals of this quality improvement project were to use DMS to identify and report safety concerns and increase frontline team knowledge and comfort with reporting safety concerns during Gemba walks.

A root cause analysis identified 5 areas for improvement and several countermeasures were …

Depresi Berhubungan Dengan Kualitas Hidup Penderita Kanker Kolorektal Di Rumah Sakit Kota Makassar, Nuridah Nuridah, Ariyanti Saleh, Cahyono Kaelan

Jurnal Keperawatan Indonesia

Depression Related to Life Quality of Colorectal Cancer Patients in Makassar CityHospital. Colorectal cancer is a cancer which incidence increased year by year. This research aimedto analyse factors related to the quality of life of patients’with colorectal cancer. The research applieddescriptivepre-experimental correlations witha cross-sectional study design with a total sample technique of colorectalcancer. A sample of 50 people was obtained from the hospital in the city of Makassar. Data were analyzed using the Pearson and Spearman correlationtest to find outthe relationship, and Chi square test to find out the difference. The results showed that there was a relationship between fatigue …

Improving The Health And Functional Status Of Institutionalized Older Adults Through The Nurse, Caregiver And Older-Adults Partnership Model (Miradasia), Junaiti Sahar, Dwi Nuviyandari Kusuma Wati, Etty Rekawati

Jurnal Keperawatan Indonesia

Health and functional status are standard measurements in older adult’s services that showed physical and mental condition. However, institutionalized older adults with several adjustments and their limited source might cause compromised health and functional status. The quasi-experimental study aimed to investigate the effect of MiRaDaSia (nurses and caregivers joined the partnership model) on health and functional status among institutionalized older adults in Jakarta. It included 106 participants as intervention groups and 106 participants as control groups, who selected by multistage random sampling. We used the SF-12 and Barthel index to measure older-adults health and functional status. MiRaDaSia model was implemented …

Penurunan Kemampuan Kepala Keluarga Dalam Memenuhi Kebutuhan Ekonomi Keluarga: Studi Fenomenologi Pengalaman Orang Dengan Gangguan Jiwa Paska Pasung, Novy Helena Catharina Daulima, Rasmawati Rasmawati, Ice Yulia Wardani

Jurnal Keperawatan Indonesia

Kepala keluarga bertanggungjawab secara ekonomi memenuhi kebutuhan hidup anggota keluarga yang meliputi kebutuhan sandang, pangan dan papan. Seorang kepala keluarga yang mengalami gangguan jiwa selepas dari pemasungan perlu menyesuaikan diri terhadap fungsi sosial yang meliputi kemampuan untuk bekerja dan terlibat dalam hubungan sosial. Tujuan penelitian adalah ini untuk mendeskripsikan pengalaman kepala keluarga paska pasung dalam memenuhi kebutuhan ekonomi keluarga. Pendekatan fenomenologi diterapkan untuk mengekplorasi pengalaman kepala keluarga. Sejumlah enam orang berpartisipasi dalam penelitian ini yang dipilih melalui metode purposive sampling. Pengumpulan data dilakukan dengan wawancara mendalam kemudian dianalisis dengan metode Colaizzi. Tiga tema dihasilkan dalam penelitian ini yaitu harga diri …

The Influence Of Self-Efficacy On The Relationship Between Depression And Hiv-Related Stigma With Art Adherence Among The Youth In Malawi, Eric Umar, Judith A. Levy, Geri Donenberg, Mary Ellen Mackesy-Amiti, Hening Pujasari, Robert C. Bailey

Jurnal Keperawatan Indonesia

Depression and HIV-related stigma, among other factors, have been inversely linked independently with adherence to antiretroviral therapy (ART) among the youth. However, the processes through which the various factors influence this relationship is not fully known. Guided by Social Action Theory, we examined the interactive mechanisms through which depression, HIV-related stigma, and self-efficacy influenced ART adherence and whether or not these relationships are moderated by gender. A total of 450 HIV-positive youth (13–24 years) in Malawi receiving ART participated in this cross-sectional study. Moderated mediation analyses were conducted using Hayes’ PROCESS macro 2.11 in SPSS. ART adherence was measured by …

Determinan Epidemiologi Penyakit Pada Mahasiswa Akademi Keperawatan Pemerintah Kabupaten Garut, Jawa Barat Tahun 2015, Iwan Salahuddin, Theresia Eriyani, Sandra Pebriamti

Jurnal Keperawatan Indonesia

Determinants of Epidemiology of Disease in Nursing Academy Students in Garut, West Java in 2015. The process of adaptation and interaction of students with the new environment can result in physiological balance disorders of the body, thus becoming susceptibleto disease. This cross-sectional study aimed to identify the epidemiological determinants of disease in 2015 Garut District Nursing Academy students. A total of 235 students were involved. Data collected included respondent characteristics, the characteristics of the place of origin of the students, morbidity using a questionnaire about the history of previous illness or morbidity. The results showed that 70.2% of students experienced …

Intervensi Rehabilitasi Jantung Fase I Pada Pasien Yang Menjalani Operasi Bedah Pintas Koroner (Bpk): Literatur Review, Indah Dwi Astuti, M, Rizki Akbar, Aan Nuraeni

Jurnal Keperawatan Indonesia

Cardiac Rehabilitation Phase I in Patient Undergoing Coronary Artery Bypass Grafting Surgery. A patientunder-goingcoronary artery bypass graftingCABGsurgery hasa risk of post operative complication,which can cause prolonged length of stay and even mortality. Thepatient necessarily needs todointervention cardiac rehabilitation phase I to help the recovery process after surgery and prevent post operative complications.The articles related to cardiac rehabilitation have been carried out.However,it is necessary to review research articles about the effectiveand safe intervention of cardiac rehabilitation phase I for patientsundergoing CABGsurgery. The aim of this studywasto explore the effectiveand safe intervention of cardiac rehabilitation phase I. This literature review was conducted …

Penerapan Evidence-Based Nursing Pengaruh Earplug Dan Eye Mask Terhadap Kualitas Tidur Pada Pasien Di Icu, Mutarobin Mutarobin, Elly Nurachmah, Muhammad Adam, Rita Sekarsari, Erwin Erwin

Jurnal Keperawatan Indonesia

Evidence-Based Nursing Application Effect of Earplugs and Eye Mask on Quality Sleep in Patients in ICU. Sleep disorders in ICU are caused by many factors, including environment, noise, lighting, nursing activities, illness, nursing, medication therapy, and mechanical ventilation. The effects will affect the immune function, metabolic system, central nervous system regulation, and psychological conditions. The purpose of this study to apply and prove the effectiveness of the use of Earplug and Eye Mask in improving sleep quality in patients in ICU. The design used randomized controlled trial (RCT) crossover design. The researchers divide Group A and Group B by simple …

Optimizing Clinical Processes Using The Electronic Health Record To Improve Patient Outcomes In Primary Care, Alex Jubril

Doctoral Projects

Background: The EHR has been used to leverage clinical processes for the improvement of patient outcomes. The average users of EHR limit its uses to the minimum level required to complete the daily tasks needed, regardless of the existence of features within the EHR that are readily available to optimize clinical processes for efficiency and effectiveness.

Objectives: The objective of this project was to improve the documentation in a nurse-managed health clinic related to the patient-centered medical home (PCMH) core criteria through enhancing the EHR to foster the quality improvement metrics and reporting.

Methods: This was a quality improvement project …

Using Short Message (Sms) To Deliver Appointment Reminders And Reduce No-Show Rates: An Evidence-Based Practice Project, Fernando Serrano

Doctor of Nursing Practice Final Manuscripts

Background/Objectives: Missed appointments (MAs) are correlated with reduced treatment efficacy, increased financial burden on medical institutions, and early treatment terminations for therapy (DeFife, Conklin, Smith, & Poole, 2010). MAs occur for a variety of reasons including, but not limited to severity of illness, financial/geographic constraints, and forgetting the appointment (Filippidou, Lingwood, & Mirza, 2014). Appointment compliance within outpatient mental health clinics has a wide variance with some clinics reporting MAs ranging from 15% to 50% (Car, Gurol-Urganci, de Jongh, Vodopivec-Jamsek, & Atun, 2013).

With decreasing costs and a subsequent massive increase in mobile phone technology use by the general population, …

Patient’S Utilization Of Health Information Technologies For Disease Self-Management, Mahmoud Hamzeh Altawalbih

Dissertations

Background: The rapid growth of Health Information Technologies (HITs) provides

patients with greater opportunity to take control over their health. HITs utilization has

been proven to be a critical component of disease self-management and can result in

positive outcomes. Its widespread adoption and utilization is still relatively low among

patients with chronic disease. It is important to understand the factors that may impact

HITs utilization, such as the perceived Task-Technology Fit (TTF). A very limited

number of studies have examined the relationship between HITs utilization and the

perceived fit between task and technology in the context of TTF theory.

Aims/ …

The Use Of Clinical Decision Support To Improve Nursing Practice, Kathleen Klimpel

Dissertations

Healthcare information technology is solidly entrenched in most acute care hospitals but the need to demonstrate its positive impact on patient outcomes persists. Clinical decision support (CDS) is an informatics tool that is highly customizable to promote patient improvement activities. Despite its high potential, studies have had mixed results regarding the impact of CDS and it has not been widely studied in the realm of nursing practice. One aim of this dissertation was to analyze the concept of CDS in order to inform the examination of the relationships between CDS implementation and nursing interventions. The determining factors of nurses use …

Perceptions Of Adult Patients Accessing Telehealth In An Urban Medical Group, Katharine Shepherd West

Doctoral Projects

Problem: Although implementation of in-patient electronic healthcare records is nearly complete in the United States, this achievement has not translated into consumer-to-business telehealth in the primary care setting. Because there are few studies that describe how and why patients select telehealth, the aim of this study was to learn about perceptions of adult patients in an urban setting when telehealth options are available. Research questions included a) How do patients select any type of appointment? b) How do patients perceive and use telehealth options? c) How and when might telehealth be useful in the future?

Methods: A qualitative study design …

Using Technology-Driven Patient Communication Appointment Reminders To Improve Uniform Data System Measures In A Federally Qualified Health Center, Ana Torres

Doctoral Projects

Background: Process of meeting Uniform Data System (UDS) measures in a west Michigan Federally Qualified Health Center (FQHC) has several components with different team members sharing responsibility in the process and workflow to document preventative screenings. An evidence-based technology-enhanced patient communication intervention was developed to meet benchmarks for the FQHCs UDS reporting metrics. The purpose of this quality improvement project was to answer the clinical question: Will technology-enhanced communication appointment reminders using automated telephone communication increase rates of screening follow-up visits to improve data reported to UDS at a west Michigan FQHC organization?

Objectives: Increase percentage of screening visits after …

Program Perencanaan Pulang Dapat Meningkatkan Pengetahuan Dan Keterampilan Ibu Yang Melahirkan Bayi Prematur Merawat Bayinya, Erna Julianti, Yeni Rustina, Defi Efendi

Jurnal Keperawatan Indonesia

Discharge Planning Improving Knowledge and Skill Mother Who Birth Premature to Take Care Baby. Premature babies have a greater risk for health problems. Therefore, they need an intensive care since they are in the hospital until they go home. The purpose of this research was to find out the influence of education program for the knowledge and skills of the mothers on caring for their premature babies during discharge planning. This research was a quasi-experimental study with pre and post-test design without control groups. The sample of this research was 35 mothers who gave birth to premature babies and their …

Prediktor Kegagalan Menyusui Ekslusif: Studi Di Puskesmas Buaran Kabupaten Pekalongan Jawa Tengah Indonesia, Isyti'aroh Isyti'aroh, Siti Rofiqoh, Nurul Aktifah

Jurnal Keperawatan Indonesia

Predictors for Exclusive Breastfeeding Failure: Study at Buaran Community Health Center Pekalongan Regency, Central Java, Indonesia. The failure of exclusive breastfeeding (EBF) is still a phenomenon in the community. In 2015 Pekalongan Regency had exclusive breastfeeding coverage of 30.3%. It indicates that most mothers failed to give exclusive breastfeeding. This study aimed to determine the factors that related to exclusive breastfeeding (EBF)failure. This descriptive cross sectional study was carried out among 151 mother in the Buaran Health Centre Pekalongan Regency, selected using cluster random sampling method. The research instrument was questionnaires from the research of Isyti'aroh, Setyowati and Afifah (2013). …

Hubungan Tingkat Pengetahuan Dan Diabetes Self-Management Dengan Tingkat Stres Pasien Diabetes Melitus Yang Menjalani Diet, Kusnanto Kusnanto, Putri Mei Sundari, Candra Panji Asmoro, Hidayat Arifin

Jurnal Keperawatan Indonesia

The correlation between knowledge level and diabetes self-management towards stress level of patients DM with diet. Knowledge is very important in developing diabetes self-management to prevent the risk of long-term complications with a strict diet. The purpose of this study was to determine the relationship between knowledge and diabetes self-management with stress levels of people with diabetes mellitus who went on a diet. This study uses a cross-sectional design. The total samples obtained were106 respondents with multistage sampling, inclusion criteria included patients with DM years, did not use insulin injection, DM patients were still married and lived with their families. …

Kepuasan Pasien Terhadap Penerapan Keselamatan Pasien Di Rumah Sakit, Widiasari Widiasari, Hanny Handiyani, Enie Novieastari

Jurnal Keperawatan Indonesia

Patient Satisfaction Against Patient Safety Application at Hospital. The level of patient satisfaction with nursing services in Indonesia is mostly unsatisfied. The cause of patient dissatisfaction is due to misidentification, miscommunication, medication errors, and inappropriate risk management of falls. This study aimed to identify the relationship between the application of patient safety and patient satisfaction at Hospital X. The study design used a cross-sectional approach by distributing questionnaires to 143 patients. Sampling using cluster random sampling by determining the number of samples that meet the inclusion criteria, then given a questionnaire until the number of samples is met, and conduct …

An Insight Into Maternal Death Caused By Postpartum Hemorrhage In Western Timor, Indonesia, Kristiani Desmina Tauho, Ferry Fredy Karwur

Jurnal Keperawatan Indonesia

Maternal deaths in Timor Island, East Nusa Tenggara Province, are one of the contributors to the overall maternal mortality rate (MMR) of Indonesia. The MMR of Western Timor Island was150/100,000 live births in 2015. The aim of this qualitative study was to explore the perceived causes of maternal death due to postpartum hemorrhage. Data were obtained from family members, traditional birth attendants, and Posyandu cadres, as well as health providers. Using the retrospective method, this study traced six out of nine postpartum hemorrhage cases in the four sub districts with the highest maternal deathrate in 2010. The research findings showed …

Dampak Frekuensi Pernapasan Predialisis Terhadap Kram Otot Intradialisis Di Rsud Panembahan Senopati Bantul, Cornelia D Y Nakeda, Mohamad Judha

Jurnal Keperawatan Indonesia

Effect of Predialysis Respiration Rate on Intradialysis Muscle Cramps at Regional Hospital Panembahan Senopati Bantul. Hemodialysis process often causes painful impact such as muscle cramps during intradialysis. The objective of this research was to identify the increased between respiratory rate and intradialysis muscle cramps. The method of this research was analytical survey method. This research is descriptif quantitative with cross sectional design. This research conducted in hemodialysis unit in Panembahan Senopati General Hospital in Bantul. The subjects of the research taken using accidental sampling. The total research subjects were 91 respondents. The researchers measured the relationship between predialysis respiratory rate …

Distraction Techniques: Telling Stories To Decrease Pain For Preschool Children During Infusion, Lina Dewi Anggraeni, Widiyanti Widiyanti

Jurnal Keperawatan Indonesia

Hospital procedures, such as infusions, are often associated with pain. Preschool-aged children who are hospitalized for infusions will often exhibit a strong fearful response because their concept of body integrity has not fully developed. One way to reduce the fear of infusion pain is by using stories as a distraction technique. The purpose of this study was to identify differences in the scale of pain between members of an intervention group, to which the distraction technique was applied, and a control group, to which it was not applied. The study used quasi-experimental methods, with intervention and control groups. The study …

Latihan Pernapasan Diafragma Meningkatkan Arus Puncak Ekspirasi (Ape) Dan Menurunkan Frekuensi Kekambuhan Pasien Asma, Dian Kartikasari, Ikhlas Muhammad Jenie, Yanuar Primanda

Jurnal Keperawatan Indonesia

Effect of Diaphragmatic Breathing Exercises on Peak Expiratory Flow Rate(PEFR) Enhancement and The Mild-Moderate Asthma Patients’ Relapse Frequency Reduction. One of the management of asthma is diaphragmatic breathing exercises that could improve lung function of asthma patients. The objective of the study was to examine the effect of diaphragmatic breathing exercises on Peak Expiratory Flow Rate (PEFR) and decreased frequency of mild-moderate asthma relapse on the patients. True experiment method pretest-posttest with control group was applied in this study with involved 28 random research subject. Subjects were divided into intervention groups and control groups through randomization of 14 people for …