Nursing Commons^™

A Provider-Driven Approach To Preventative Oral Care In Nursing Home Facilities, Molly Anderson, Brandon Mccrossin, Kary Franchetti, Ruth Hanselman, Suneela Nayak, Stephen Tyzik, Amy Sparks

Operations Transformation

Oral care is an essential part of preventative medicine as it minimizes risk for pneumonias and other infections. In nursing home settings, often oral health care is not routinely provided due to a number of issues. A health care system that either owns or contracts nursing home facilities initiated a performance improvement plan to address this patient care concern.

The first goal of this project was to reduce the variation in oral care between nursing home facilities within the system. The second goal was 100% of their patients will have one oral health care exam documented in EPIC once a …

Optimizing Intraprofessional Communication At Patient Handover, Allison Crabtree

Doctor of Nursing Practice Projects

This performance improvement project aimed to increase the communication competency of nurses during intraprofessional interactions at patient handover. An educational program focused on optimizing communication among nurses was implemented in a community-based, not-for-profit, rural hospital. The course was designed to incorporate a variety of instructional strategies to meet learner needs. Consistency and standardization of the patient handover process was a central theme. Topics of the course focused on the use of a standardized communication tool, the relationship of communication on patient safety, the importance of clear and effective communication, the role of the nurse as gatekeeper and facilitator of patient-specific …

An Examination Of Student Performance In Pre-Requisite Coursework And Upper Division Nursing Coursework, Jennifer L. Brown, Cheryl M. Smith

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Admission and retention of qualified nursing students are essential in meeting the demands of a rapidly changing health care environment and nursing shortage. The purpose of this exploratory correlational study was to determine the relationship between student performance in quantitative pre-requisite coursework and student performance in upper division nursing coursework in order to identify students at-risk for attrition. A series of descriptive and correlational analyses were conducted using pre-existing institutional data. A moderate relationship existed among the chemistry II and first-year upper division nursing courses (r = .21 to r = .40). These results suggest that prerequisite chemistry course …

Just Culture: It's More Than Policy, Linda Ann Paradiso, Nancy Sweeney

Publications and Research

Any healthcare organization’s top priority is effective and safe care. Despite this, medical error is the third-leading cause of death in the US. Hospitals are imperfect systems where nurses have competing demands and are forced to improvise and develop workarounds. Errors rarely occur in a vacuum, rather they’re a sequence of events with multiple opportunities for correction. Clinical nurses can have a significant impact on reducing errors due to their proximity to patients. When errors are identified, the events and impact on safe care need to be shared. Just culture is a safe haven that supports reporting. In a just …

Use Of Best Practice Alerts To Improve Adherence To Evidence-Based Screening In Pediatric Diabetes Care, Daniel Desalvo, Sara K. Bartz, Blair Mockler, Rona Y. Sonabend

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Background: Youth with type 1 diabetes (T1D) are at increased risk for comorbid autoimmune conditions and long-term complications. To help with early identification of these complications, the American Diabetes Association (ADA) has published evidence-based screening guidelines. The aim of our quality improvement intervention was to improve and sustain adherence to the ADA recommended screening guidelines to >90% for youth with T1D in the Texas Children’s Hospital (TCH) Diabetes Center by utilizing best practice alerts (BPA) within the electronic medical record (EMR).

Methods: In accordance with the ADA Standards of Care screening guidelines for youth with T1D, we analyzed the database …

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/ …

Implementation Of A Critical Incident Stress Management Program For Nurse Anesthetists., Peter C. Slivinski, Joanne V. Hickey

Journal of Nursing & Interprofessional Leadership in Quality & Safety

BACKGROUND: Healthcare is a stressful profession where in addition to routine stressors, there are critical incident (CI) events which are occurrences capable of overwhelming an individual’s normal coping mechanisms. The purpose of this quality improvement project was to improve the process by which certified registered nurse anesthetists (CRNAs) exposed to critical incident events are provided post-critical incident support thus mitigating the potential for CI stress

METHODS: We created a CI stress management pilot program for nurse anesthetists employed by an academic hospital located in the Southeastern United States. The program was based upon concepts introduced by Medically Induced Trauma Support …

What You Need To Know About Bar-Code Medication Administration, Marie E. Mcbee Dnp, Msn, Martha Kuhlmann Dnp, Msn, Rn, Fnp, Pmhcns-Bc, Aprn, Pam Patterson Dnp, Msn, Ne-Bc

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Medication errors are the most common type of preventable error. Bar-code medication administration (BCMA) technology was designed to reduce medication administration errors. Poor system design, implementation and workarounds remain a cause of errors. This paper reviews the literature on BCMA, identifies a gap in the findings and identifies three evidence based practices that could be used to improve system implementation and reduce error. The literature review identified that Bar-code medication administration and system workarounds are well documented and affect patient safety. Based on the critical analysis of 10 studies, we identified gaps in the standardization of BCMA planning, implementation, and …

Peripheral Intravenous Infiltrates: Engaging Staff To Increase Reporting, Emily Weber, Kimberly Castrillon, Joyce Ramsey-Coleman

Journal of Nursing & Interprofessional Leadership in Quality & Safety

A large free standing children’s academic hospital aimed to improve patient safety and outcomes by decreasing the overall severity of peripheral intravenous infiltration and extravasations (PIVIEs). A care bundle was developed by creating a PIVIE measurement tool within the electronic medical record (EMR) and integrating the tool into standardized daily practice for nurses. The care bundle included creating a team of clinical leaders consisting of empowered bedside nurses acting as mobilized resources embedded into each unit. The initiative resulted in a large scale increase in reported PIVIEs system-wide within 1 month of education dissemination to bedside RN staff. The QI …

Improving Nurse Anesthetist Intraoperative Handoff Process By Developing And Implementing An Evidence-Based, Facility-Specific Cognitive Aid, Jason Silva, Myron Arnaud

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Miscommunication or non-transfer of pertinent patient information during intraoperative handoffs between anesthesia providers creates patient safety risks. An evidence-based facility-specific cognitive aid was developed and introduced to nurse anesthetists in an anesthesiology department of a large academic hospital with the aim of improving the intraoperative patient handoff process. The program used a handoff cognitive aid that addressed five pertinent patient information points. A secondary measure was evaluation of provider satisfaction. Twenty-four nurse anesthetists utilized the handoff cognitive aid during handoffs in the course of a 4-week pilot program. Eighty-eight nurse anesthetist handoffs were observed (23 with and 65 without the …

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 …

Leadership Development In Nursing: Planning From The Bedside To The Executive Suite, Janet C. Wright

UNLV Theses, Dissertations, Professional Papers, and Capstones

Nurses comprise the largest portion of the healthcare sector workforce over 4 million professional nurses licensed in the United States (National Council of State Boards of Nursing, 2019). Leading within a vast workforce such as nursing requires the nurse leader to have the expertise of the nursing profession along with leadership and business skills to maintain competitiveness in the complex healthcare industry. Consequences of effective leadership include improved patient outcomes, decreased staff turnover, and decreased costs to the organization related to patient outcomes and turnover costs. These results suggest the importance for organizations to ensure their leaders are properly trained …

Evidence-Based Practice Guide And Workflows: Improving Hospital Throughput And Reducing Emergency Department Overcrowding, Maulah Halley

UNLV Theses, Dissertations, Professional Papers, and Capstones

Hospitals in the United States are experiencing disruptions to patient throughput. These disruptions create barriers to patients who seek emergent care in the Emergency Department (ED) and who must be moved to hospital inpatient beds after the decision to admit has been made. As a result, patients requiring hospital admission via the ED may have long wait times, which, in turn, contribute to ED crowding and overcrowding. The root causes of ED overcrowding are inefficiencies within the system and the inability of hospitals to meet demand. Although bed capacity on any given unit may not be altered, ED patient’s arrival …

Professional Experience At Ohio Council For Home Care & Hospice, Emma T. Hill

Masters Theses/Capstone Projects

No abstract provided.

Patient Perception Of Telephone Follow-Up After Resection For Colorectal Cancer: Is It Time For An Alternative To The Out-Patient Clinic?, Marcus Gilmartin, Nicholas Leaver, George Hall, Helena Fawdry, Seung Lee, James Nicholson, Ramya Kalaiselvan, Raj Rajaganeshan

Patient Experience Journal

The economic reality of modern healthcare provides a timely reminder to clinicians of their duty to provide outstanding and cost-effective care. Although multiple guidelines outline investigation, management and surveillance of colorectal cancer, none advocate a particular delivery method. Nurse-led telephone follow-up in multiple specialties has demonstrated equivalent clinical outcomes and patient satisfaction when compared to traditional outpatient department follow-up. This paper aims to compare nurse-led telephone and outpatient follow-up, following surgical resection of colorectal cancer (CRC), focusing on patient perceptions. This cross-sectional study distributed adapted patient satisfaction questionnaire (PS-Q 18) to patients undergoing surveillance following CRC resection via either nurse-led …

Sustainability In Quality Improvement And Patient Safety Initiatives, Angelo P. Giardino, Eileen R. Giardino

Journal of Nursing & Interprofessional Leadership in Quality & Safety

The question often asked of a quality improvement initiative is whether the improvement process has been sustained within the organization. Rarely is the question answered satisfactorily. The sustainability of an improvement process is important as it justifies the investment of human and financial capital. The term 'evaporation of improvements' addresses the dilemma that between 33% to 70% of all innovations are reportedly not sustained (Fleiszer, Semenic, Ritchie, Richer, & Denis, 2015) . This evaporation of improvement captures the frustrating inability of many institutions to maintain the achieved improvement after the newness of the initial effort wears off (Buchanan, Fitzgerald, & …

Improving Nursing Staffing Methodology And Nursing Sensitive Outcomes With The Addition Of A Patient Centered Acuity Measure, Douglas C. Howard Rn, Ms, Ne-Bc

Doctor of Nursing Practice Projects

Background: Assigning the correct nursing resources to hospitalized patients positively impacts patient outcomes. The current process for matching nurses to patients is highly variable and involves a combination of simple ratios, historical workload data, and expert opinion but lacks objective measurement of the patient’s condition.

Objectives: This project evaluated change in selected quality indicators and the daily unit-level management of nursing resources after implementing the Troubled Outcome Risk (TOR) into existing nursing staffing methodology in a Department of Veterans Affairs hospital.

Methods: TOR provides objective measurement of individual patient allostatic load. Daily calculation of TOR scores for each patient on …

An Integrated Model Of Palliative Care In The Emergency Department To Improve Referrals, Jennifer L. Schlatter

Doctoral Projects

Introduction: The emergency department plays a critical role in the trajectory of in-hospital patient care. The Center to Advance Palliative Care (CAPC) along with the American College of Emergency Physicians (AECP) recommend early referral to palliative care for patients with life limiting illnesses that present to the emergency department. Research demonstrates that early palliative care consultations result in patient directed goals of care, improved symptom management, decreased length of stay, and reduced direct costs for inpatient hospitalizations.

Objectives: The goal of this project was to implement evidence-based recommendations for early palliative care referrals in an adult emergency department to improve …

Improving Patient Handover From The Pediatric Emergency Department To The Pediatric Intensive Care Unit, Kathryn Devinney

Doctoral Projects

Patient safety can be at risk during registered nurse handover, particularly when transitioning between high risk areas. According to The Joint Commission (2017), a standardized transition process should be implemented during patient handover. The purpose of this paper was to evaluate the effect of a standardized process with a cognitive aid on handover between a pediatric emergency department and an intensive care unit. Objectives of the project were to decrease conversion time in the emergency department, increase standardized process utilization, and improve patient outcomes, registered nurse perception and satisfaction, and patient proxy satisfaction. This evidence-based quality improvement project took place …

Improving Heart Failure Care Plan Coordination Across The Health Care Continuum, Amy Veltkamp

Doctoral Projects

Heart failure costs the United States 31 billion dollars each year, with much of those costs attributed to hospital admissions. Coordinating care across the health care continuum is a critical factor in improving heart failure care and reducing readmissions. An organizational assessment was conducted using the Burke and Litwin Causal Model of Organizational Performance and Change. The quality improvement project implemented a longitudinal plan of care (LPOC) across 10 hospitals and numerous ambulatory care sites at a large Midwestern health organization. Nurse care managers (NCMs) were the focus of this project due to their high-level of involvement in care coordination. …

Organizational Wellness Programs As Internal Social Marketing: A Literature Review Of Feasible Approaches, Faith Bontrager Rn, Bsn, Kimball P. Marshall Ph.D.

Atlantic Marketing Association Proceedings

No abstract provided.

Does Work-Induced Fatigue Accumulate Across Three Compressed 12 Hour Shifts In Hospital Nurses And Aides?, Brennan J. Thompson

Kinesiology and Health Science Faculty Publications

Fatigue-related impairments in the nursing workforce contribute to a multitude of health, safety, and economic consequences at the individual, organizational and societal levels. Long and compressed work schedules are commonly worked in the healthcare industry, but more research is needed to understand the cumulative effects of multiple work shifts on physiology-based performance outcomes in nurses. The purpose of this study was to compare the effects of a single nursing work shift versus three compressed (one every 24 hours) 12 hour shifts on performance-based fatigue in nurses and aides. Twenty-six fulltime hospital working nurses and aides (age = 36.1 ± 13.3 …

Director Of Nursing Role Conflict And Ambiguity, Commitment, And Intent To Stay, Amy Elizabeth Thiesse

Walden Dissertations and Doctoral Studies

High rates of turnover and the limited tenure of directors of nursing (DONs) in long-term care creates instability in the nursing workforce and the quality of care provided. Organizations, industry, and stakeholders have made little progress to change this turnover crisis. The purpose of this quantitative study, guided by organizational role and social exchange theories, was to determine if there was a difference in levels of affective organizational commitment and intent to stay mediated by leader-member exchange in long-term care DONs with different levels of role conflict and role ambiguity. The key variables were measured with the Role Questionnaire, Leader-Member …

Reducing 30-Day Readmission Rates In Chronic Obstructive Pulmonary Disease Patients, Stacey Jerrick Machado

Walden Dissertations and Doctoral Studies

Early avoidable 30-day post discharge readmission among patients diagnosed with chronic obstructive pulmonary disease (COPD) is associated with poor transition care processes. The purpose of this project was to analyze organizational system processes for admission and discharge transition care of patients diagnosed with COPD to identify key intervention strategies that could decrease the rate of 30-day post-discharge readmission by 1%. The project used the transitional care model as the framework to target specific care transition needs and create patient-centered, supportive, evidence-based relationships among the patient, the providers, the community, and the health care system to identify key intervention strategies for …

The Impact On Cost, Quality, And Patient Satisfaction When Delivering Care To Acutely Ill Adults In An At-Home Care Model Versus An Inpatient Hospital Setting., Franchesca M. Adams

Honors Theses and Capstones

The impact on cost, quality, and patient satisfaction when delivering care to acutely ill adults in an at-home care model versus an inpatient hospital setting. Hospital level care for certain acute conditions can be safely delivered in the patient’s home while lowering the cost per episode of care, maintaining or improving patient experience, and improving safety and patient/care giver education as well as care coordination, at the Critical Access Hospital (CAH) level.

Graduate Bulletin: 2019-2020, Minnesota State University Moorhead

Graduate Bulletins (Catalogs)

No abstract provided.

Evaluation Of Emergency Department Use By Adult Patients With Established Primary Care Provider, Sherry Tolentino

DNP Projects

BACKGROUND: Overutilization of the Emergency Department (ED) contributes to the unnecessary use of healthcare resources. One common cause is related to barriers to Primary Care access. Patients use the ED for conditions that can be managed in primary care due to the perception of urgency and convenience.

PURPOSE: The purpose of this project was to evaluate factors contributing to the use of the ED for adult patients with primary care providers (PCP). METHODS: A retrospective chart review was completed on 280 randomly selected patients over the age of 18 who presented to the ED between January and June 2018. Only …

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; …

Acuity-Based Nurse Staffing And The Impact On Patient Outcomes, Sara Kollman

Walden Dissertations and Doctoral Studies

The costs of healthcare in the United States are of national concern. The systematic review of the literature (SRL) explored the practice-focused nursing question regarding the relationship between the use of acuity-based staffing (ABS) models and positive patient outcomes. Analyzing the impact of ABS models on patient quality outcomes and the potential economic value could provide evidence essential for the healthcare executives responsible for fiscally prudent labor management and for creating an evidence-based business case for adequate, patient-centric nurse staffing. The synergy model for patient care and Covell's nursing intellectual capital theory guided the doctoral project. The Preferred Reporting Items …

Impact Of Smoking Cessation Education On Workplace Wellness, Monica Coles

Walden Dissertations and Doctoral Studies

Guidelines and laws prohibit smoking in public places, and evidence supports the safety and effectiveness of workplace wellness programs in promoting healthy environments. A long-term care (LTC) facility selected as the focus for this project does not offer wellness programs and does not restrict on-site smoking by employees. The purpose of this project was to construct an evidence-based smoking cessation education program for delivery to employees at the LTC facility. The practice-focused question addressed whether a workplace wellness smoking cessation education program would increase employees' knowledge of the harmful effects of smoking and promote engagement in smoking cessation strategies. A …