Nursing Commons^™

The Reality For Minorities Exploring Nurse Executive Leadership Roles: An Integrated Review, Trarina Harris

DNP Qualifying Manuscripts

While nurses in direct patient care are serving a growing minority population, nurse executives are not racially representative of the patient population. This integrated review sought to understand the benefits of formal mentorship. Results included 2 themes: increasing diversity and self-efficacy through formal mentorship. The themes are explored in the literature. Implications for organizations and leaders will be discussed.

Using Simulation For Oncology Nursing Competency Evaluation In Hospitals, Dana N. Littlepage

Doctor of Nursing Practice (DNP) Projects

Problem: Hospitals in an integrated health system, are experiencing low levels of oncologic admissions to their medical surgical units. This is creating a challenge for the organization to maintain nursing competencies for this subset of patients.

Context: In low volume, high risk acute care environments, where chemotherapy is to be provided, seasoned registered nurses grapple with maintaining their competencies, professional confidence and feeling safe enough to administer, monitor and care for this patient population (Muehlbauer, Parr, & Perkins, 2013). The purpose of this project was to ensure that both new and seasoned acute care oncology nurses have access …

The Use Of Life-Like Robotic Animals In The Acute Care Setting To Assist In The Care Of Patients With Dementia, Abby Denby

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

The purpose of this pilot project was to describe the effect of life-like robotic animals on the nurses’ ability to provide care, patients’ level of agitation, use of antipsychotic medications, restraint and sitter use for patients with dementia in an acute care setting. Nurses report challenges and feelings of helplessness while caring for patients with dementia. Dementia may cause depression, agitation, aggression (physical or verbal) and a decrease quality of life. Animal Assisted Therapy (ATT) is a growing therapy in many healthcare settings but there is a lack of literature specifically related to the use of AAT in the acute …

A Program Evaluation Of Violence Prevention Task Force To Address Type Ii Workplace Violence Utilizing Precede/Proceed Model, Stephanie Autry

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Aim: The primary aim of this project was to complete a program evaluation of the institution’s Violence Prevention Task Force. Evaluation allowed for assessment of outcomes including 1). decrease in assaultive incidents; 2). decrease in assaults leading to injury; 3). increase in team member reporting of assaultive incidents; and 4). demonstrate the program’s adherence to published guidelines on workplace violence prevention.

Background: Violence against healthcare workers has been an increasing problem in our nation’s healthcare system. Type II workplace violence is defined as patient, family member, or visitor as the perpetrator directing violent/aggressive behavior towards healthcare worker and is described …

Assessing Healthcare Leader Competency Proficiency Levels In Evaluating Graduate Healthcare Leadership Student Competency Proficiency Levels And Curriculum, Brandi A. Sillerud, Heather C. Winkler

The Interactive Journal of Global Leadership and Learning

Healthcare leaders must possess specific competencies to perform their job requirements by identifying what competencies may need development and take steps to further their education, knowledge, and proficiency. This exploratory research aims to utilize industry data when evaluating student competency proficiency and how that data might impact curriculum development. The research question that is addressed: At what competency proficiency level do working healthcare leaders rate themselves utilizing Benner’s Novice to Expert Theory (1982)? Graduate programs should evaluate current industry data to evaluate how students’ progress in their programs and determine if curriculum changes are needed. Graduate programs should …

A Compelling Case For Evidence-Based Practice Mentor Development Programs: An Integrative Review, Stacy Alves

DNP Qualifying Manuscripts

Background: In 2008, The Institute of Medicine (IOM) set a goal that by 2020, 90% of healthcare decisions would originate from the best evidence available. This goal remains intangible for many organizations. Despite reporting quality and safety as a top organizational priority, a survey of 276 Chief Nurse Executives (CNEs) found that only roughly 50% of the CNEs said that EBP was practiced in their hospitals only “somewhat” or “not at all” (Melnyk, Gallagher‐Ford, Thomas, Troseth, Wyngarden, Kzalacha, 2016). Many organizations struggle to systematically integrate EBP into practice (Melnyk et al., 2018; Warren et al., 2016a). The Advancing Research and …

Improving Clinical Communication And Collaboration Through Technology, Michelle Machon

Doctor of Nursing Practice (DNP) Projects

Problem: Over the last 30 years, clinical communication methodologies in healthcare have evolved to become such disparate systems that they lead to confusion, wasted time, and clinician dissatisfaction. The Joint Commission (2016) reports up to 78% of sentinel events in hospitals are linked to communication failures, which have obvious implications for hospital systems in the quality and safety of their current communication systems.

Context: The purpose of this project was to determine the effectiveness of implementing a unified clinical communication technology platform in an acute care hospital setting and to make recommendations from that implementation to the organization’s larger health …

#Leadershipaccelerated: A Coach Mindset Focused Leadership Development Program, Diane Rindlisbacher

Doctor of Nursing Practice (DNP) Projects

Problem: Developing leaders to lead in environments that are dynamic, complex, and ambiguous is an area of focus for healthcare leaders. How leaders lead and how organizations develop leaders is tied to the outcomes they achieve (Development Dimensions International [DDI], 2019; Moldoveanu & Narayandas, 2019; Till, Dutta, & McKimm, 2016). To create a climate of trust and safety where teams succeed requires leaders to embed key attributes and competencies into their day-to-day work.

Context: A leader’s ability to create a climate of trust and safety and to adopt and apply a coach mindset to their work is intended to help …

A Performance Improvement Nursing Fellowship To Enhance Timely Access To Care, Cheryl Reinking

Doctor of Nursing Practice (DNP) Projects

This scholarly report describes a Doctorate of Nursing Practice (DNP) project that advanced the performance improvement (PI) knowledge of frontline nurses to improve timely access to acute care during a 6-month PI/Lean management nursing fellowship. Patient flow issues delay access to care and result in negative patient quality outcomes and safety failures. Patient experience, confidence, and satisfaction in healthcare organizations erode when timeliness and efficiency are deficient. The project site is a 443-bed, two-campus, not for profit community hospital in Northern California. This project included the implementation of a PI/Lean nursing fellowship program as an evidence-based intervention to address patient …

Creating A Thriving Informatics Culture, Nicholas Webb

Doctor of Nursing Practice (DNP) Projects

Nurses thrive best when they are empowered to make decisions that can positively impact healthcare delivery. Knowledge and application of nursing informatics principles can influence clinical, quality, operational, and financial outcomes in ways that were not available in previous professional nursing generations.

If nursing informatics is the solution, what is the problem? A survey regarding use and attitudes about nursing informatics was taken of chief nurse executives (CNEs) at an integrated, not for profit healthcare system in the Northern California region, where the author oversees the electronic health record (EHR). The results were surprising. Half said they did not know …

Transformational Leadership For Frontline Leaders, Marta L. Hudson

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem. Transformational leadership (TL) represents the gold standard of leadership styles in contemporary healthcare organizations. The transformational leader's ability to motivate, influence, stimulate, inspire, and attend to followers' individual needs is an antecedent to job satisfaction, quality, and patient safety. The project aimed to improve TL constructs among frontline leaders (managers and assistant nurse managers). Based on the results of a needs assessment, these frontline leaders were provided an opportunity to improve their TL style.

Context. Leadership development is a strategic priority for a medium-sized medical center in a healthcare system in Northern California. Frontline leaders within patient care …

From Team Huddle To Team Cuddle: Rekindling Caring, Self-Compassion, And Joy In Work!, Amerizza Quemada

Master's Projects and Capstones

Problem: The healthcare industry suffers from a high level of burnout and unhealthy work environments, which has been heightened by the COVID-19 pandemic. The consequences of burnout may be expressed in both individuals and teams as a lack of caring, disengagement, incivility, and staff turnover.

Context: One department in an integrated healthcare organization displayed a pattern of annual low employee engagement scores and alleged workplace bullying. Team members also observed that employees failed to speak up when experiencing incivility. The Clinical Nurse Leader (CNL) student determined that an improvement initiative was needed to create a culture of caring to improve …

Creating An Educational Intervention To Combat Nursing Incivility Benchmark Study, Kathleen P. Melancon

MSN Capstone Projects

When most people reflect on the nursing as a profession, the term compassionate typically comes to mind. The association with compassion is no surprise as nursing is considered to be the most compassionate profession in the world. Nurses, by trade and in all areas of practice, have an ethical and professional responsibility to create and uphold an environment of mutual respect and civility. However, the notion of “nurses eat their young” and the behaviors that stem from this mindset are causing detrimental effects not only to those organizations employing nurses but to patients and the nurses themselves.

Over the last …

Chief Nurse Executive Work Engagement: System Leadership Through A Natural Disaster, Strike, And Pandemic, Ryan Fuller

Doctor of Nursing Practice (DNP) Projects

Problem. In a 21-hospital region of a 39-hospital integrated health system, CNE turnover peaked at 63% (12 CNEs) in 2015. Interviews were conducted in 2019 with 12 CNEs across the region to understand potential issues related to CNE job satisfaction. Responses revealed concerns regarding empowerment, alignment, work-life balance, information transparency/sharing, and recognition. While identifying a solution to address CNE concerns, the organization experienced successive crisis events during a 12-month period that included a record-setting wildfire, multiple labor union strikes, and a novel pandemic. The regional leadership team (RLT) required new approaches to facilitate effective communication during a crisis between the …

Workplace Violence: An Urgent Call For Integrated Staff Education In Acute Care Hospitals, Nicole Bellisario

Doctor of Nursing Practice (DNP) Projects

Problem: Type II workplace violence (WPV) in acute care hospital settings has become an epidemic of costly proportions in the United States. Regulatory mandates and healthcare accreditation standards increasingly require healthcare employers to provide a safe and healthy healing environment for patients and a safe work environment for staff. Implementation of a comprehensive WPV prevention program depends largely on organizational culture, participation and commitment from key stakeholders, and readiness for change.

Context: The patient-clinician relationship has drawn urgent attention, as healthcare organizations around the world implement key components of WPV prevention programs. The clinical management of patient aggression …

Using Simulation For Oncology Nursing Competency Evaluation In Hospitals, Dana Littlepge

Doctor of Nursing Practice (DNP) Projects

Problem Oncologic patients requiring acute nursing care are usually admitted to the designated oncologic medical surgical nursing unit, these care settings often have low admission volumes of oncologic patients that require chemotherapy and or post-therapy care (Muehlbauer, Parr, & Perkins, 2013). Nurses in these environments have reported decreased professional confidence and not feeling safe enough to administer chemotherapy, monitor, and care for cancer patients (Muehlbauer, Parr, & Perkins, 2013).

Context: The current education structure for many hospitals in an integrated healthcare system, does not consistently provide all the components needed for an onsite oncologic nursing competency validation program. Developing a …

Nurse Interrupted: Educating Nurses To Reduce Work Interruptions In The Intensive Care Unit, Lelayitu Shiferaw

Master's Projects and Capstones

Background: Interruptions occur in high frequency in the critical care hospital setting.

The purpose of this study is to understand the impact of work interruption for the critical care nurse and to examine ways to mitigate predominant, non-urgent interruptions.

Methods: The nurse interrupted project followed the Lean methodology framework to identify which high-frequency interrupters to address. Baseline assessment of the intensive care unit (ICU) nurses identified alarms and patient family member calls as predominant causes of interruption. A literature review was conducted to understand work interruption for nurses and to identify available solutions.

Intervention: To address the …

Meaningful Recognition And The Effect On A Medical-Surgical Unit's Staff Satisfaction And Retention, Lindsey Greene

MSN Capstone Projects

The current state of the American healthcare system is riddled with challenges. Nurse administrators are faced with the formidable tasks of decreasing operating costs; improving the patient experience; delivering high-quality and safe patient care; and decreasing the mounting rates of nurse turnover. Nurse leaders must understand the complexities of their work environment, including the key drivers for nurse satisfaction and retention. In 2005, the American Association of Critical Nurses developed six standards for creating a healthy work environment. (American Association of Critical Care Nurses, 2016). An adult, medical-surgical unit at a South Texas hospital was faced with rising rates of …

Medication Error Prevention Strategies, Shana L. Brown

MSN Capstone Projects

The fundamental purpose of every healthcare organization is to enhance patient quality of life through the provision of superior healthcare to produce the best patient outcomes. In the pre-hospital practice setting of helicopter emergency medical service (HEMS) the desire of system leaders and medical staff is to be primarily patient-centered, focused on the safety and wellbeing of patients while at the same time managing the business finances and budget of the organization. Maintaining a healthy environment with safe patient practices is the responsibility of organization administrators, physicians, nurses, paramedics, and all healthcare providers.

One of the primary duties that healthcare …

Burnout And Fatigue: A Potential Downside Of The Critical Care Nursing Profession, Samantha L. Ford

MSN Capstone Projects

Studies show that burnout and fatigue increase healthcare cost and decreases organizational profit due to increased rates of employee turnover, decreased employee satisfaction, a decrease in the quality of care provided to patients, and the development of a toxic work environment. The three principal factors of job-related burnout and fatigue will be addressed within the context of this paper including emotional exhaustion, depersonalization, and personal accomplishment.

Critical care nurses suffer from feeling emotionally depleted to the point they feel as though they can no longer give anymore of themselves to the patients they care for, which is a result of …

Heart Failure 30-Day Readmission Frequency, Rates, And Hf Classification, Yolanda R. Brown, Twonia M. Goyer, Margaret C. Harvey

Doctor of Nursing Practice Projects

30 Day Hospital Readmission Rates, Frequencies, and Heart Failure Classification for Patients with Heart Failure

Background Congestive heart failure (CHF) is the leading cause of mortality, morbidity, and disability worldwide among patients. Both the incidence and the prevalence of heart failure are age dependent and are relatively common in individuals 40 years of age and older. CHF is one of the leading causes of inpatient hospitalization readmission in the United States, with readmission rates remaining above the 20% goal within 30 days. The Center for Medicare and Medicaid Services imposes a 3% reimbursement penalty for excessive readmissions including those who …

Increasing Nurse Knowledge Using A Formal Lung Transplant Education Program, Amy M. Stoddard, Donna Lynch-Smith, Kate Carlson Wrammert, Bobby Bellflower

Doctor of Nursing Practice Projects

This quality improvement project was completed to show that a formal lung transplant education course for nurses caring for lung transplant patients increased their knowledge. An eight-hour education course was developed by experts in the field of lung transplantation. A pretest was administered before the education course. A posttest was administered to determine if knowledge was improved. A three-month follow-up test was administered to determine knowledge retention. Based on the data analysis, nurse knowledge improved after formal education. Item analysis determined what areas of educational content need to be the focus of quarterly education. The education course was adopted as …

Reducing Patient Falls By Realigning Nursing Hours Per Patient Days, Hermes Vargas

Student Scholarly Projects

Patient falls are the “second leading cause of unintentional injury death” (World Health Organization [WHO] (2018), para. 3) and increase healthcare costs by an estimated $13,806 per fall (Walsh et al., 2018). These fall-related costs translate to a potential savings of approximately $400,374 to the selected organization since the unit chosen for the practice change project experienced 29 falls in the fiscal year 2019 (C. Hernandez, personal communication, September 23, 2019).

The PICOT question that guided this project was: In a medical/surgical inpatient population in acute care (P) how does realigning the Nursing Hours per Patient Days (NHPPD) (I) compared …

Fall Risk Factors Among Hospitalized Older Adults With Alzheimer’S Disease And Related Dementias, Jean Bettencourtt Sconza

Doctoral Dissertations

Falls are a common and devastating complication of hospital admission for older adults. Falls are especially significant for those with Alzheimer’s Disease and related dementias (ADRD) as they are at high risk to fall and to suffer injuries from falling. Despite the large body of research on falls in hospitals, less is known about fall risk factors among patients with ADRD. The purpose of this retrospective case-control study was to determine which risk factors are predictors of falls among hospitalized older adults with Alzheimer’s disease and related dementias (ADRD) by comparing those who fell with those who did not fall. …

Transformational Leadership - An Integrated Evidence Review, Marta L. Hudson

DNP Qualifying Manuscripts

Abstract

For chief nurse executives to survive in contemporary healthcare organizations must cultivate nurse leaders who are poised to produce nurse job satisfaction and subsequently, patient outcomes, including quality and patient safety. The article describes an integrated evidence review of the relationship between transformational leadership and nurse job satisfaction. The author identifies implications for practice and further research.

The Impact Of A Digital Intervention On Perceived Stress, Resiliency, Social Support, And Intention To Leave Among Newly Licensed Nurses: A Randomized Controlled Trial, Lisa Concilio

Electronic Theses and Dissertations

The nursing shortage has been deemed a public health crisis with the turnover rate of newly licensed nurses (NLNs) growing (Robert Wood Johnson Foundation, 2014). One out of five NLNs are leaving the profession due to work dissatisfaction and feelings of inadequacy (National Academy of Medicine, 2017). NLN attrition during the first year of hire has been associated with feelings of overwhelming stress and decreased sense of support which negatively impact patient safety (Spence Laschinger et al., 2016). As seasoned nurses are attempting to retire amidst a nursing shortage (American Association of Colleges of Nursing, 2018), NLNs require more support …

Implementing Purposeful Rounding As A Quality Improvement Project To Improve Patient Satisfaction In The Emergency Department, Kersten O'Brien

Master's Projects

Purpose: The purpose of this paper is to describe a quality improvement project to develop and implement a purposeful rounding protocol to improve patient satisfaction and call light rates which affect both patient and nursing staff satisfaction in the emergency department (ED). Importantly, patient satisfaction scores in the ED tend to be low but high scores are related to improved competitive advantage, reimbursement rate, patient outcomes, and nursing staff interruptions.

Methods: A literature review was conducted to determine best practices. Using the lean process and the Plan-Do-Study-Act (PDSA) model, this information was used to identify opportunities for improvement and to …

Advance Care Planning Barriers For Young Adults, Emily K. Songer

Honors Projects

According to the CDC, 40.6% of young adult deaths occur from unintentional injuries, which is the leading cause of death for this age group (Heron, 2019). When accidents occur, they sometimes result in a loss of the ability to make medical decisions, and young adults most likely have never had the opportunity state their wishes regarding their medical care. This is why advance care planning is important, because it allows the opportunity to express those desires before it is too late. Many people often confuse advance care planning as a process that is only needed for the elderly and those …

Effect Of A Self-Care And Self-Awareness Education Program On Resilience To Burnout And Depression In Clinically Experienced Nursing Students, Andrew Taylor

Undergraduate Honors Theses

The purpose was to examine the effect of a self-care educational intervention on nursing student resilience and thus the potential for compassion fatigue, depersonalization, burnout, depression, and inadequate self-care. A one-group pretest-posttest research design was applied to a convenience sample of 104 nursing students near the end of their last semester in a baccalaureate nursing program. The measurements were demographics, a psychometric resilience scale, program evaluation, and reflection question. The intervention was a standardized, intensive 30 min training program on the high degree of stress and burnout nurses face and the core self-care methods that can promote resilience to these …

Reducing Patient Falls Through Purposeful Hourly Rounding, Amanda Savage

Student Scholarly Projects

Practice Problem: Falls significantly affect patients, resulting in temporary or permanent harm, even death. In a large acute care facility, patient falls increased from 444 in 2016 to 556 falls in 2019.

PICOT: In an adult inpatient hospital setting, does purposeful hourly rounding (PHR), compared to no rounding, reduce patient falls over a period of 30 days during the same time period from the previous year?

Evidence: Of the 360 articles reviewed, 12 articles, varying from evidence levels two (1), level three (4), and level five (7), supported PHR as effective in reducing harm from falls in adult …