Nursing Commons^™

Improving The Patient Experience By Implementing Patient-Centered Care In A Community Hospital, Richard A. Billingsley Dnp, Mha, Rn

Doctor of Nursing Practice (DNP) Projects

Health care is a complex business currently undergoing extensive reform. These changes require new methods of care deliver and ways in which health care organizations are operating. At the forefront of this change effort is the 2010 Patient Protection and Affordable Care Act, which is transforming health care from a volume-based, fee-for-service process to the delivery of services that have value, improve quality outcomes, increase satisfaction, elicit greater efficiency, demonstrate improved safety outcomes, show cost-effectiveness, promote better access to services, and result in high reliability between providers and organizations. The goal of providing a more positive health care experience is …

Caution: Line-Of-Sight In Icu Designs, Diane C. Bartos

Doctor of Nursing Practice (DNP) Projects

It has been estimated that by the end of 2015, the U.S. will spend approximately $200 billion in new healthcare facilities construction. Infection prevention, patient and family satisfaction, and technologies influence contemporary designs of critical care units. All of these impacts have created larger patient care units, with a majority of single patient rooms. These larger spaces have created challenges for the clinicians to maintain the line-of-sight. The line-of-sight is one tool clinicians often use to maintain patient safety.

Since the seminal publication by the Institute of Medicine in 1999, patient safety concerns have escalated after revealing numerous deaths in …

Preventing 30-Day Readmissions Of Clostridium Difficile Patients Utilizing Targeted Discharge Instructions, Keith A. Howard

Doctor of Nursing Practice (DNP) Projects

The Patient Protection and Affordable Care Act of 2010 ushered in a new era of fiscal accountability for healthcare organizations. Healthcare organizations and providers are now jointly held responsible for the improved quality of patient care and sustained reductions in patient care events termed healthcare-acquired conditions. To ensure compliance with this newly enacted legislation, the Centers for Medicare and Medicaid Services (CMS) began penalizing hospitals for targeted conditions leading to 30-day readmissions beginning in October 2012. Annually, CMS has focused attention on conditions that endanger patient health and welfare while secondarily attempting to reduce the excessive financial expenditures in …

Student Nurse Behaviors And Barriers To Successful Completion Of The Traditonal Bachelor's In Science Of Nursing (Bsn) Program., Carri Shaw

Honors Theses

Change is often said to be the only constant in life. This holds true to the rapidly growing field of nursing. In order to meet the demands of new challenges that emerge in nursing, the way future nurses are educated also has changed. Not all nursing students find that the profession is for them. Therefore, some attrition from school is expected. This descriptive study will explore factors that the literature suggests are related to attrition at a mid-sized public university in the Midwest. A survey given to two different level nursing cohorts will give insight to pre-licensure nursing students’ experiences …

The Effects Of Consistent Exercise On Work Productivity Among Anesthesia Providers, Samuel K. Self

Doctoral Projects

Studies have been done that link various measurements of workplace productivity with varying levels of individual health. A thorough literature review examined the research to find any significant relation between regular exercise (as defined by the American Heart Association) and an improvement in workplace productivity among anesthesia providers. A Qualtrics survey was used to measure specific results regarding exercise activity and work productivity from anesthesia providers. This group included 53 certified registered nurse anesthetists and anesthesiologists. Descriptive analysis, Chi-square test of Independence, Fisher’s Exact test, and Cramer’s V test were all used to analyze the data. One significant correlation was …

Comparison Of Older Urologic Patients' Perceptions And Nurses' Assessments Of Discharge Readiness, Elizabeth Dodge

Master of Science in Nursing Final Projects

Purpose: The purpose of this study was to explore older urological patients’ perceptions and clinical nurses’ assessments of discharge readiness. In addition, this study examined the difference among older urological patients’ perceptions and clinical nurses’ assessments of discharge readiness.

Design: A descriptive, comparative, cross-sectional design was used.

Methods: Convenience samples of older urological patients and clinical nurses were recruited from three surgical units. Data were collected using The Patient Readiness for Hospital Discharge and Nurse Readiness for Hospital Discharge questionnaires.

Results: Patients perceived low total discharge and personal status readiness for discharge. This was in contrast to 93.9% of …

Issues Within Nursing Facilities Involving Quality Of Care For The Elderly, Kendal Fluhr

University Honors Program

The elderly population in the U.S. is growing each and every year. As this population grows, so does the number of senior citizens in need of constant care. Many are put into nursing homes instead of staying with family or receiving in-home care. The issue with this is that far too many nursing facilities do not give high quality care to residents. The goal of this study was to investigate what concerns are common at nursing homes and what can be done to resolve these problems. Based on research studies, articles, statistics, and informational websites, it was found that some …

Nurses’ Knowledge And Attitudes Toward Implementation Of Electronic Medical Records, Cathy H. Abell, Tonya Bragg-Underwood, Lori Alexander, Caitlyn Elizabeth Abell, Vanessa Burd

International Journal of Faith Community Nursing

With the growth of Faith Community Nursing (FCN), one topic that needs further exploration is documentation. This includes the use of electronic medical records (EMRs). Nurses play a vital role in the planning and implementation of EMRs in the acute care setting and will also play a key role in Faith Community Nursing Programs that stand alone or partner with a health care agency. Individual computer expertise and/or attitude and knowledge of EMRs could be important in the successful implementation. Researchers utilized a modified version of the EMR questionnaire designed by Beiter and colleagues to examine nurses’ knowledge and attitudes …

Improving Patient Satisfaction Through Reducing Nurse Overtime And Redesigning Nurse Staffing And Scheduling, Abby Romme

Master's Projects and Capstones

Increasing cardiac device patient demands within a large Midwest healthcare institution resulted in significant increases in staff shift requirements and corresponding patient complaints. The quality improvement project aimed to decrease patient complaints by executing a standard baseline daily full time equivalent (FTE) staffing strategy for future schedules, increasing nursing FTE, and maintaining institutional staffing standards. Standard calculated daily nursing requirements targeted 17.0 FTE. Implementation occurred over a three month period including schedule reprocessing, a pending incremental nursing FTE request, and a restructuring of unit based scheduling and paid time off guidelines. The completed schedule accurately captured staffing requirements for 100% …

Simulation And Educational Strategies To Decrease The Incidence Of Medication Errors In A Small Rural Acute Care Hospital, Queen Victoria Walters

Doctoral Projects

The Institute of Medicine (IOM) estimates 1.5 million medical errors occur per year (2007). Medication errors are the leading medical error. Medication errors are defined as adverse drug events, and are 100% preventable. Some categories of adverse drug events include, medications administered at the wrong time, by the wrong route, using the wrong method of administration, and administration of the wrong dose of medication. Adverse drug events also include administration of an overdose of medication or the omission of medications as well as administering the wrong medication.

The purpose of this capstone project was to increase the competency of nurses …

Elevating Research: An Important Role For Nurse Leaders, Katreena Collette Merrill, Diane Andrews, Barbara B. Brewer, Diane Storer Brown

Faculty Publications

As leaders, we recognize the importance of professional scholarship to provide the evidence needed to transform practice. One key initiative for the American Organization of Nurse Executives (AONE) is the elevation of nursing research and AONE competencies for nurse executives emphasize utilization, dissemination and participation in studies. However, given our current healthcare climate and competing priorities, nurse leaders must often focus efforts on fiscal responsibility and operational effectiveness, making time and resources to support nursing research challenging. Initiatives that do not directly impact patient care, such as research, may be given a lower priority. Given today’s pressures, nurse leaders may …

Process Change At An All-Volunteer Run Clinic With Pcmh Level 1 Recognition, Erin Flynn

Master's Projects and Capstones

This project directly involves the Clinical Nurse Leader (CNL) essential Informatics and Healthcare Technologies, and the CNL role function will be to act as a Team Manager. (AACN, 2013). The global aim of this process improvement is to improve the clinic workflow to increase patient and provider satisfaction in a Patient-Centered Medical Home (PCMH). The need for this project was discovered during the process of applying for PCMH recognition (of which the clinic has now earned level 1), and successful implementation of this project will meet PCMH guidelines. While applying for PCMH recognition, a clinic workflow document had to be …

Alumna's Dedication To Nursing Spans 50 Years

DePaul Magazine

2014 marked the 20th anniversary of Professional Healthcare Resources for founder and president Eileen DeCesare (LAS MS ’78). Her home health care, hospice and personal care services organization in Washington, D.C. that was one of a handful of agencies preapproved to take affected patients when a health care fraud crackdown in 2014 closed 10 agencies. DeCesare talks about her nursing career and the legacy she hopes to leave.

Leadership Style And Patient Safety: Implications For Nurse Managers, Katreena Collette Merrill

Faculty Publications

OBJECTIVE: The purpose of this study was to explore the relationship between nurse manager (NM) leadership style and safety climate.

BACKGROUND: Nursing leaders are needed who will change the environment and increase patient safety. Hospital NMs are positioned to impact day-to-day operations. Therefore, it is essential to inform nurse executives regarding the impact of leadership style on patient safety.

METHODS: A descriptive correlational study was conducted in 41 nursing departments across 9 hospitals. The hospital unit safety climate survey and multifactorial leadership questionnaire were completed by 466 staff nurses. Bivariate and regression analyses were conducted to determine how well leadership …

Diabetic Prevention The Hard Way: Modified Diet And Increased Exercise, Torrie Reese St.Julien

Doctor of Nursing Practice Final Manuscripts

Background and Purpose: In the United States, 79 million people are pre-diabetic: most have no symptoms. If left untreated, 37% will develop diabetes within 4 years. Fourteen percent of United States health care expenditures are related to diabetic complications. This Evidenced Based Project (EBP) involved a behavioral lifestyle change with the purpose of 7% weight loss and a minimum of 150 minutes of physical activity a week. It was also designed to reduce risk factors and glycated hemoglobin A1c (HgA1c) levels.

Methods: The interventional approach was modeled after the Diabetes Prevention Program (DPP) and Group Lifestyle Balance Program. Participants were …

Perinatal Patient Management, Natalie Whitten

Master's Projects and Capstones

The medical center has lacked the bed capacity and nursing staff to accommodate the needs of maternity patients. Patients are redirected to other network and non-network medical centers due to lack of bed availability, inadequate nurse staffing, and poorly managed patient movement. This project aims to improve patient management in the perinatal departments, including the discharge process. We will have 100% staff participation to facilitate bed management. The patient management project was conducted in a 200-bed hospital serving the residents of an urban area. The perinatal areas of labor & delivery (L&D), antepartum, and postpartum (OB) are highly productive units …

Improving Patient Safety: Reducing Medication Errors In The Microsystem, Erica M. Dent

Master's Projects and Capstones

In a 72-bed for-profit long-term acute care hospital located in an urban setting, there has been a fifteen percent increase of medication errors that the pharmacy department has detected across nursing, and pharmacy departments, as well as with physicians from both day and night shifts. Over the last month there has been a total of twenty-eight medication errors including the transcription, administration, evaluation, and documentation processes. The microsystem consists of a telemetry/medical-surgical unit as well as a small intensive care unit consisting of ten beds.

The prospectus details a project implemented to reduce medication errors within the microsystem. The steps …

An Investigation Of The Relationships Between And Among Power, Trust And Job Satisfaction Of Nurse Managers In Acute Care Hospitals Using Rogers Science Of Unitary Human Beings, Maureen A. Schneider

Seton Hall University Dissertations and Theses (ETDs)

Background: Defined as control and freedom, power is often characterized as hierarchical. Power-as-freedom exists as a unitary manifestation of the whole and is acausal. Thus a worldview that emphasizes mutual process rather than a causal (control) view supports a culture of trust in the healthcare environment that generates a committed and a thriving work force. When nurse leaders support a climate of trust, managers develop a sense of commitment to the organization which may lead to job satisfaction. However, there is a lack of empirical evidence supporting the relationship between power, trust and job satisfaction among nurse managers.

Purpose: The …

Factors Contributing To Registered Nurse Job Satisfaction In The Nursing Home, Michael Shipley

Seton Hall University Dissertations and Theses (ETDs)

Over the next several years the aging population will increase the number of patients suffering from chronic illness. A sicker aging population, coupled with changes in healthcare reimbursement will require nursing homes to admit sicker patients for shorter lengths of stays. To meet the needs of the increased number of chronic patients and those patients with higher acuities, nursing homes will require more skilled, registered nurses. Registered nurses (RNs) are the linchpin to providing high-quality care in the healthcare environment and especially in nursing homes.

Understanding the factors of RN job satisfaction in the nursing home is important in increasing …

Implementation Of The Transition To Practice Regulatory Model For Nurse Preceptors In A Rural Setting, Donna Renee Honour

Doctoral Projects

Registered nurse turnover is a recurring problem for healthcare organizations. The inability of hospitals to retain registered nurses threatens the adequacy of healthcare delivery and increases personnel and patient care cost. The purpose of this capstone project was to take a leadership role in translating evidence into practice by successfully preparing preceptors to help new graduates transition successfully from the role of student to that of a profession nurse.

Healthcare organizations require a stable, highly proficient and totally engaged nursing staff to provide effective and efficient levels of patient care. The first year of practice for a nurse graduate, the …

The Effects Of Implementing Best Practices On 30-Day Readmission Rates In Adults Following Cabg Surgery, Linda Elaine Kline

Evidence-Based Practice Project Reports

Coronary artery bypass graft (CABG) surgery is one of the most frequent and expensive cardiac surgical procedures in the U.S. today. Complications from CABG surgery are one of the top causes of 30-day hospital readmissions. Readmissions after CABG surgery are often preventable and add to health care costs. Recent government legislation mandates penalties for hospitals with excess readmission rates. The purpose of this evidence-based practice project was to determine if implementation of best practice recommendations effected 30-day readmission rates following CABG surgery. A critical appraisal of the literature was conducted to identify best practice recommendations. The Iowa model and Lewin’s …

Implementation Of A Patient Satisfaction Survey In A Federally Qualified Health Center, Ricardo Jose Ballin Ii

Doctoral Projects

Safety net FQHCs are typically challenged with initiating and sustaining standardized measurement of patient satisfaction. Baseline survey data establishing how patients rate their satisfaction at San Francisco General Hospital (SFGH) Urgent Care Center (UCC), a public safety net federally qualified health center, located in San Francisco, California is needed. Implementing an existing patient satisfaction survey instrument using a standardized method, with volunteer survey administrators, made this study unique and resulted in a higher rate of survey participation that any other method previously attempted. Survey results determine whether patients' needs and expectations were being met, adding value and allowing for comparison …

Nurse Managers' Hiring Selection Of Newly Licensed Rns: A Grounded Theory Approach, Susan Adamek

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this research study was to construct a substantive grounded theory regarding how acute care nurse managers select the newly licensed RNs (NLRNs) they hire. This is important because a good selection process can reduce expensive employee turnover and improve teamwork on units. There has been extensive research regarding interventions that improve the retention of NLRNs after they are hired, such as residency programs, preceptors, mentors and support groups, but there is very little in the literature about the processes or preferences nurse managers use to select the right candidates to be hired. A constructivist grounded theory approach …

Health Care In The Community: Developing Academic/Practice Partnerships For Care Coordination And Managing Transitions, Mary E. Fortier, Edd, Rn, Cnl, Donna M. Fountain, Phd(C), Aprn, Phcns-Bc, Maryelena Vargas, Phd, Rn, Lisa Heelan-Fancher, Phd, Fnp-Bc, Anp-Bc, Tracy Perron, Phd, Rn, Katherine Hinic, Phd, Rn, Anp-Bc, Beth Ann Swan, Phd, Crnp, Faan

College of Nursing Faculty Papers & Presentations

Executive Summary

The delivery of health care is quickly changing from an acute care to a community-based setting.

Faculty development and mastery in the use of new technologies, such as high-definition simulation and virtual communities are crucial for effective student learning outcomes.

Students' benefit include opportunities for hands-on experience in various patient care scenarios, real-time faculty feedback regarding their critical reasoning and clinical performance, interdisciplinary collaboration, and access to a nonthreatening learning environment.

The results of this study provide some evidence of the benefits of developing faculty and nursing curricula that addresses the shift from an illness-based, acute hospital model, …

The Effect Of Education On Compassion Fatigue As Experienced By Staff Nurses, Kathryn L. Zehr

Evidence-Based Practice Project Reports

Historically, nursing has been perceived as a highly rewarding profession. Yet, due to the increasing complexity of today’s healthcare, nurses are faced with greater challenges in their work environments. Registered nurses who work in tertiary care settings are exposed to disturbing patient situations including trauma, death, abuse, or chronic disease. Joinson (1992) described this experience as compassion fatigue and symptoms include headaches, short attention span, or fatigue. A review of literature has identified that nurses should be educated about risk factors and coping strategies to combat compassion fatigue. Guided by the Model for Evidence-Based Practice Change and Jean Watson’s Theory …

An Evaluation Of Patient Satisfaction With Telephone Follow-Up In An Urgent Care, Audia L. Ellis

Doctor of Nursing Practice Scholarly Projects

Telephone follow-up (TFU) is a very valuable innovation. It is a service that is found to be desirable by both patients and health care professionals. It has been utilized successfully in a variety of settings, however, evidence of its use or evaluation of its use in the urgent care setting has not been found. Through evaluation of patient satisfaction (PS) with use of the protocol, new cost and labor effective interventions were constructed and implemented with the goal of meeting patients’ needs.

This study utilized mixed method methodology and employed a descriptive design. Convenience sampling was utilized and a sample …

Attitudes Towards An Evidence-Based Clinical Decision Support Tool To Reduce Exposure To Ionizing Radiation, Raymond Zakhari

Faculty Publications and Presentations

Patients who suffer minor brain injuries experience unnecessary ionizing radiation in the form of a non-contrast head CT scan despite the dearth of evidence supporting standard CT scans for all brain injuries. Exposure to ionizing radiation increases the incidence of certain types of cancer. This evidence-based practice change project assesses the attitude of clinicians towards evidence-based clinical decision support tools, specifically the Canadian CT head rule. The use of highly sensitive clinical decision support tools is supported in the literature to help healthcare providers mitigate the risk associated with unnecessary use of CT scan imaging studies. The project was conducted …

Do You Understand What I Mean? How Cognitive Interviewing Can Strengthen Valid, Reliable Study Instruments And Dissemination Products, Anne Hofmeyer, Brenda H. Sheingold, Ruth Taylor

Nursing Faculty Publications

It is now well accepted that working in research teams that span universities, jurisdictions and countries can be rewarding and economically prudent. To this end, investigators collaborate in the pursuit of knowledge to address human and societal problems and translate results into local and global contexts. This implies that investigators need to develop study instruments that are fit for purpose and strategically manage issues arising from geographical, linguistic and cultural diversity. A proven method is cognitive interviewing to pre-test the study materials to ensure clarity and relevance in the study population. This paper describes the steps taken to increase the …

The Nurse Manager's Leadership And Nurse Satisfaction, Deborah Bryant

Doctor of Nursing Practice Projects

Nurse managers face many challenges in today's healthcare environment including how to retain staff. The purpose of this capstone was to give tools to nurse managers on specific units to develop techniques for shaping a positive culture making a difference for the nursing staff, patients, families and others on the nursing units. Culture-shaping tools were taught to five nurse managers after completion of a pre-assessment survey by bedside nurses to determine if the behaviors of the nurse managers could impact the nurse satisfaction and improve retention. Nursing staff were queried for effectiveness in nurse satisfaction after the nurse managers had …

Perceived Patient Satisfaction With Hospital Services And Interventions, Marietta Abernathy

Nursing Theses and Capstone Projects

The patient and family voice should be heard in the healthcare setting. Gaining knowledge and insight from a parent of a pediatric patient will allow hospital staff and administrators to see the hospital experience from the vantage point of a patient and family member (Uhl, Fisher, Docherty, & Brandon, 2013). It is important to continually review feedback and suggestions from families of pediatric patients to improve the care of future patients. Ultimately, this will improve patient satisfaction scores, but most importantly, it will improve the experience of pediatric patients (Creating patient and family advisory councils, 2010). The investigator interviewed ten …