Nursing Commons^™

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 …

#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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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.

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 …

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 …

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 …

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 …

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 …

A Multimodal Analgesic Virtual Reality Program To Reduce Opioid Exposure, Jessica Hovland

Student Scholarly Projects

The opioid crisis continues to be a public health concern. Traditionally, an opioid-centric approach treats postoperative pain.

The following PICOT question guided this project: Will initiating a multimodal analgesic virtual reality quality improvement program (I) compared to current practice (C) decrease opioid requirements (O) in robotic hysterectomy patients (P) during the postoperative period (T)? Several articles promote non-opioid analgesia and non-pharmacological interventions, such as multimodal analgesia and virtual reality (VR) for pain management.

This project reviewed pre- and post-implementation data after implementing new evidence-based multimodal analgesia and VR protocols. The project captured a total of 64 patients in the pre-implementation …

Implementing The Heart Score Guideline To Decrease Length Of Stay In Low-Risk Chest Pain Patients In A Rural Hospital, Tonja D. Walker

The Corinthian

Abstract

This quality improvement (QI) project evaluated the length of stay (LOS) of low-risk chest pain (CP) patients in a rural hospital. A convenience sample of emergency department (ED) physicians and non-physician providers ages 18-75 employed at Navicent Health Baldwin were eligible for recruitment. Pre- and post-surveys were used to evaluate to evaluate ED providers’ knowledge of low-risk chest pain metrics for statistical significance and a comparison of LOS for low-risk chest pain patients was compared for clinical and statistical significance seen at the facility. The mean scores of eight items on the postintervention to preintervention knowledge survey were identical. …

Bedside Shift Report: A Way To Improve Patient And Family Satisfaction With Nursing Care, Audriana Pevec

Student Scholarly Projects

Poor communication during the handoff process contributes to approximately 30% of malpractice claims costing up to $1.3 billion annually (Fenner, 2017), which demonstrates the importance of evaluating the quality of information exchange between nurses, patients, and families when associating quality of care to patient satisfaction (Kullberg et al.,2017).

The following question guided this Evidence-Based Project (EBP) project. In adult, progressive care unit patients (P), does the implementation of a nursing bedside handoff (I) compared to current handoff practices (C) improve patient/family satisfaction with nursing care (O) over eight weeks (T)?

The literature revealed evidence from 10 studies answering …

Family Presence During Resuscitation, Brittany Whistle

Scholars Week

Background:

Families want more involvement in their loved one’s care than they did just twenty years ago. Especially, in the matter of resuscitation efforts, this involvement remains controversial.

Evidence and Findings:

Based on research, theories, and multiple educated opinions, family presence during resuscitation (FPDR) needs to be implemented in hospitals. Theories by Kolcaba and Helvie demonstrate a need for comfort and positive energy around patients to enhance the healing process. Evidence has shown multiple benefits of FPDR. The patient receives a holistic approach of care, the family gains closure and feeling of participation of care, and provides a plan for …

Peripheral Iv Bundle, Alicia Hanna

Graduate Theses, Dissertations, and Capstones

Abstract

It is estimated that over 90% of hospitalized patients require IV access during their hospitalization. Peripheral IVs (PIVs), while less risky than central lines, are not without risk to the patients. Intravenous (IV) infiltration in pediatric patients is a very common complication associated with IV access, accounting for about 67% of IV catheter removals; a less common complication, but much more serious complication of a PIV can be a blood stream infection (BSI) which can account for up to 35% of BSIs seen in patients. BSIs are associated with increased length of stay, increased morbidity and can result in …

State Actions And Shortages Of Personal Protective Equipment And Staff In U.S. Nursing Homes, Diane M. Gibson, Jessica Greene

Publications and Research

BACKGROUND: It is crucial that nursing homes have adequate personal protective equipment (PPE) and staff to protect residents and staff from COVID-19. Some states have taken actions to mitigate shortages of PPE and staffing in nursing homes, including creating dedicated long-term care (LTC) teams and supporting staffing capacity.

OBJECTIVE: To examine whether state actions and nursing home characteristics are associated with shortages of PPE and staffing.

DESIGN AND SETTING: Facility-level data, released July 31, 2020, from the Nursing Home COVID-19 Public File, were combined with data from other sources. Our sample was the 13,445 facilities with information about PPE and …

Simulation: An Effective Tool For Mentoring The Novice Nursing Faculty, Charlene B. Smith, Jeanne Hamner, Carol Hession, Cari Granier, Travis "Pete" Lewis, Ashley Thibodeaux

Journal of Interprofessional Practice and Collaboration

Abstract

The American Association of Colleges of Nursing (AACN) (2019) reported in 2018-2019, U.S. nursing schools turned away more than 75,000 qualified applicants from baccalaureate and graduate nursing programs due to insufficient numbers of faculty and clinical sites. Two-thirds of the nursing schools related a shortage of nursing faculty and/or clinical preceptors as a reason for not admitting qualified applicants (AACN, 2019).

There is a triad of challenges facing nursing today. The evolving triad is a nursing shortage, a lack of clinical facilities and nursing faculty. Nursing education must increase enrollment to fulfill the upcoming nursing shortage. Nursing schools are …

Empowering Nurses Of Minority In The Face Of Incivility And Bullying: Through The Lens Of Phenomenology, Corrine Floyd

Dissertations

Abstract

Up to 85% of nurses have reported exposure to incivility in the workplace (Hunt & Marini, 2012). The often-subtle nature of incivility toward nurses in a minority population may partially explain why it remains a problem. Healthcare organizations realize the need for civility to counter the high turnover rate, staff shortages, and low job satisfaction reported by nurses, but lack understanding of how nurses of a minority population perceive incivility and bullying. This study aimed to answer the research question how do nurses with minority representation experience incivility and bullying versus empowerment in the workplace? A descriptive phenomenological design …

Improving Patient Satisfaction In The Medical-Surgical Setting, Victoria A. Ogundeko

Student Scholarly Projects

Problem: Patients’ experiences at hospitals are multidimensional, and their satisfaction with the service is linked to the quality of patient care provided. In evaluating the quality of care of a hospital, the nursing handoff of patients, and the engagement efforts of healthcare staff is an important element of patient satisfaction.

PICOT: In adult medical-surgical patients, does the implementation of nursing bedside handoff reports, compared to the current method of nursing practice desk handoff reports, improve patient satisfaction scores by 10% within two months?

Evidence: After reviewing 103 articles, 12 were relevant to this project, and included observation …

Pressure Injury Documentation And Reporting: A Quality Gap, Mary Ann Laslo

Master's Projects and Capstones

Abstract

Problem: Inaccurate and incomplete pressure injury (PrI) assessment and documentation leads to inaccurate reporting of PrI quality reporting measures to the Centers for Medicare and Medicaid Services. Inaccurate, incomplete documentation of pressure injuries and wounds adversely affects the quality of care, financial reimbursement, and hospital reputation as well as increasing the risk of litigation to medical providers. Barriers to accurate and complete documentation by the nurses were inaccuracy in identification of PrIs Stage 1 or greater and knowing what and where to document the information in the electronic medical record.

Context: This quality improvement project attempted to improve nurse …

Nurse Leader Rounding: A Stellar Strategy To Improve The Patient Experience Of Care In The Emergency Department, Polina Shishkina

Master's Projects and Capstones

Abstract

Many clinical outcomes that occur in the emergency room determine the patient’s continued care and experience in the hospital and beyond as well as influence the organizational reputation in the community. Mack and Fill emphasize that “an ED visit is a significant encounter between a patient and a hospital and one that affects ‘repurchase’ decisions for future health care” (as cited in Welch, 2010, p. 65). Thus, patient experience in the emergency department necessitates continued quality improvement efforts. The emergency room, or “the front door to the hospital”, provides equitable and affordable care to patients who need urgent medical …