Nursing Commons^™

Sustaining Daily Management With Gemba Walks: A Scheduling Model, Suneela Nayak, Ruth Hanselman, Stephen Tyzik, Amy Sparks

Operations Transformation

SUSTAINING DAILY MANAGEMENT WITH GEMBA WALKS: A SCHEDULING MODEL

At an academic tertiary care medical center, there are 110 Operational Excellence teams across 4 campuses. Every weekday, 10 GEMBA walks occur with the 11^th on Wednesdays. The expanding program has made daily leadership visits to all KPIs challenging. As a result, consideration of reduced gemba walks to departments who have met specific maturity/performance criteria.

The scope of the eight-week pilot consisted of 13 pre-identified teams that have weekly workflows. The teams must have met a baseline level of performance. Performance was scored for 9 variables measuring engagement, PDSA, use …

Increasing Hcahps Scores By Scripting Of Hourly Rounding, Katherine Rivera

Doctoral Dissertations and Projects

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a standardized national report on patient perceptions of care and is now linked to hospital reimbursement by both government and now some independent insurance companies. Healthcare systems are therefore very interested in ways to increase patient satisfaction within their facilities. This evidence-based practice pilot project was based on the Iowa Model of Evidence and used a quasi-experimental process to ascertain if adding scripting to the hourly rounding process was able to increase patient satisfaction scores on the HCAHPS. The increase in patient satisfaction, in the area of perceived responsiveness …

Pain Management: A Flowsheet For Providers, Lisa Swezey

Doctoral Dissertations and Projects

Many different factors led to the trend of providers prescribing opioids for chronic pain. However, the misuse of and many deaths related to opioid prescriptions have caused the trend to reverse its direction. National organizations call for providers to stay clear of opioid medication and increase the use of nonpharmacological pain management, but also to treat pain adequately. There are still many barriers to decreasing the use of opioids and increasing the use of nonpharmacological methods. This scholarly project hoped to use an educational flowsheet to assist providers in meeting the demands from national organizations to decrease the use of …

1600 Rn, Jonathan Archibald, Natasha Stankiewicz, Mark Parker, Elizabeth Ridel-Dermanelian, Sandy Ridel-Dermanelian, Amy Stafford, Shawn Taylor, Deb Jackson, Alana Trottier, Roger Maynard, Bonnie Boivin

MaineHealth Maine Medical Center

Due to a changing employment arena, healthcare organizations are hiring more new graduate RNs into acute care units. MMC’s usual process is to put new hires into night shift. Historically, night shifts have less resource availability. These combined factors left staff feeling unsupported; patient care could be compromised when less support is available to those in the beginning of their careers.

Nurses Role In Health Home Mixed Methods Study, Jacqueline S. Prokop

Nursing Theses and Dissertations

Managing individuals with chronic health conditions in the primary care setting continues to be a significant challenge in the U.S. health care system. This issue is further compounded for low-income individuals with both mental health and physical health chronic conditions. With the enactment of the Affordable Care Act (ACA), new chronic disease health home opportunities have emerged to address the existing structural and process gaps found in primary healthcare. The nurse’s role is integral to health homes as they empower nurses to play a greater role in improving patient experiences, population health, and lowering healthcare costs. Three research manuscripts presented …

Improving Communication: Huddling For Change, Harnoor Chahal

Master's Theses

The purpose of this communication improvement project is to incorporate huddles between interdisciplinary departments within a microsystem in order to improve customer satisfaction by decreasing the number of grievances. Based on the increasing number of grievances due to delayed hospital discharge, which results from a lack of communication between team members, there is an increased need for communication between the microsystem. By implementing weekly huddles between the Inpatient and Outpatient nurses, not only will there be increased care-coordination, but there will also be a decreased delay in discharge from the hospital caused by missed or no communication. Evidence-based practice indicates …

Workplace Bullying, Nurse Practice Environment, Patient Outcomes: A Descriptive Study, Noreen Houck

Electronic Theses and Dissertations

Better nursing practice environments are associated with improved patient safety, yet little is known about the nurse’s experiences of bullying or flourishing within the practice environment. This study described nurses’ experiences of workplace bullying and flourishing and identified associations with patient outcomes.

The study used an exploratory cross-sectional survey design following Donabedian’s Quality Framework of structure-process-outcome and informed through critical feminist theory. The study took place at a large medical facility in the northeastern United States. A multi-instrument survey included four sections. The demographic section and the Practice Environment Scale of the Nurse Work Index (PES-NWI) were used to measure …

Standardizing The Palliative Care Referral Process, Ronaviv M. Garcia

Master's Projects and Capstones

Standardizing the Palliative Care Referral Process

Problem: Heart failure (HF) is one of the most common causes of hospital admissions and emergency department visits in the United States. HF patients are at high risk for hospital readmission: 25% of HF patients discharged from the hospital are readmitted within 30 days of discharge, and 50% are readmitted within 6 months (Vedel & Khanossov, 2015).

Context: Palliative Care (PC) has been shown to be an effective way of managing distressing HF symptoms and thus of reducing hospital readmissions, yet patients are infrequently referred to PC services during their transition from hospital to …

Uams Summer Health Literacy Study, Merritt Osment

Health, Human Performance and Recreation Undergraduate Honors Theses

Background: Health Literacy is a barrier to self-care; patients often lack the skills to understand complicated instructions that deal with medications, wound care, follow up schedules, and preventative care. Patients who undergo hip and knee replacements are often older adults, a population that normally struggles with various aspects of health literacy. Patient education materials are a common means of communicating with these individuals. However, if the patient does not understand the materials that they are given, they are more likely to experience negative side effects after their operation. Purpose: The purpose of this study is to compare the health literacy …

Failure-To-Rescue Simulations As A Risk Management Strategy For Registered Nurses, Trena K. Seago

Graduate Theses, Dissertations, and Capstones

In the hospital setting, prevention of failure-to-rescue (FTR) events is an important aspect of patient safety. The use of patient simulation as a strategy to educate nurses on the prevention of these events offers two modes of learning: 1) experiential learning through simulation and 2) reflection through debriefing. The act of practicing to recognize a deteriorating patient through experiential learning and reflection may help increase nurses’ self-efficacy in recognizing a similar situation in their future practice. This quasi-experimental, one-group, pretest-posttest pilot study investigated the use of patient simulation among registered nurses (RNs) in the hospital setting as an anticipatory educational …

Letter To The Editor: Patient And Staff Experiences With Inpatient Video Monitoring, Eric Shoemaker Md, Aysha Athar Do, Jonathon Brewis Md, Daniel Angell Do, Rana Zaban Do

Clinical Research in Practice: The Journal of Team Hippocrates

We describe the patient experience with remote video monitoring on a general practice inpatient floor in the hospital. We raise questions about unexplored areas relevant to this practice.

Building The Foundation Of A Mentoring Program For Chief Nurse Executives, Patricia Gooch

Doctor of Nursing Practice (DNP) Projects

The chief nurse executive (CNE) is the senior leader whose primary responsibility is to assure quality of care and patient experience in acute care hospitals. Uncertainty in the political arena and further changes to the Affordable Care Act (ACA) highlight the need for hospitals to maintain continuity of leadership for the executive closest to patient care – the CNE. In a large and complex health system, the role of the CNE can be an overwhelming responsibility for seasoned professionals – and especially daunting if you are new to the role of CNE or new to an organization as an experienced …

Development Of An Advanced Practice Provider Onboarding Structure, Amy Ziegler

Doctor of Nursing Practice (DNP) Projects

Advanced practice providers, also referred to as nurse practitioners and physician assistants, are increasingly being employed to function in a variety of healthcare settings. As organizations grow their advanced practice provider staff, they must develop a distinct advanced practice provider orientation and onboarding program. Finding the right staff is only half the battle; if you do not orient and onboard staff properly the will not stay (National Systems Contractors Associations [NSCA], 2017). Administrators, certainly directors of advanced practice providers, are pursuing unique and dynamic ways to facilitate credentialing, privileging, orientation and onboarding of these individuals. The director for advanced practice …

Ethics Education To Empower Nurses To Effectively Consult The Hospital Ethics Committee, Elaine L. Ware

Doctor of Nursing Practice (DNP) Projects

Nurses interacting with patients and family members need support when the course of the patient’s care becomes uncertain or conflicted leading to ethical concerns. Educating nurses about the purpose of the Hospital Ethics Committees (HEC) may support nurses with ethical concerns, alleviate moral distress and improve job satisfaction. Utilizing the HEC for ethically challenging care situations enhances the professional practice and supports the code of ethics for nurses. HECs which are often underutilized can provide valuable resources for nurses. This DNP project sought to increase the number of nurses’ ethics consultations to the HEC after providing ethics education using a …

An Assistant Nurse Manager Leadership Laboratory Program And Its Effect On Nursing Outcomes, Alexandra Wiggins

Doctor of Nursing Practice (DNP) Projects

Aim: This paper summarizes the project development, implementation and outcomes of an Assistant Nurse Manager leadership laboratory program and elements involved in the coursework. Through lecture, simulation, and mentoring components, noted change in leadership ability of novice/advanced beginner Assistant Nurse Managers were assessed over a six-month period and monitored the effects on quality and financial metrics, as well as the self-confidence of the Assistant Nurse Managers. Evaluation conducted included both quantitative and qualitative outcome assessment.

Background: The literature shows that quality leadership produces quality nursing outcomes (Houser, 2003). Leadership style (Wong & Cummings, 2007), communication skills (Vogus & Sutcliffe, 2011), …

Manager Leadership: Beginning At Novice, Kathy Bay

Doctor of Nursing Practice (DNP) Projects

To meet the current and anticipated nursing leadership gaps, there is a critical need for tools and programs to develop of future leaders. Unfortunately, there is a deficiency related to the preparation and readiness of novice nurse managers which impacts turnover, burnout, and the quality, safety and cost of care for patients. The aim of this Doctor of Nursing evidence-based change in practice project was to create an online training program that integrated two national nursing leadership competencies to assist the development of novice nurse managers as they transition to a formal leadership role.

A video-based module system with active …

Advanced Access: Creating An Infrastructure For Success In Primary Care, Kimberly D. Perris

Doctor of Nursing Practice (DNP) Projects

The Humboldt Independent Practice Association (IPA) has sought to improve the health of Humboldt County through practice transformation efforts. To date, Humboldt IPA’s primary care practice, the Priority Care Center, is building a foundation toward an Advanced Access model of care with an overarching aim of effectively improving access to quality care in Humboldt County. The 10 Building Blocks of High Performing Primary Care Practices framework set the stage for the intervention and was used as a roadmap to build an infrastructure for success. Team-based care was highlighted as the project relied on having systems and processes that empower the …

Reducing Inter-Unit Patient Report Delays And Transfer Times, Natalya Marinov

Master's Projects and Capstones

Inter-unit coordination is essential in preventing a bottleneck in patient flow and its resultant stresses to staff, hindering quality patient care, and wasting time. The Medical-Surgical Unit (MSU) and Post Anesthesia Care Unit (PACU) struggle to establish efficient patient report times and transfers. Preliminary data demonstrated report delays attributed to an arduous workload and overburdened MSU nursing staff. The project’s objective focuses on reducing nurse-related report time delays by 10%, increasing understanding and teamwork, promoting proactive thinking to manage workflow efficiently, improving patient flow, and improving the inter-unit relationship between MSU and PACU. Increasing awareness and reducing transfer times are …

Multifarious Interventions To Reduce Falls On The Medical-Surgical Units, Wenjie Ying

Master's Projects and Capstones

The CNL project was conducted on the 56-bed adult medical-surgical units in a trauma center. There were total eight fall incidences from January to February. The SWOT analysis, stakeholder analysis, pre-educational survey, cost-effective analysis and root-cause analysis suggested in-depth training on multifaceted fall prevention. The objectives include reducing falls by 50%, increasing staff’s adherence to fall prevention protocols, boosting staff’s confidence in patient mobility, improving staff responsiveness and communication with meds in HCAHPS, and enhancing knowledge of medications’ side effects by May 14, 2018. The literature reviews indicated that the multicomponent preventative measures to prevent falls along with leadership supports …

The Relationship Between Perceptions Of Patient Safety Culture, Nurse Advocacy, And Nurse Sensitive Patient Outcomes, Margaret Dicuccio

Electronic Theses and Dissertations

The purpose of the study was to understand relationships between and among patient safety culture, nurse reported attitude toward patient advocacy and key patient outcomes. Nurses play an integral role in patient safety, providing care through constant interaction with the patient and clinical team. Advocating for patients is part of that role; however little research existed that explored how advocacy was related to the safety culture or specific patient outcomes.

A correlational cross-sectional design was chosen for this secondary data analysis. Correlation and regression models were applied to medical/surgical unit data from seven facilities within one hospital system. Sources of …

The Costs And Benefits Of Outsourcing Marketing, Student Recruitment And Retention Services In An Online Rn-To-Bsn Program, Jacqueline M. Wuellner

Doctor of Nursing Practice Scholarly Projects

ABSTRACT

In 2010, the Institute of Medicine advised that by 2020, 80% of working nurses should have at minimum a baccalaureate degree. Across the country, the profession will fall short of that goal. In New Mexico, the numbers of associate degree nurses and baccalaureate degree nurses are nearly equal. As the flagship university for the state, the University of New Mexico has offered a program for baccalaureate degree completion for registered nurses for over 55 years. Wishing to fulfill the IOM mandate, the University of New Mexico, College of Nursing desires to grow its RN-to-BSN program by expanding its marketing, …

When Disaster Strikes: A Training Intervention To Improve Nurses' Confidence And Preparedness For The Surge, Nichole M. Weber

Evidence-Based Practice Project Reports

There has been an exponential rise in mass casualty incidents (MCI) internationally. These human induced and naturally occurring events have affected over 4.6 billion people, and are not discriminatory to region or community (World Health Organization, 2011). Governing bodies require training and education, but nurses continue to report suboptimal competence and self-reported readiness, and a need for standardized, evidence-based training remains. The purpose if this evidence-based practice project is to authenticate current research supporting implementation of competency-based education, to improve nurses’ self- perceived preparedness and confidence in their ability to respond to MCI. The project results can be utilized for …

The Efficacy Of The Teach-Back Method Of Education On Readmission Rates In Heart Failure Patients Within 30 Days Of Discharge, Catherine Lynch

Senior Honors Projects, 2010-2019

Background: The teach-back method is a method of education that is being used with heart failure patients in order to improve their quality of education and lower readmission rates. This literature review is aimed at synthesizing studies conducted to determine the efficacy of the teach-back method with this specific patient population.

Methods: Electronic searches of CINAHL and PubMed were performed through James Madison University libraries. Articles selected for inclusion were evaluated for study design, relevance, and sample size.

Results: Three studies met eligibility criteria, these studies showed statistically significant evidence that the teach-back method did reduce readmission rates in heart …

Promoting Empowerment And Innovation: A Technology Initiative, Theresa Marcotte

Doctor of Nursing Practice Projects

Improving empowerment through a supportive organizational culture can lead to innovation in practice and promote positive outcomes. Supporting employee empowerment, through a supportive organizational culture and environment, provides opportunities to innovate and creatively meet desired outcomes. Using these concepts, an Associate Degree Nursing Program empowered faculty to address a strategic planning opportunity to improve practice. The innovation, a Technology Initiative, provides opportunities for evidence-based testing practices, leading to improved, first-time pass rates on the National Council Licensure Exam (NCLEX). Technology use in the classroom can improve dissemination of nursing knowledge and retention strategies and therefore improve program retention. The utilization …

Correctional Nursing: Why Is Retention An Issue?, Bethany Jernigan

Nursing Theses and Capstone Projects

The specialty of correctional nursing has its own set of considerations and concerns that impact retention and affect healthcare outcomes for the offender population. The purpose of this research study was to identify specific areas causing poor nursing staff retention and recruitment within the correctional environment. The literature review revealed correctional nursing can benefit from: improved education and training for correctional nurses, emphasis and focus on public health in the correctional environment, role confusion in correctional nursing, and further investigation and research needed in recruitment and retention. Prison nursing staff at a large, rural correctional facility, completed the revised Casey-Fink …

Improving Nurse Managers Skills In The Veterans Health Administration, Charles Silveri

Doctor of Nursing Practice Scholarly Projects

The Veterans Health Administration (VHA) provides an education module for nurse mangers that prepares them for unique duties and responsibilities. This project explores the self-reported confidence in knowledge learned of nurse managers who participated in an online management and leadership training program through measurement of pre- and post- training participation. The aim of this study is to analyze an online training program for nurse managers in regards to improvement in leadership/management skills and promote better management and patient advocacy (Kvas, Seljak & Stare, 2014; American Organization of Nurse Executives (AONE) Nurse Executive Competencies, 2005).

Effects Of Incorporating Patient Acuity Into The Rn Assignment Process, Melissa L. Forton

Evidence-Based Practice Project Reports

As the largest sector of healthcare, nurses are the primary providers of patient care. By 2025, it is estimated that there will be a shortage of over 250,000 registered nurses (RNs) (American Association of Colleges of Nursing, 2011). Factors contributing to the nursing shortage include increased complexity of patients and decreased staffing that leads to decreased job satisfaction (Fox & Abrahamson, 2009). Over half of neonatal intensive care nurses reported missing at least one nursing task per shift when staffing was inadequate or patient acuity was high (TubbsCooley, Pickler, Younger, & Mark, 2015). The purpose of this evidence-based practice (EBP) …

News From The Graduate School - Nursing, Otterbein Office Of Graduate Programs

Graduate School

Newsletter that provides updates from the Graduate School and the Nursing Graduate Program.

Evaluating Transfer Of Continuing Education To Practice: A Retrospective Mixed-Methods Study, Tiffany Bryant, Dnp, Msn, Rn-Bc

Doctor of Nursing Practice Projects

Background: Continuing education (CE) is an essential component of building and maintaining the competence and performance of health professionals. Evidence of its impact on practice is lacking. Organizations need evidence of CE transfer to the practice setting to demonstrate its value and inform CE practice.

Objectives: The purpose of this study was to provide evidence of CE’s impact on practice by analyzing nurses’ reports of intent to change practice, actual practice change, and examples of practice change. Research assessing the effects of CE on nursing practice across multiple courses involving different topics, levels of nursing practice and location supports generalizability. …

Nurse Managers And Hospital Nurse Educators’ Views Related To The Knowledge, Skill And Attitude Requirements Of Newly Licensed Nurses In The Las Vegas And Salt Lake Valleys, Delos Jones, Dnp, Msn, Rn

Doctor of Nursing Practice Projects

Background: In 2017, approximately 230,569 new Registered Nurses (RNs) were licensed in the United States. Of these, over a quarter will leave their first position in less than a year. While 90% of academic leaders feel nursing graduates are ready for practice, only 10% of clinical leaders agree. Recent changes in health care, and an intensifying theory-practice gap hint that newly licensed nurses (NLNs) may not be equipped for today’s workplace.

Objective: This qualitative project asked, “What do nurse managers and hospital educators perceive as required knowledge, skills and attitudes (KSAs) for NLNs to ensure successful and safe orientation or …