Nursing Commons^™

Physician Orders For Life-Sustaining Treatment (Polst) Utilization In A Skilled Nursing Facility: An Educational Quality Initiative, Ryan Hazley Bsn, Rn, Dnp Student, Karl Steinberg Md, Cmd, Joseph Burkard Dnsc, Crna

Doctor of Nursing Practice Final Manuscripts

According to expert reports and recent research, frequent clinician-patient conversations about individual end-of-life preferences are necessary to avoid unwanted treatment and to ensure that desired treatments are received. The ongoing diffusion of Physician Orders for Life-Sustaining Treatment (POLST) educational initiatives in skilled nursing facilities (SNFs) are vital to success of California’s POLST program, which is now recognized as only 1 of 3 mature POLST programs in the country. The purpose of this evidence-based practice project was to answer the question: Among staff in a skilled nursing facility, does implementing a formal POLST education program compared to current practice improve staff …

Breast Cancer Patient Preparedness For Transition To Survivorship: Individualized Survivorship Care Plans, Kimberly Beringer

Master's Projects and Capstones

Purpose. For breast cancer survivors, after-effects of surgery, radiation and chemotherapy can be substantial, and recurrence is a concern requiring constant surveillance. National healthcare organizations have promulgated guidelines that include providing individualized survivorship care plans (SCP’s). At a northern California oncology department, SCP’s will be prepared for breast cancer patients and delivered in-person by the oncology nurse navigator (ONN).

Method. The author worked with the ONN to develop the format and content requirements for the SCP’s. The ONN prepared individualized plans for patients and scheduled in-person appointments to deliver the SCP’s. A feedback survey to assess preliminary impact was then …

I’M A Big Kid Now: Enhancing Transition Rn Residents’ Confidence During Pediatric Patient Care, Emily W. Lam

Master's Projects and Capstones

The title of the clinical nurse leader project is “I’m a Big Kid Now: Enhancing Transition RN Residents’ Confidence During Pediatric Patient Care”. The project aims to improve the support components for Transition RN residents during their Transition RN Residency at Children’s Hospital Los Angeles. The clinical leadership theme that correlates to this project is communication. The clinical nurse leader’s role is to act as an educator and a facilitator throughout this project. In examining the clinical nurse leader competencies, competencies “use performance measures to assess and improve the delivery of evidence-based practices and promote outcomes that demonstrate delivery of …

Process Improvement Manual: Front And Back Office, Hafsah Badar

Master's Projects and Capstones

The global aim of this project is to decrease variations and improve efficiency in the tasks assigned to the support staff at an outpatient breast clinic. The breast center has a five-person administrative team who rotate through four positions monthly. The specific aim is by May 1, 2017, 100% of the five employees will have a comprehensive knowledge of their role, and adhere to a standardized way of completing tasks. The CNL Leadership themes used were Educator, Team Leader Manager, and Outcomes Manager. Informative interviews were conducted with the staff to gauge the unique needs of the team. 100% of …

Nursing Assignments Based On Patient Acuity: The Road To Nursing Job Satisfaction, Kristina Tomic

Evidence-Based Practice Project Reports

Challenges in the healthcare industry, including nursing shortages and low nursing retention, have resulted in nurses’ job dissatisfaction. Improving work environment and workload can lead to improved and equitable nursing shift assignments, which may improve nursing job satisfaction. The purpose of this EBP project was to (a) implement a patient acuity tool in the hospital unit, (b) assess its effectiveness in appropriating nursing shift assignments, and (c) evaluate its effect on nursing job satisfaction. The Evidence Based Medicine (EBM) Model was used as a guide to facilitate the transition of the best evidence into practice. As suggested within the evidence, …

Implementing An Evidence-Based Education Program For Labor And Delivery Nurses In A Community Hospital Setting, Sara E. Humphrey

Graduate Theses, Dissertations, and Capstones

Many factors contribute to the success of an organization. The nursing workforce is the guiding strength behind the delivery of safe patient care resulting in quality outcomes. Preparing the nursing staff to deliver safe care begins with the introduction of evidence based practice as a viable partner to clinical expertise and knowledge. Implementing an evidence based education program is a critical step in the process of integrating evidence into clinical practice. This paper focuses on the implementation of an evidence based education program or Labor and Delivery nurses in a community hospital setting. Evidence based education can promote competency development, …

Combating Workplace Violence: An Evidence Based Initiative, Diana L. Giordano

Evidence-Based Practice Project Reports

Patient/visitor violence against healthcare (HC) employees is a type of workplace violence (WPV) and considered a dangerous hazard within HC occupations (Bureau of Labor Statistics, 2015). Lack of recognition of the true incidence and underreporting of WPV may contribute to a false sense of security within a HC facility (HCF). Therefore, fully addressing the problem may be met with administrative resistance, resulting in poor employee perceptions of support and commitment for a zero-violence environment. A retrospective analysis was conducted on the HCF’s online incident reports, security request calls, and data from a previously deployed WPV employee survey. The emergency department …

The Application Of Grounded Theory: An Example From Nursing Workforce Research, Latoya J. Lewis-Pierre 4572586, Joann Kovacich, Linda Amankwaa

The Qualitative Report

The application of grounded theory was the conduit to theory development in this study. The intent was to explore nurse manager, educator, preceptor, and new graduates’ perceptions of workplace readiness for new graduates entering an Intensive Care Unit. Research participants were drawn from five different ICUs: Medical, Coronary Care, Surgical, Neuroscience, and Trauma. One-on-one interviews were conducted to collect participants’ perspectives on readiness to practice in the ICU. Using grounded theory, four themes emerged giving rise to the novice nurse embracing the ICU theory (NNEIT). Reflections on the type of grounded theory used, reasons for the selection, challenges faced in …

The Relationship Between Just Culture, Trust And Patient Safety, Linda Ann Paradiso, Nancy Sweeney

Publications and Research

PROBLEM: Medical errors are now considered to be the third leading cause of death in the United States, estimated at more than 250,000 deaths per year. The Institute of Medicine’s landmark report, To Err is Human, identified that errors are not the fault of individuals, but systems, processes, and various conditions. In healthcare, the cornerstone of the process by which we learn from errors has been voluntary reporting. The primary barrier to reporting errors is the negative response from administrators, and the potential risk of disciplinary action. An environment of trust and fairness is known as “Just Culture” and …

Implementation Of A Multifactorial Fall Prevention Protocol, Laura Wilkerson

Evidence-Based Practice Project Reports

According to the Joint Commission Center for Transforming Healthcare (2016), moderate to severe injuries from falls on average add 6.3 days to a hospital stay and cost approximately $14,056 per patient hospitalization. The purpose of this evidence-based practice (EBP) project was to implement a multifactorial approach to identify patients at risk for falls on admission to the orthopedic/neurosurgical unit and provide individualized interventions necessary to prevent falls. The Iowa Model of Evidence-Based Practice and Orlando’s Nursing Process Discipline facilitated the implementation of this project. A total of 45 staff members on the unit were educated on the multifactorial fall protocol …

Implementation Of A Standardized Handoff During Transition Of Care From The Emergency Department To The Intensive Care Unit, Melinda Abbring

Evidence-Based Practice Project Reports

Patient safety and nursing communication are crucial to the nursing handoff during transition of care from the emergency department (ED) to the intensive care unit (ICU). The Institute of Medicine published To Err is Human: Building a Safer Health System (1999) and Crossing the Quality Chasm (2001) highlighting ED handoffs as a safety measure. In 2006, the Joint Commission recognized handoffs with the National Patient Safety Goal 2E. The purpose of this evidence-based practice project was to determine if implementation of a standardized handoff would improve nursing communication and patient safety during transition of care from the ED to the …

Pediatric Hematology/Oncology Outpatient Care: The Effect Of A Standardized Collaborative Medication Reconciliation Process, Traci R. Pulliam

Evidence-Based Practice Project Reports

Pediatric patients are at an increased risk for medication errors and can benefit from processes that facilitate and promote medication safety (Stone et al., 2010). Medication reconciliation (Med Rec) is a valuable tool in improving patients’ medication safety and reducing adverse drug events (The Joint Commission, 2015). The purpose of this evidence-based practice (EBP) project was to improve the accuracy of the Med Rec process in a Midwestern pediatric hematology/oncology outpatient clinic by developing, promoting, and evaluating a standardized, collaborative Med Rec process. The Stetler EBP model guided the implementation of the intervention, with the goal of integrating current evidence …

Provider Based Interventions To Mitigate Risk For Opioid Pain Medication Abuse Among Adult Patients In A Primary Care Setting, Sheree Lamara Conley-Donaldson

Doctoral Projects

Mental and substance use disorders are predicted to exceed all physical disease processes causing major disability by 2020. Misuse and overdose of opioid pain medications is a significant public health concern in the United States. Approximately 1 in 4 patients receiving prescription opioids in primary care settings struggle with misuse. Half of all opioid prescriptions are written by primary care providers, including nurse practitioners. The purpose of this DNP project was to determine if nurse practitioner providers are implementing evidence-based practice guidelines including screening, brief intervention, and referral to treatment (SBIRT) to mitigate risk of prescription opioid pain medication misuse …

Factors That Affect Turnover Intention Of Registered Nurses In The Acute Hospital: A Meta-Analysis From 2006-2016, Helen Pagilagan

Doctoral Projects

Multiple complex variables influence nurse turnover. This meta-analysis examines the strength of the relationships between factors that affect turnover intent among staff registered nurses employed in the acute hospital setting in the United States. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) was used to guide the reporting of essential components of this study. Included studies were published in English between 2006-2016, reported study sample sizes, a Cronbach coefficient for the study instruments, conducted quantitative analysis and reported Pearson correlation r values. Two factors affecting turnover intention were found in the four included studies. Statistical analyses show that …

A Quality Improvement Project To Improve Blood Specimen Acceptance Rates In An Emergency Department, Christian Hankins

DNP Projects

Purpose: The purpose of this project was to implement a quality improvement project to improve blood specimen acceptance rates at a specific Emergency Department (ED) using strategies to enhance knowledge, improve motivation, and reinforce skill. Background: Specimen acceptance rates continue to fall outside of the recommended target rate of 98% or higher at a specific ED. In this particular ED, the responsibility for specimen collection has shifted away from phlebotomists and towards nurses, many of whom have received little to no phlebotomy training. Without proper blood collection techniques, specimens are more likely to be rejected, and re-collection of rejected blood …

An Assessment And Analysis Of The Complexity Of The Frontline Nurse Leaders' Role, Robert Alan Vos

Doctoral Projects

Purpose: The purpose of this research study is to identify frontline nurse leaders' perception of their role, to have them assess their skills in relationship to that role and to identify knowledge needs and gaps that they face in fulfilling their role.

Design: This doctoral research explored the role of the frontline nurse leader. The research was a quantitative survey, non-experimental, descriptive, cross-sectional onetime study. The survey studied the self-assessment of the frontline nurse leader's role and their rating of noted complexities and challenges in their role.

Methods: A survey tool was developed using thirty statements. The statements covered the …

Staff Nurse Perception Of Professional Role Modeling For Student Nurses In The Clinical Learning Environment, Tamara Montgomery

Doctor of Nursing Practice Scholarly Projects

Acute care settings continue to be the primary setting for undergraduate nursing education clinical experiences. Staff nurses in acute care settings are expected to provide nursing care with pre-licensure nursing students at their side (even though there are little to no incentives for staff nurses to provide mentoring leadership), which most often takes the form of professional role modeling. In addition, there is no clear evaluative expectation that motivates staff nurses to provide contextual role modeling. Without stated expectations, staff nurse perception of the significance of role modeling for pre-licensure non-precepted nursing students may be deficient.

Because fifty-six percent of …

Poster: Communication Strategies For The School Nurse Mentor: A Pilot Training Program, Amy Hotler Dnp, Rn, Lsn, Aphn-Bc

Doctor of Nursing Practice Scholarly Projects

Mentorship has widespread support among many disciplines for the impact on improved job satisfaction, decreased job turnover and decreased costs to organizations. Ongoing support through mentorship is critical to nurses transitioning to a new role and nurse mentors must be prepared for the role with relevant education tailored to their needs . Though literature describing training programs for mentors is limited, some studies have reported an increase in confidence among mentors after training. In addition, improved mentoring skills (that includes communication) is in literature.

In one large urban school district in Ohio, a school nurse, mentorship program was developed and …

Communication Strategies For The School Nurse Mentor: A Pilot Training Program, Amy Hotler Dnp, Rn, Lsn, Aphn-Bc

Doctor of Nursing Practice Scholarly Projects

Mentorship has widespread support among many disciplines for the impact on improved job satisfaction, decreased job turnover and decreased costs to organizations. Ongoing support through mentorship is critical to nurses transitioning to a new role and nurse mentors must be prepared for the role with relevant education tailored to their needs. Though literature describing training programs for mentors is limited, some studies have reported an increase in confidence among mentors after training . In addition, improved mentoring skills that includes communication is in literature.

In one large urban school district in Ohio, a school nurse, mentorship program was developed and …

Analyzing Organizational Commitment And The Effect On Job Turnover In Nurse Residents, Cory D. Church

Nursing Theses and Dissertations

This dissertation is an exploration of psychosocial concepts related to the experiences of a vital health human resource, newly licensed registered nurses. Newly licensed registered nurses are at risk for leaving their first job within the first year due to the difficulty of transitioning to practice. The pressure to gain competence and deliver quality care, all while navigating the workplace environment, can impact their commitment to an organization and the profession. The reader will notice these concepts threaded throughout the dissertation. While these concepts are explored in other nursing workforce populations, the researcher determined a gap in the research on …

Developing A Nursing Peer Review Program For Nurse Leaders, Holli D. Roberts

Graduate Theses, Dissertations, and Capstones

Abstract

Peer review is described as a best practice in assessing professional competence for all levels of nurses. However, barriers exist in implementing peer review among nurses in leadership roles. Nurse leaders have limited interactions to observe how others manage their units making assessment of professional competence difficult. A gap analysis of peer review in an acute care hospital revealed a need to revise the peer review program for nurse leaders. The American Organization of Nurse Executives list of leadership competencies was used as a framework to revise peer review instruments for the nurse leaders. Each instrument included a self-assessment …

Compassion Satisfaction And Compassion Fatigue Among Pediatric Nurses And The Impact On Patient Satisfaction, Maribeth Thornton

Nursing ETDs

Compassion fatigue and compassion satisfaction are two inter-related concepts. Individuals in helping professions may occasionally face compassion fatigue from giving so much of themselves to others. Compassion fatigue has been studied in a variety of settings: medical, social work, nursing, law enforcement, and fire departments, to name a few. While some researchers have studied nurses, little published work has focused exclusively on nurses who care for specialty pediatric populations. Additionally, there is scant research on whether compassion satisfaction and compassion fatigue are associated with patient satisfaction. The purpose of this study was to determine the level of compassion satisfaction and …

An Assessment Of Errors And Near-Misses From Pre-Licensure Student Nurses, Megan Wolfe, Dnp, Fnp-C, Ms Ed., Rd, Rn, Cne

Doctor of Nursing Practice Projects

Background: Approximately one-half of new nurses with less than one year of experience who were involved in adverse patient events identified that their formal education preparation was a causal factor in their error (Saintsing, Gibson & Pennington, 2011). An examination of quality and safety measures of a current hospital based associate degree nursing (ADN) educational program provided data regarding errors committed by prelicensure students. Tracking and analysis of frequency and type of student clinical errors provided for identification of similarities and an opportunity for system evaluation and improvements.

Objectives: To identify the number, types and categories of Student …

Screening, Brief Intervention And Referral To Treatment Implementation In The Emergency Department, Arvind Venkat Md, Gary Shank Phd, Sherry Rickard-Aasen, Janice Pringle Phd, William Johnjulio Md

The Qualitative Report

We sought to qualitatively evaluate impediments in implementing a novel Screening, Brief Intervention and Referral to Treatment (SBIRT) protocol into normal emergency department (ED) workflow for patients with at-risk drug/alcohol behavior. From 2010, administrative and nursing champions trained nurses at a single ED (census: 50,000 visits/yr) in SBIRT and incorporated SBIRT into normal ED nursing workflow in 2012. To qualitatively analyze impediments in SBIRT implementation, we created a semi-structured questionnaire for protocol champions with subsequent follow-up. Investigators analyzed responses using qualitative methodology based on a modified grounded theory framework. In 2012, 47693 visits by 31525 patients met SBIRT protocol initiation …

Communicative Behaviors Elicited By Leisure Activities In Memory Care Units, Tarynn Clune

Honors Projects

A wide variety of leisure activities used in reminiscence care have been studied for their merits in terms of preventing cognitive decline, and increasing quality of life; however, little is known about what different types have to offer in terms of communicative opportunities. Communication with peers is imperative for quality of life, and is crucial for maintenance of relationships between the person with dementia (PWD) and their loved ones. As a result of this importance, an exploration of communication elicited by different activities facilitated in a unit was conducted. The communication explored in this study was solely vocal, and included …

Improving Patient Safety Through High Reliability Organizations, Jared Padgett, Kenneth Gossett, Roger Mayer, Wen-Wen Chien, Freda Turner

The Qualitative Report

Preventable medical errors result in the loss of 200,000 lives per year with associated financial and operational burdens on organizations and society. Widespread preventable patient harm occurs despite increases in healthcare regulations. High reliability organization theory contributes to improved safety and may potentially reverse this trend. This single case study explored the introduction of a safety culture and subsequent improvements in patient safety in a reliability-seeking organization. Fourteen participants from a subacute nursing facility were selected using purposeful sampling criterion. Data were collected through participant interviews, document reviews, and group observation. Five themes emerged from an analysis of collected data …

Warmth And Competence Traits: Perceptions Of Female And Male Nurse Stereotypes, Randolph E. Gross

Dissertations, Theses, and Capstone Projects

A nursing shortage looms ahead; 1.03 million new nurses will be needed by 2022 to meet society's healthcare needs. A major barrier to recruitment of women and men are nurse stereotypes. The literature suggests four female and four male stereotypes exist; however, no quantitative research exists that explores perceptions of non-nursing undergraduate students. Approximately, 90% of college students do not consider nursing as a career option, and 72% have misconceptions of what nurses do in reality.

According to social cognitive theory's Stereotype Content Model (SCM), perceptions are viewed through a combination of two dimensions: warmth and competence. The author devised …

Transformational Leadership Assessment Of Nurse Managers And Assistant Nurse Managers, Susan Braun Duggar

Nursing Theses and Capstone Projects

Transformational Leadership behaviors are essential to build and sustain a healthy work environment in healthcare. Nurse Managers who possess transformational leadership behaviors lead nursing teams with a higher degree of engagement, work satisfaction, and retention. The purpose of this project was to perform an assessment of transformational leadership characteristics among nurse managers and assistant nurse managers, develop an educational program to teach transformational leadership behaviors, and incorporate a transformational leadership assessment into the orientation onboarding process of new nurse managers and assistant nurse managers. The Full Range Leadership Model (FRLM) asserts leaders should use multiple leadership characteristics or behaviors to …

Adult Qdts, Chinese, Marianne E. Weiss, Binghua Wang

Quality of Discharge Teaching Scale

The Readiness for Hospital Discharge Scale, Quality of Discharge Teaching Scale, and Post-Discharge Coping Difficulty Scale were developed by Dr. Marianne Weiss to measure nurse-sensitive discharge care processes and patient outcomes. Three versions of the scales were developed concurrently for different patient populations – Adult medical-surgical patients, Parents of hospitalized children, and Postpartum Patient mothers (see Weiss & Piacentine, 2006, Weiss et al., 2007, and Bobay et al., 2018 for description of the development and initial testing). Additional scales and information about translation rights are located at Marquette Nursing.

PERMISSION TO USE

The Readiness for Discharge Scale, Quality of Discharge …

Risk Of Medication Errors In The Home: An Integrative Literature Review, Maria M. Crescenzi

Honors Undergraduate Theses

Regardless of the setting, medication errors are of great concern when associated with an individual’s health outcomes, along with the increased costs to society, healthcare institutions, and providers. Current research focuses on medication error data primarily in acute and extended care facilities. However, there is a paucity of research examining the causes of medication errors that occur post hospital discharge when individuals transition to the home. The purpose of this integrative literature review is to examine risk factors for medication errors outside of these settings, specifically in the home. A systematic literature search was conducted using multiple databases for relevant …