Nursing Commons^™

Full Practice Authority: Determining Readiness Among Nurse Practitioner Students In Mississippi, Betty Hoffman

Doctoral Projects

Full practice authority has been granted to nurse practitioners by many states. These practitioners are educated and trained as full primary providers of health care. Full practice authority for nurse practitioners is not granted in Mississippi, which currently ranks in the lowest positions for health care in the United States. The low ranking can be attributed to a lack of providers and access to services.

This project seeks to explore attitudes and understanding of nurse practitioner students in the State of Mississippi regarding full practice authority. A survey will be electronically distributed to determine what is already known and understood …

Developing An Evidence-Based Preceptor Program To Improve The Orientation Process, Emily Nobles

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Background: Creating a positive experience for the new nurse during the orientation period is vital in ensuring safe practice, employee satisfaction, and improved self-efficacy and retention of the employee long-term. Problem: At a 245-bed acute care hospital in the southeastern United States, nursing retention and preceptor practices have surfaced as an opportunity for improvement. Methods: A quality improvement project involving the implementation of an evidence-based preceptor program with formal preceptor education, preceptor application, and a standardized feedback tool was evaluated to determine the effect on preceptor/preceptee self-efficacy, intent to stay, and preceptor engagement. Results: 10 preceptor-preceptee pairs with previous nursing …

Communicating Comfort In Crisis: A Literature Review On Overcoming The Emergency Room Environment To Foster The Nurse-Patient Relationship, Faith G. Davenport

Senior Honors Theses

The average emergency room patient is not receiving the compassionate nurse-patient communication that patients experience on other hospital floors. Fewer positive nurse-patient interactions prompt patients to state that they feel uncomforted and dissatisfied on hospital exit surveys, inciting hospital management to investigate how to reverse this trend to retain their federal funding. Emergency room nurses cite multiple barriers inherent in their work environment that prevent them from building rapport with their patients, including a layout not conducive to private conversations, strict time constraints, and a fluctuating workload. Working for a prolonged period under these conditions is driving many nurses to …

Understanding How To Promote Healthy Dietary Habits Among Parents Of Adolescents, Jazmine D. Collins

Electronic Theses and Dissertations

Adolescents in the United States today have record-high prevalence rates for childhood obesity and overweight, which are conditions that have lifelong negative health consequences for individuals, and also carry high financial and social costs for the entire nation. The disproportionate burden of obesity and associated health conditions falls on adolescents of racial and ethnic minority group identities and from lower-income households. The increased risk that adolescents have for developing conditions like childhood obesity is closely associated with youth having diets that are unhealthier than in the past. Parents have a large influence on the eating habits and preferences of their …

Reducing Catheter-Associated Urinary Tract Infections: Beyond The Bundle, Deana Cirillo

Student Scholarly Projects

Practice Problem: Catheter-associated urinary tract infections (CAUTIs) are preventable but are still the most common healthcare-associated infection (HAI) worldwide, encumbering the health of patients and escalating financial burden on society (CDC, 2021; Shadle, 2021).

PICOT: In adult patients with spinal cord injury, does direct observation of urinary catheter insertion, compared to the standard of care, reduce the rate of catheter-associated urinary tract infections, within ten weeks of implementation?

Evidence: Multiple factors contribute to Healthcare-Associated Infections (HAIs), but hand hygiene is the most important prevention measure to decrease contact transmission (Gould et al., 2017). The Centers for Disease Control (CDC) clinical …

Evidence-Based Best Practice For Discharge Planning: A Policy Review, Marissa Lewis

Student Scholarly Projects

Ineffective discharge planning produces poor patient healthcare outcomes, potential adverse events, and medical errors. A primary deterrent to successful discharge planning is communication, either within the interdisciplinary team or during handoff to the receiving transition of care facilities of home health, skilled nursing, or acute rehabilitation.

The purpose of the evaluation project was to determine if current policies, communication tools, and workflows of three healthcare organizations were based on evidence and make recommendations for policy revisions. The Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals Model (JHNEBP) was used with the Centers for Disease Control (CDC) Policy Process (POLARIS) …

Perception Is Everything: Implementation Of A Peer Evaluation Program For Nurse Leaders In A Hospital Setting, Teruko Williams

Student Scholarly Projects

Practice Problem: A hospital in the Sacramento County area seeking the ANCC Pathway to Excellence Program^® designation determined upon performing a gap analysis that Element of Performance 2.8, a peer evaluation program, was absent, thus creating a deficiency in the fulfillment of the requirements for the designation.

PICOT: The PICOT question that guided this project was: In nurse leaders (P) how does the development of a formal peer evaluation process (I) compared to no formal process (C), influence the performance outcome score of self-efficacy (O) over 8 weeks (T)?

Evidence: The evidence demonstrated that if a …

Nurse-Driven Protocols For Abdominal Pain In The Emergency Department, Chris Schmidt

Student Scholarly Projects

Practice Problem: Emergency department (ED) crowding hinders the opportunity to deliver safe, quality care to abdominal pain patients and detrimentally affects clinical outcomes. Leadership of a rural community ED recognized a comparable issue by introducing a nurse-driven protocol (NDP) to reduce patient length of stay (LOS) and the rate of patients who leave the department prior to physician evaluation.

PICOT: The PICOT question that guided this project was: For adult patients in an emergency department, how does a nurse-driven protocol for abdominal pain compared to no protocol use affect the LOS and left without being seen (LWBS) rate over 10 …

Prevention Of Central Line-Associated Blood Stream Infection (Clabsi) In Adult Icu Patients, Salima Allahbachayo

Student Scholarly Projects

Practice Problem: Central line-associated bloodstream infections (CLABSI) account for most hospital-associated preventable infections in the United States and globally. Implementation of a multifaceted approach including evidence-based CLABSI bundle care has shown to prevent this infection in patients with a central line.

PICOT: The PICOT question that guided this project was that in adult intensive care unit (ICU) patients, how does the use of central line bundle care compared to central line care without bundle decrease central line-associated bloodstream infections within eight weeks?

Evidence: The evidence from a rigorous literature review showed that using a central line bundle …

Evaluation Of The Clarity, Usefulness And Willingness To Adopt A Joint Military Nursing Professional Practice Model By Military Nurse Leaders, Lozay Foots Iii

Graduate Theses, Dissertations, and Capstones

Abstract

The goal of this project was to evaluate the clarity, usefulness and willingness to adopt a Joint Military Nursing Professional Practice Model by military nurse leaders into the military health system. This paper specifically examined leader feedback and perceptions prior to implementation of the Joint Professional Practice Model (JPPM) into designated pilot sites within the Military Health System (MHS) Nursing environment. This project includes Chief Nursing Officer (CNO) discussions reflecting the clarity of definition of model components, usefulness of the model and its components, and willingness to adopt the JPPM. This information will be used to modify the new …

“This Isn’T Just Busy, This Is Scary”: Stress, Social Support, And Coping Experiences Of Frontline Nurses During The Covid-19 Pandemic, Erin S. Craw, Tess M. Buckley, Michelle Miller-Day

Communication Faculty Articles and Research

Despite having previous experience and extensive trauma training, the COVID-19 pandemic presented unprecedented challenges for nurses working in hospital settings. During the pandemic, nurses struggle to care for patients and protect themselves from infection, while navigating ongoing organizational changes. Guided by prior literature on social support and coping, this study explores nurses’ experiences of coping with stress while treating COVID-19 patients during the pandemic. In-depth semi-structured interviews were conducted with 14 active staff nurses working in hospitals and one licensed practical nurse (LPN) at a rehabilitation center who treated COVID-19 patients during the pandemic. An inductive thematic analysis was employed …

Nurse Practitioner Role Perception, Job Satisfaction, And Anticipated Turnover In The Middle Atlantic States, Jenna R. Sabatino

Seton Hall University Dissertations and Theses (ETDs)

Background: The need for nurse practitioners (NPs) in the US has become very evident in recent years. However, the established significance of NPs in the healthcare system does not ensure that NPs are satisfied with their role. To date, no studies have examined NP job satisfaction in the Middle Atlantic States (MAS), which includes New York, New Jersey, and Pennsylvania. Only one study, thus far, has looked at NP role perception from the NPs own perspective, and was completed in the Midwest region of the US. Similarly, no studies have examined NP anticipated turnover the Mid-Atlantic region of the US. …

Implementation Of An Evidence-Based Bundle To Reduce Hospital Acquired Pressure Injury Harm Rates In The Intensive Care Unit: A Quality Improvement Project, Jessica Tripp

Doctor of Nursing Practice Scholarly Projects

A pressure injury (PI) is a condition in which prolonged pressure or shear causes localized damage to the soft tissue and skin and is usually over a bony prominence (National Pressure Ulcer Advisory Panel (NPUAP), 2016). PIs can increase morbidity and mortality, increase length of stay, increase infection rates, increase healthcare costs and decrease quality of life (Agency for Healthcare Research and Quality (AHRQ), n.d.; Coyer et al., 2017). PIs are largely preventable yet continue to occur, despite the growing number of high-quality research articles that focus on this problem. Quality improvement initiatives are an effective way to translate evidence-based …

Factors Affecting Nurses’ Intention To Leave Their Primary Nursing Position, Scott P. Kaye

Dissertations, Theses, and Capstone Projects

The United States is facing an imminent nurse staffing crisis. An aging workforce, an increasing elder population, and new staffing legislation have added to existing difficulties in retaining nurses. Retaining nurses is a priority in emergency departments, one of the few specialty departments that exceed the national average turnover rate, with an average of 95% of the nursing staff leaving their positions every five years. This dissertation used dual-factor theory, dimensions of nursing surveillance, and intersectionality as theoretical frameworks; employed secondary analysis of the National Sample Survey of Registered Nurses (2018) dataset; and utilized hierarchical regression Modeling to examine the …

Usability Of Health-Related Websites By Filipino-American Adults And Nursing Informatics Experts, Kathleen Begonia

Dissertations, Theses, and Capstone Projects

Filipino-Americans are an understudied minority group with high prevalence and mortality from chronic conditions, such as cardiovascular disease and diabetes. Facing barriers to care and lack of culturally appropriate health resources, they frequently use the internet to obtain health information. It is unknown whether they perceive health-related websites to be useful or easy to use because there are no published usability studies involving this population. Using the Technology Acceptance Model as a theoretical framework, this study investigated the difference between website design ratings by experts and the perceptions of Filipino-American users to determine if usability guidelines influenced the perceived ease …

Qualitative Research In Nursing: Bibliometric Study, Edna Johana Mondragón Sánchez, Patrícia Neyva Da Costa Pinheiro, .Paulo Henrique Alexandre De Paula, Miguel Henrique Da Silva Dos Santos, Adriana Gomes Nogueira-Ferreira, Jose Enver Ayala Zuluaga

The Qualitative Report

In this study, we explored the production of qualitative nursing research in program repositories evaluated by the Coordination for the Improvement of Higher Education Personnel in Brazil, with concepts six and seven. We utilized a bibliometric study in which we considered Brazilian theses and dissertations with qualitative methodology published in 2018 and 2019 with qualitative methodology. In the 100 papers, 79 theses, and 13 dissertations, we identified that the types of studies that stood out were phenomenology, the wording of the objectives predominantly used the verbs “understand,” and “analyze,” and the instruments and techniques used were semi-structured interviews which present …

Fluid State And Diet Control In Patients With Acute Kidney Injury On Hemodialysis, Carolyn Evans-Howard

Master of Science in Nursing Theses and Projects

Prolonged hospitalization, high number of readmissions, and high mortality rates are associated with patients diagnosed with Acute Kidney Injury (AKI). The purpose of this quality improvement proposal is to address the need for more education for nurses caring for these patients. If the kidneys shut down temporarily due to acute illness or medication taken, fluid and toxins will build up in the body with no way of being released. It is proposed that if dietary and fluid restrictions are followed it may help the patient recover faster. The method proposed is to have nurses learn the necessary dietary and fluid …

Nursing Annual Report: 2022, Centracare Health

Nursing Annual Report

Message from the CNO

Message from Central Operations, SVP - St. Cloud Hospital President

St. Cloud Hospital Statistics

Magnet Program Director Message, Nursing Strategic Plan FY 2022

Patient Experience

Nursing Care Delivery

Exemplary Professional Practice

Shared Governance

Working Relationships

Professional Development

Nursing Makes a Difference

It's Time To Break Old Habits: Admitting Stemis To The Telemetry Unit, Teresa Jahn, Tanya Glenz

Nursing Posters

Beginning December 2020 uncomplicated ST-Elevated MI patients will be admitted directly to Telemetry following intervention instead of CICU.

June 2020: Review and develop evidence- based exclusion criteria for admission to Telemetry

June 2020: Create a process for communication between the nursing supervisor, cath lab, Telemetry Unit and CICU for patient placement

Fall 2020: Meeting with Telemetry and CICU charge nurse, nursing supervisor and cath lab RN to discuss communication process

Dec 2020: Begin tracking STEMI patients

• Unit admitted to (Telemetry or CICU/ICU)
• Requiring transfer to CICU/ICU from Telemetry

A Multidisciplinary Approach To Reduce Complications From Blind Small Bore Feeding Tube (Sbft) Insertion, Teresa Jahn, Jennifer Burris, Peggy Lange, Elizabeth Plante, Mithun Suresh Md

Nursing Posters

Between 2019 and 2021, six lung perforations related to blind placement of SBFTs.

A multidisciplinary team reviewed current methods of placing SBFTs and the feasibility of each:

• Fluoroscopy
• 2 Step X-Ray
• Capnography
• Electromagnetic visualization

Capnography was selected as a safe and cost-effective way to attempt to identify insertion location in real time.

• Four team members were selected and trained to insert SBFT using capnography
• Each placement attempt and outcome of placement was tracked
• Outcomes were identified as successful or unsuccessful
• Any adverse events were to be tracked

Open All Hours!: Bariatric Surgery Patients Love Csc, Naomi Schneider, Mallory Mondloch

Nursing Posters

During the fall and winter of 2020, St. Cloud Hospital saw a dramatic increase in the number of COVID-19 patients. Additionally, elective surgeries in Minnesota were on hold during the early months of the pandemic, and later in 2020 there was a significant backlog of these patients, waiting for their procedure. To serve patients and their families, St. Cloud Hospital teams planned for a way to safely and professionally offer surgical care needs to Central Minnesota.

Early Detection Of Sepsis, Holly Kockler, Evalyn Michira

Nursing Posters

The aim for this project was to improve early identification and intervention for sepsis to lower mortality rates and increase sepsis order set usage.

Key Drivers:

• Sepsis mortality rate is higher than compare groups
• Sepsis Order Set utilization is low
• Sepsis core measure performance is below benchmark

Centracare Launch Of Covid Antiviral Therapy, Jessica Miller, Todd Lemke Pharmd, Dennis Heinen Rph

Nursing Posters

• Efficiently monitor the limited available stock of oral antiviral COVID therapies during surge states
• Prescribe safely and appropriately
• Dispense to patients close to home.

Icu Liberation: Early Mobility And Exercise, Leann Volkers, Holly Kockler, Kristi Patterson

Nursing Posters

The aim of this project was to streamline and standardize the delivery of the follow up Important Message from Medicare (IMM) for IP admissions across CC and Carris-RWF in compliance with regulatory standards of care.

Key drivers identified:

• Site specific variation
• Underutilization of Epic functionality
• Use of data to understand performance

Promoting Patient Outcomes: Clabsi Prevention, Woon Paek

Nursing Posters

What is a CLABSI?

“A central line-associated bloodstream infection (CLABSI) is a serious infection that occurs when germs (usually bacteria or viruses) enter the bloodstream through the central line” (CDC, 2021)

Best practices for preventing CLABSIs:

• Perform hand hygiene
• Don proper PPE
• Sterile/aseptic technique during insertion
• Prioritize for cares related to central line first
• Daily assessment for need of central line
• Daily chlorhexidine gluconate bathing
• Remove catheters that are unnecessary
• "Scrub the hub" BEFORE EVERY access
• Change dressings every 7 days or as needed
• Assessment of site/dressing condition
• Change purple Ultrasite caps with dressings
• Tubing changes per CentraCare policy
• Discard …

Innovative Use Of Ehr To Support Admission Screening For Emerging Pathogens, Patricia Dumonceaux Msn, Rn, Cic, Phn, Carolyn Harlander-Zimny, Elizabeth Kiffmeyer, Ellen Simonson, Tamara Welle

Nursing Posters

• CentraCare hospitals were the first in Minnesota to identify a patient with Candida auris (C. auris), an emerging pathogen.
• 2018 Centers for Disease Control and Prevention (CDC) and state health department recommended adoption of enhanced admission screening process to allow for early identification of patients at risk of being colonized with C. auris/Carbapenem-Resistant Organisms (CROs).
• C. auris, a fungus, and CROs, comprised of organisms from the Enterobacteriaceae family resistant to carbapenems, are emerging multidrug resistant pathogens. Emphasis on identification and early isolation of at-risk patients decreases risk of transmission.

Improving The Management Of Tardive Dyskinesia On An Inpatient Mental Health Unit, Jennifer Krebsbach

Nursing Posters

Implement a practice change on the adult mental health unit to improve the accuracy and increase the rate of completion of the abnormal involuntary movement scale (AIMS) for tardive dyskinesia (TD).

Perioperative Glucose Monitoring Protocol, Nicole Helgeson

Nursing Posters

Currently, there is no established glucose management protocol for our surgical patients. Poor outcomes related to hyperglycemia may include increased morbidity/mortality, surgical site infection (SSI), sepsis, renal, and cardiac concerns. The purpose of this protocol is to improve the care and outcomes for surgical patients through a consistent standardization of glucose management.

Purewick External Female Catheter, Elizabeth Kiffmeyer, Mallory Mondloch

Nursing Posters

Catheter-Associated Urinary Tract Infection (CAUTI) rates increased in FY21 compared to FY20, and many units continue to not meet their National Database of Nursing Quality Indicators (NDNQI) target goal even through FY22.

A group of CentraCare stakeholders gathered, including bedside nursing staff, urology techs and nursing leadership, to discuss barriers and areas for opportunity. Representatives from BARD®, our urinary catheter supply company, were invited to conduct an analysis on our urinary catheter/ CAUTI reduction practices. Findings from the analysis included an opportunity to implement an external female catheter.

Icu Liberation: Early Mobility And Exercise, Vanessa Fuller, Andrea Nyquist

Nursing Posters

ICU Liberation:

The Society of Critical Care Medicine’s (SCCM) Intensive Care Unit (ICU) Liberation Bundle was created to reduce the harmful effects of events that occur in the ICU setting. Early mobility and exercise is part “E” of the ICU Liberation Bundle; goals are to reduce ICU and hospital length of stay (LOS), prevent readmissions, reduce discharges to long term care facilities, reduce delirium and coma days, and reduce likelihood of hospital mortality (SCCM, 2021)