Nursing Commons^™

Implementing A Rib Fracture Management Pathway And Pic Scoring Tool To Reduce Icu Readmissions, Susan Mastroianni

Master's Projects and Capstones

The purpose of the project was to improve the management of patients with rib and or sternal fractures in a 413 bed Level I Trauma Center. The pathway included best practice guidelines paired with clinical expertise to reduce Intensive Care Unit (ICU) readmissions, costs, complications and length of stay (LOS). Analysis of the data revealed 55% of ICU readmissions were due to respiratory causes. The timeline guided the creation, deployment, and evaluation of the project over a two phase, one and one half year period. Methods included analysis of the data, meetings with lead team members to define the scope …

Prospectus Summary Brief: Nicu Communication Improvement, Joy E. Lawley

Master's Projects and Capstones

Joy Lawley RNC, NICU Communication Improvement: A prospectus summary brief. Effective communication in the neonatal intensive care unit (NICU) not only reduces errors and adverse patient outcomes but also create an environment that promotes staff satisfaction. The purpose of this prospectus is that of improving the process of communication between the perinatal departments. The specific aim was to improve communication to the NICU through standardize communication tools (SBAR) from patient delivery to discharge starting April 1, 2015. With 100% participation of all staff members within a three month period and a 95% staff satisfaction related to improved communication from staff …

Perinatal Patient Management, Natalie Whitten

Master's Projects and Capstones

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

Improving Hand Hygiene Compliance To Reduce Clabsi Rate In Oncology Icu, Lorenzo D. San Pedro

Master's Projects and Capstones

The aim of this project is to reduce the rate of central line associated blood stream infection (CLABSI) occurrence in oncology ICU by 50% by the last quarter of 2015. This study was conducted in ICU to assess adherence to the facility’s hand hygiene (HH) protocol among the staff nurses and allied healthcare workers. The facility is best known as a non-profit cancer treatment center and designated as a Comprehensive Cancer Center. Evidence showed that hand hygiene is the most effective way of preventing CLABSI, one of the most common types of infection in ICU microsystem. The project utilized The …

Emergency Response Improvement Project, Ewan Stephen Macdonald

Master's Projects and Capstones

The objective of this CNL internship project is to improve team response to emergencies through staff education and protocol development with 100% participation within six months. This need was determined after an intense analysis following a near code on a pediatric patient. After an investigation, two problems were chosen as a focus for improvement: limited educational opportunities, and poor coordination and delegation during codes. Lewins’s theory of change was used as the theoretical framework, which involves the concept of unfreezing, movement, and refreezing. The method utilized was to offer education and training sessions twice per month in the form of …

Improving Dental Care To The Elderly In A Nursing Home, Cara M. Licavoli

Master's Projects and Capstones

The project is about the collaboration between Peninsula Health Care District (PHCD) and Apple Tree Dental (ATD) in a team approach to address the current issues of improving dental care of frail and elderly patients in nursing home facilities. The specific aim is to improve dental care of clients at the San Mateo County nursing home facility by 100% by May, 2015. The methods use in this project was the adaptation and implementation of existing dental/oral health assessment tools, that is nurse driven for patient assessment upon admission to the nursing facility. The process includes staff education regarding the adapted …

Delirium Education For Nurses On A Medical-Surgical Unit, Carole Santos

Master's Projects and Capstones

Failure to recognize delirium compromises patient safety and may lead to harmful outcomes. By June 2015, nurses on medical-surgical units will screen 100-percent of patients for delirium according to an established protocol. The project mesosystem is a 411-bed, level I trauma center and teaching hospital; the microsystem is a 28-bed medical-surgical telemetry unit.

An audit of microsystem data collected over four months in 2014 revealed that delirium was consistently underidentified (10% in September, 26% in October, 34% in November, and 22% in December), suggesting that medical-surgical nurses were not equipped to effectively perform delirium screening.

Nursing education consisting of bedside …

Pre-Exposure Prophylaxis (Prep) Education Improvement Project, Reginald M. Hilarie

Master's Projects and Capstones

In 2012, the US Food and Drug Administration approved the pill Truvada for use as pre-exposure prophylaxis or PrEP. Its purpose is to help prevent HIV infection by taking one pill every day. This project aims to improve PrEP patient education provided by the multi-disciplinary team and to decrease new HIV infection and sexually transmitted infections (STIs) to zero. The focus of the study is patients on PrEP at the Infectious Disease and HIV Clinic in San Francisco Veterans Administration Medical Center. The Clinical Nurse Leader, in collaboration with the multidisciplinary team, incorporated Pender’s Health Promotion Model Theory in developing …

Patient Engagement In Transitional Care, Sheeree Dela Pena

Master's Projects and Capstones

The Clinical Nurse Leader Master’s project was conducted about a public health program called the Transitional Care Program that was working in partnership with a county hospital system, Santa Clara Valley Medical Center. The specific aim was to reduce hospital re-admissions of high-risk patients by supporting patient motivation and engagement in the Transitional Care Program by May 2015. Over a four-month period, data was collected through ten client visits, interviews with two public health nurses, information available about the program, and current research conducted on transitional care, hospital discharges, and patient engagement. Various aspects of the program were assessed, such …

In-Patient Self-Management Diabetes Education, Amy Matthews

Master's Projects and Capstones

The diabetes program strives to provide diabetes self-management education to the in-patient with diabetes. The specific aim is to improve and standardize diabetes education for the inpatient with diabetes by June 2015. The microsystem is a medical surgical unit for patients 18 years and older who present with diabetes as either a primary diagnosis or secondary diagnosis. Fifty percent of the diabetes patients on this unit are ages 65-89 years old, twenty nine percent are ages 50-64. The unit has 32 beds and is filled to capacity ninety five percent of the time. The fishbone diagram revealed our microsystem lacked …

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

Master's Projects and Capstones

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

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

Improving Care Of Assisted Living Residents With Dementia Through A Competency-Based Behavioral Training Curriculum For Assisted Living Caregivers, Mary Ann Z. De Vera

Doctor of Nursing Practice (DNP) Projects

Behavioral and psychological symptoms of dementia (BPSD) are common among residents of assisted living facilities. Inadequately managed symptoms of BPSD can lead to problematic behaviors with significant consequences for patients and caregivers. Non-pharmacologic approaches to the management of problematic behaviors in individuals with dementia are the preferred management option. Caregiver training and education to enhance knowledge and skills in managing behavioral and psychological symptoms for assisted living caregivers is indicated to provide optimum care for patients with dementia. The purpose of this doctor of nursing practice (DNP) project was to develop and implement a caregiver-training workshop utilizing a competency-based behavioral …

Assessing The Cultural In Culturally Sensitive Printed Patient-Education Materials For Chinese Americans With Type 2 Diabetes, Evelyn Y. Ho, H Tran, Catherine A. Chesla

Communication Studies

Type 2 diabetes affects Chinese Americans at an alarming rate. To address this health disparity, research in the area of cultural sensitivity and health literacy provide useful guidelines for creating culturally appropriate health education. In this article, we use discourse analysis to examine a group of locally-available, Chinese and English language diabetes print documents from a surface and deep structure level of culture. First, we compared these documents to research findings about printed health information to determine if and how these documents apply current best practices for health literacy and culturally appropriate health communication. Second, we examined how diabetes as …

Mobile Nurse Practitioner: A Pilot Program To Address Service Gaps Experienced By Homeless Individuals, Joan Alviar Fraino

Nursing and Health Professions Student Research and Publications

An estimated 2.3 to 3.5 million individuals are homeless in the United States, many of whom have chronic medical and mental illnesses. Underserved individuals who are homeless experience gaps in services, resulting in poor health care outcomes and readmission to the hospital setting, often presenting in crisis through the emergency department. The financial state of hospitals is negatively impacted by the burden of patients returning to the hospital due to unresolved issues. The current article presents the role of a psychiatric-mental health nurse practitioner as part of a pilot program, Opportunity Village Mobile Health, that provides a comprehensive approach to …

Auditory Hallucinations Interview Guide: Promoting Recovery With An Interactive Assessment Tool, Louise Nigh Trygstad, Robin Kay Buccheri, Martha D. Buffum, Dau-Shen Ju, Glenna A. Dowling

Nursing and Health Professions Faculty Research and Publications

Auditory Hallucinations Interview Guide: Promoting Recovery with an Interactive Assessment Tool Abstract The Auditory Hallucinations Interview Guide (AHIG) is a 32-item tool to help psychiatric-mental health nurses assess the past and current experience of each voice hearer so they can provide more individualized care. This tool was developed as a research tool but has been found clinically useful in both inpatient and outpatient settings to help voice hearers and nurses develop a shared terminology of auditory hallucinations. Using the AHIG, voice hearers are able to tell their story in a structured and safe environment that encourages recovery. Through respect and …

A Feasibility Pilot Study On The Use Of Complementary Therapies Delivered Via Mobile Technologies On Icelandic Surgical Patients' Reports Of Anxiety, Pain, And Self-Efficacy In Healing, Margaret M. Hansen Edd, Msn, Rn

Nursing and Health Professions Faculty Research and Publications

Background Complementary therapies (CT), such as relaxation technique, massage, guided imagery, and accupuncture have shown to benefit patients undergoing surgery. The aim of this study was to determine the feasibility of using audio relaxation technique (ART), music intervention (MI), nature video application with music (NVAM), and nature video application without music (NVA) delivered via mobile technologies in a clinical setting. Secondary, the effects of ART, MI, NVAM and NVA on patients’ state anxiety, pain perception, and perceived self-efficacy in healing were determined. Methods A randomized clinical trial (RCT) involving 105 same day surgery (SDS) patients, who were assigned to an …

Utilization Of Clinical Practice Guidelines: Barriers And Facilitators, Melanie R. Keiffer

Nursing and Health Professions Faculty Research and Publications

Key points

• Clinical practice guidelines are tools used to assist health care professionals in clinical decision making with the ultimate goal of improving patient care.

• Promoting the implementation of clinical practice guidelines at the point of care delivery is a hurdle to translating scientific findings into practice.

• As access to electronic evidence sources increase, the amount of evidence available to clinicians for clinical decision support is overwhelming.

• Increased adoption of electronic health records and clinical decision support tools will move clinical practice guidelines more rapidly to the patient encounter.

The Association Between Self-Rated Mental Health Status And Total Health Care Expenditure: A Cross-Sectional Analysis Of A Nationally Representative Sample, Muoi T. Nguyen, Winnie Y. Chan, Courtney Keeler

Nursing and Health Professions Faculty Research and Publications

Both clinical diagnoses and self-rated measures of mental illness are associated with a variety of outcomes, including physical well-being, health utilization, and expenditure. However, much of current literature primarily utilizes clinically diagnosed data.

This cross-sectional study explores the impact of mental illness and health care expenditure using 2 self-rated measures: self-rated measured of perceived mental health status (SRMH) and Kessler Screening Scale for Psychological Distress (K6).

Data from the 2011 Medical Expenditure Panel Survey Household Component, a nationally representative sample of noninstitutionalized individuals (n = 18,295), were analyzed using bivariate χ² tests and a 2-part model (logistics regression and …

Scaled-Up Mobile Phone Intervention For Hiv Care And Treatment: Protocol For A Facility Randomized Controlled Trial, Kelly L'Engle, K Green, S M. Succop, A Laar, S Wambugu

Nursing and Health Professions Faculty Research and Publications

Background: Adherence to prevention, care, and treatment recommendations among people living with HIV (PLHIV) is a critical challenge. Yet good clinical outcomes depend on consistent, high adherence to antiretroviral therapy (ART) regimens. Mobile phones offer a promising means to improve patient adherence and health outcomes. However, limited information exists on the impact that mobile phones for health (mHealth) programs have on ART adherence or the behavior change processes through which such interventions may improve patient health, particularly among ongoing clients enrolled in large public sector HIV service delivery programs and key populations such as men who have sex with men …

Effects Of A Mental-Health Clinical Simulation Experience Using Standardized Patients And Two Debriefing Styles On Prelicensure Nursing Students' Knowledge, Anxiety, And Therapeutic Communication And Psychiatric Assessment Skills, Debrayh Gaylle

Doctoral Dissertations

The purpose of this quasi-experimental pretest-posttest study was to compare the effects of two debriefing styles (insimulation and postsimulation) on (a) students’ knowledge of psychiatric assessment and therapeutic communication, (b) students’ performance of a psychiatric assessment using therapeutic communication, (c) students’ perceived anxiety related to a clinical rotation in psychiatric mental-health, and (d) students’ perceptions of the efficacy of the insimulation debriefing. The participants (n = 67) were senior, prelicensure nursing students enrolled in a baccalaureate degree program. Students were assigned randomly to either the treatment or the compression group and participated in a series of simulated interviews using student …

Reliability And Validity Of A Tool Measuring Preceptor Evaluations Of Competencies Among New Rn Graduates In A Transition-To-Practice Program, Susan K. Prion, A Berman, Arthur Karshmer, P Van, J Wallace, N West

Nursing and Health Professions Faculty Research and Publications

Four transition-to-practice programs for new RN graduates who had not yet found employment in nursing were based on the Quality and Safety Education for Nurses (QSEN) competencies of knowledge, skills, and attitudes (KSAs). To support consistent evaluation of participants by preceptors, a 35-item tool was developed that used a 4-point scale to assess selected behaviors. This article describes the initial reliability and validity testing of the tool, which had good internal consistency, with a Cronbach's alpha of 0.92 for preceptor evaluation of participants and 0.82 when used as a self-evaluation tool. Six content experts evaluated the tool's face validity; it …

Critical Cultural Awareness And Diversity In Nursing: A Minority Perspective, Chenit Ong-Flaherty

Nursing and Health Professions Faculty Research and Publications

Increasing multiculturalism and ongoing issues related to poor patient-centered care, teamwork, and safety call for urgent readdressing of cultural competency training. Critical cultural awareness education is needed to improve diversity in the nursing profession. Using Hofstede’s cultural dimension of Invidualism-Collectivism, this paper proposes that the dominance of one culture may be the contributory factor in the slow acceptance of change towards critical cultural awareness education. Experiential learning by way of gaming and critical reflection on cross-cultural interactions can contribute to the development of critical cultural awareness.

Job Satisfaction And Horizontal Violence In Hospital Staff Registered Nurses: The Mediating Role Of Peer Relationships, Christina Purpora, Mary A. Blegen

Nursing and Health Professions Faculty Research and Publications

Aims and objectives

To describe the association between horizontal violence and job satisfaction in hospital staff registered nurses and the degree to which peer relationships mediates the relationship. Additionally, the association between nurse and work characteristics and job satisfaction were determined.

Background

Horizontal violence is a major predictor of nurses' job satisfaction. Yet, not enough is known about the relationship between these variables. Job satisfaction is an important variable to study because it is a predictor of patient care quality and safety internationally. Peer relationships, a job satisfier for nurses, was identified as a potential mediator in the association between …

A Cross Sectional Exploration Of Emotional Intelligence In Us Baccalaureate Nursing Students, Marcianna Nosek

Nursing and Health Professions Faculty Research and Publications

Objective: New nurses may be vulnerable to bullying as they often lack confidence or do not have the skills or maturity to communicate their needs or those of their patients. Increasing emotional intelligence particularly in at-risk nursing students may be one way to foster resiliency. This exploratory cross sectional study aimed to exam the overall level and specific components of emotional intelligence as well as associations with age, ethnicity, gender, or academic standing in baccalaureate nursing students.

Methods: A cross sectional analytical study was conducted using a paper demographic survey and an online emotional intelligence (EI) instrument, the …

Recommendations For Enhancing Psychosocial Support Of Nicu Parents Through Staff Education And Support, S L. Hall, J Cross, Nancy Selix, C Patterson, L Segre, R Chuffo-Siewert, P A. Geller, M L. Martin

Nursing and Health Professions Faculty Research and Publications

Providing psychosocial support to parents whose infants are hospitalized in the neonatal intensive care unit (NICU) can improve parents’ functioning as well as their relationships with their babies. Yet, few NICUs offer staff education that teaches optimal methods of communication with parents in distress. Limited staff education in how to best provide psychosocial support to families is one factor that may render those who work in the NICU at risk for burnout, compassion fatigue and secondary traumatic stress syndrome. Staff who develop burnout may have further reduced ability to provide effective support to parents and babies. Recommendations for providing NICU …

Use Of Root Cause Analysis In Nursing Education: Best Practice From The Quality And Safety Officer, Elizabeth E. Cooper, Susan Pauly-O’Neill

Nursing and Health Professions Faculty Research and Publications

Teaching nursing students to be safe in practice is a key element to any nursing curriculum. This article will discuss the use of a Root Cause Analysis (RCO) framework with prelicensure nursing students, by the Quality and Safety Officer (QSO) in a School of Nursing and Health Professions, as a method to enhance transparency and improve patient safety. The aim is to provide a rationale for using this strategy, to identify the steps of a root cause analysis, to disclose barriers to its successful use, and to explore dissemination to the partnering healthcare environments.

The Effect Of Simulation With Debriefing For Meaningful Learning In Courses Of Nursing Theory And Practicum On Student Knowledge And Perception Of Instruction, Kathleen L. Shea

Doctoral Dissertations

Nursing students are expected to apply knowledge from lectures and laboratories to the clinical setting. One major challenge of nursing educators is facilitating the transfer of knowledge to the clinical-practice setting. Simulation-based education provides students with an experiential-learning activity within the context of a simulated clinical environment. Following the simulation activity, the instructor facilitates a debriefing session and guides student discussion and reflection related to the experience. Debriefing promotes understanding of nursing concepts (Benner, Sutphen, Leonard, & Day, 2010).

The purpose of this research is to compare two debriefing methods: traditional method and Debriefing for Meaningful Learning DML (Dreifuerst, 2012). …

Just Sit For A Bit: A Moment Of Caring, Gabrielle M. Malouf

Master's Projects and Capstones

Background: Research shows that time spent sitting at the bedside promotes trust, which ultimately improves nurse satisfaction, patient satisfaction and patient outcomes. Patient satisfaction scores have been below benchmark for several months on an adult medical unit at an academic medical center.

Overview: The purpose of this project was to improve patient satisfaction in the areas of nursing courtesy, friendliness, and listening. Nurses were asked to sit down for at least 5 minutes per shift with each patient, engaging in a “moment of caring”. Nurse surveys were given and both pre and post implementation. These surveys assessed whether or not …

Fall Prevention Through Proactive Toileting, Kristin Smith

Master's Projects and Capstones

This paper will summarize the quality improvement falls prevention project conducted by a University of San Francisco Clinical Nurse Leader student. Falls in the hospital setting are an ongoing problem in our healthcare system as they have great physical and financial impacts (Salamon, Victory, & Bobay, 2012). Hospital A, an urban teaching hospital, uses the Schmid scale for determining if a patient is a fall risk which includes the assessment of need for ambulatory aids, history of falls, and impaired cognition among other criteria (Schmid,1990). Fall rates are climbing in the United States and the trend is similar on Hospital …

Outpatient Medication Error Improvement, Savannah M. Klinginsmith

Master's Projects and Capstones

Patient Safety Initiative -Improving Medication Administration (Outpatient Care)

SPECIFIC AIM: We aim to Improve the medication administration process and involve all staff within 6 months

In the microsystem consisting of 14 family practice and urgent care clinics, there is not a standard process based on evidence based practices for medication administration. With and estimated of 400-600 medications (immunizations included) being administered per day, without a standard of care protocol, the risk for medication errors is evident.

Objectives and changes anticipated based on implementation of the project is to engage staff in support for improving medication administration standard of care based …