Nursing Commons^™

#Leadershipaccelerated: A Coach Mindset Focused Leadership Development Program, Diane Rindlisbacher

Doctor of Nursing Practice (DNP) Projects

Problem: Developing leaders to lead in environments that are dynamic, complex, and ambiguous is an area of focus for healthcare leaders. How leaders lead and how organizations develop leaders is tied to the outcomes they achieve (Development Dimensions International [DDI], 2019; Moldoveanu & Narayandas, 2019; Till, Dutta, & McKimm, 2016). To create a climate of trust and safety where teams succeed requires leaders to embed key attributes and competencies into their day-to-day work.

Context: A leader’s ability to create a climate of trust and safety and to adopt and apply a coach mindset to their work is intended to help …

Illicit Substance Use In Acute Care Hospitals: Creating A Safe Environment, Christina Sanford

Doctor of Nursing Practice (DNP) Projects

Problem: In January 2019, a medium-sized acute care hospital in Northern California reported new safety concerns related to patients using illicit substances in the hospital.

Context: Leaving the hospital AMA is an increasing problem in acute care hospitals among patients who use illicit substances, with a rate of 25% to 30% (Ti & Ti, 2015). Grewal et al. (2015) conducted a study of over 1,000 illicit substance users who had experienced a hospitalization, where 43.9% reported use of illicit substances while in the hospital.

Intervention: The project was the creation, implementation, testing, and evaluation of multiple interventions to improve …

Application Of Sustainability Framework For Quality Improvement In An Integrated Health System, Cristine Lacerna

Doctor of Nursing Practice (DNP) Projects

Problem: Sustaining improvement in quality and patient safety is a critical challenge confronting healthcare today (Lennox, Maher & Reed, 2018). Failure to sustain the gains achieved with the improvement and results in harmful patient outcomes, wasted resources, and impact future improvement work (Lennox et al., 2018). Context: To address this challenge, the organization for this DNP project was a large, integrated healthcare system with 21 medical centers in Northern California with a redesigned a regional quality program to focus primarily on supporting the sustainability of patient safety initiatives that have been successfully implemented and spread. Interventions: Two frameworks from the …

Implementing Virtual Sitters To Reduce Falls And Sitter Costs, Asia Quovadis Williams Plahar

Doctor of Nursing Practice (DNP) Projects

The setting for this DNP project was a 326-bed, suburban hospital in Northern California that was facing challenges with preventing falls with injury and rising sitter costs. Between May 2018 and June 2019, there were four sentinel events related to falls with significant injuries. This hospital was financially impacted by the growing cost of the expanding sitter program caused by the rising elderly patient population, with demographics requiring one-to-one, in-person sitters to observe them visually. There is ample research demonstrating the utility of video monitoring systems to improve patient safety by reducing falls, enhancing staff safety by reducing workplace injuries …

Workplace Violence: An Urgent Call For Integrated Staff Education In Acute Care Hospitals, Nicole Bellisario

Doctor of Nursing Practice (DNP) Projects

Problem: Type II workplace violence (WPV) in acute care hospital settings has become an epidemic of costly proportions in the United States. Regulatory mandates and healthcare accreditation standards increasingly require healthcare employers to provide a safe and healthy healing environment for patients and a safe work environment for staff. Implementation of a comprehensive WPV prevention program depends largely on organizational culture, participation and commitment from key stakeholders, and readiness for change.

Context: The patient-clinician relationship has drawn urgent attention, as healthcare organizations around the world implement key components of WPV prevention programs. The clinical management of patient aggression …

Using Simulation For Oncology Nursing Competency Evaluation In Hospitals, Dana Littlepge

Doctor of Nursing Practice (DNP) Projects

Problem Oncologic patients requiring acute nursing care are usually admitted to the designated oncologic medical surgical nursing unit, these care settings often have low admission volumes of oncologic patients that require chemotherapy and or post-therapy care (Muehlbauer, Parr, & Perkins, 2013). Nurses in these environments have reported decreased professional confidence and not feeling safe enough to administer chemotherapy, monitor, and care for cancer patients (Muehlbauer, Parr, & Perkins, 2013).

Context: The current education structure for many hospitals in an integrated healthcare system, does not consistently provide all the components needed for an onsite oncologic nursing competency validation program. Developing a …

Improving Frequency Of Hand Hygiene Education From Providers To Patients, Christopher Sutton, Nancy Moran, Vanessa Hernandez

Master's Projects and Capstones

Hand hygiene compliance is one of the most simplest forms of preventing infection. This paper focuses on improving the frequency and standardizing hand hygiene education to patients delivered by health care professionals from a primary care clinic. The ambulatory suburban community clinic in Oakland primarily serves the underserved population. The target population are the following providers: Physicians, Physician Assistants, Nurse Practitioners, Registered Nurse, Licensed Practical Nurse, and Medical Assistants. A survey was adapted from evidence-based studies, WHO, and CDC to collect data on current hand hygiene education provided to patients from healthcare professionals. An additional survey was given to patients …

Nurse Interrupted: Educating Nurses To Reduce Work Interruptions In The Intensive Care Unit, Lelayitu Shiferaw

Master's Projects and Capstones

Background: Interruptions occur in high frequency in the critical care hospital setting.

The purpose of this study is to understand the impact of work interruption for the critical care nurse and to examine ways to mitigate predominant, non-urgent interruptions.

Methods: The nurse interrupted project followed the Lean methodology framework to identify which high-frequency interrupters to address. Baseline assessment of the intensive care unit (ICU) nurses identified alarms and patient family member calls as predominant causes of interruption. A literature review was conducted to understand work interruption for nurses and to identify available solutions.

Intervention: To address the …

Standardizing The Bedside Shift Report: Improving Nurse-To-Nurse Communication, Deepi Sahota

Master's Projects and Capstones

PROBLEM: The Community Living Center (CLC) reveals an immense concern on shift-to-shift handoff report. Shift-to-shift report is done in the report room, often times unclear information is given and critical information is not appropriately conveyed.

CONTEXT: The project was implemented on a 50-bed unit at the Veterans Affairs. The improvement project was focused on collaborative partnerships, standardized bedside shift report, and utilization of the SBAR tool. in the prevention of communication errors.

INTERVENTIONS: The SBAR tool was utilized to provide a framework for effective communication between nurses. The CNL facilitated an hour in-service on bedside shift report to nurses …

Aiming For Zero: Creating A Culture Of Safety And Improving Cauti Outcomes In The Microsystem, Shiela Escobar

Master's Projects and Capstones

Abstract

Problem: Catheter-associated urinary tract infection (CAUTI) remains the leading cause of hospital-acquired infection (HAI) despite being preventable. CAUTI increases the length of stay, morbidity, mortality, readmissions, and costs. There is also increasing antimicrobial resistance in pathogens causing CAUTI. Thus, reducing HAIs such as CAUTI should be a priority for every institution.

Context: The microsystem for this CAUTI quality improvement project is a 24-bed adult medical-telemetry unit in an acute care teaching hospital with excessive CAUTI. This project aims to improve the unit’s CAUTI standardized infection ratio (SIR) from a baseline of 2.54 to 1.75 by October 2020. A SIR …

From Team Huddle To Team Cuddle: Rekindling Caring, Self-Compassion, And Joy In Work!, Amerizza Quemada

Master's Projects and Capstones

Problem: The healthcare industry suffers from a high level of burnout and unhealthy work environments, which has been heightened by the COVID-19 pandemic. The consequences of burnout may be expressed in both individuals and teams as a lack of caring, disengagement, incivility, and staff turnover.

Context: One department in an integrated healthcare organization displayed a pattern of annual low employee engagement scores and alleged workplace bullying. Team members also observed that employees failed to speak up when experiencing incivility. The Clinical Nurse Leader (CNL) student determined that an improvement initiative was needed to create a culture of caring to improve …

A Systems Approach To Increase The Icu Nursing Workforce During A Pandemic, Jennifer Mendenhall

Master's Projects and Capstones

A Systems Approach to Increase the ICU Nursing Workforce During a Pandemic

Abstract

In early March 2020 an intensive care unit (ICU) patient died of COVID-19 in an integrated healthcare system hospital in Northern California. Data from China and the CDC indicated that more healthcare members would require intensive care and could overwhelm the 21 acute care hospital macrosystem. A microsystem pilot program to upskill peri-anesthesia care unit (PACU) RNs to care for ICU patients was initiated. Concurrently the upskill pilot program was reviewed by macrosystem nursing leadership. Over a three-week period, the program was standardized, disseminated and implemented across …

Improving Frequency Of Hand Hygiene Education From Providers To Patients, Nancy Moran, Vanessa Hernandez, Christopher Sutton

Master's Projects and Capstones

Hand hygiene compliance is one of the most simplest forms of preventing infection. This paper focuses on improving the frequency and standardizing hand hygiene education to patients delivered by health care professionals from a primary care clinic. The ambulatory suburban community clinic in Oakland primarily serves the underserved population. The target population are the following providers: Physicians, Physician Assistants, Nurse Practitioners, Registered Nurse, Licensed Practical Nurse, and Medical Assistants. A survey was adapted from evidence-based studies, WHO, and CDC to collect data on current hand hygiene education provided to patients from healthcare professionals. An additional survey was given to patients …

Improving Quality Of Care Through Discharge Planning, Maria Pasillas

Master's Projects and Capstones

Providing good education for the new mother is key to improving the quality of care for both mom and baby. Since nurses are frontline health care providers who perform the most postpartum education, it is imperative they work to improve discharge education so information provided is consistent, appropriate, and evidence based (Suplee et al., 2016).

The aim of this project is to improve the discharge planning process of a local community hospital utilizing evidence-based research (EBR) with the intent to increase patient satisfaction scores in care transitions to above 65% within 3 months.

The community hospital is a 122-bed acute …

Perinatal Substance Use Screenings In Marin County: A Brief Overview Of Screening Protocols And Identifying Gaps In Care, Breanna Wiliams

Master's Projects and Capstones

Introduction

Perinatal substance use continues to be a major public health issue in women’s health. The purpose of this study was to determine the frequency of substance use screenings in care and assess how well the existing services in Marin County are serving the needs of pregnant and parenting women and identifying the gaps and/or weaknesses in current practice.

Methods

Data for this study was collected via semi-structured interviews with five professionals that worked at the local community clinic, hospital and a non-profit agency. Some questions were slightly modified to be configured toward the participant’s specific profession.

Results

Results from …

Introducing A New 12 Week Education & Simulation Program To Optimize Financial Performance Of Nurse Managers, Melissa Hathcoat

Master's Projects and Capstones

Problem: Several nurse executives (Waxman 2018; Massarweh, 2017; Hunt, 2018) agree that in today's increasingly complex health care environment, the reality of decreasing reimbursements and increasing focus on value-based metrics reflects a crucial knowledge base for nurse managers. Therefore, it is imperative for unit-based nurse leaders to receive education and support to attain and maintain the requisite business competencies to achieve both fiscal and quality targets in their microsystem (McFarlan, 2020). In an integrated managed care delivery system in northern California, no education curriculum exists for nurse managers and assistant nurse managers that addresses gaps in financial knowledge, skills, and …

An Innovative Contest: A Team Approach To Improving Patient Satisfaction Scores For Medication Side Effects, Jennifer Natsch-Jensen

Master's Projects and Capstones

Problem The Home Healthcare Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey question 14 regarding providers discussing possible side effects is below the organizational goal of 74.1 linear mean in this home health microsystem.

Context According to the Agency for Healthcare Research and Quality (AHRQ), nearly 20% of patients discharged home from the hospital had an adverse event within the first few weeks of discharge and most are related to medications (AHRQ, 2019).

Interventions An innovative contest was introduced to promote engagement and to use teach-back best practices, including planned discussions with the patient and caregivers regarding name of …

Creating A Culture Of Teamwork And Communication, Ikjae Yang

Master's Projects and Capstones

This paper aims to explain an innovative strategy for integrating research processes and quality improvement in a medical/ surgical telemetry unit (2 North). The project is targeted to improve health care team communication regarding patient safety to improve patient outcomes. The PICO question guiding this project stated: Does the implementation of TeamSTEPPS during orientation improve communication and teamwork? CINAHL database searched terms "TeamSTEPPS", "new graduate nurses", "communication", "healthcare", "teamwork", and TeamSTEPPS effectiveness. In addition to CINAHL, Google Scholar and PubMed databases were used to narrow down database searches.

The project includes a TeamSTEPPS planning guide that offers the planning organization, …

Prospectus For Mitigating Loneliness During Quarantine For Older Adults In Long Term Care Facilities, Emily Gines

Master's Projects and Capstones

In 2020 as the COVID-19 pandemic resulted in quarantine safety measures and facility closures, facilities that cared for older adults in particular were hit the hardest. Long term care facilities (LTCFs), specifically those that care for older adults with memory care problems, must find ways to provide high-quality, standard care, despite many regulations and changes. Although infection control is an important aspect of care among this population, we must also consider how we can maintain quality of life and social connection. Loneliness is defined as the subjective feeling of being alone or perceived isolation. It can also relate to the …

Three Good Things To Extinguish Caregiver Burnout, Justin Haley

Master's Projects and Capstones

Caregiver burnout is a widespread issue in healthcare and institutions should be increasingly concerned about burnout because of the significant impact on quality of patient care, employee health, and financial stability. Many interventions and studies regarding burnout are focused on improving systems issues or removing negative stressors on caregivers. Although such interventions may be necessary to attempt, comprehensive systems-wide changes can be cumbersome and expensive, while removing negative stressors may be an unrealistic goal in a fast-paced, demanding healthcare environment. The Three Good Things method is an evidence-based, effective, simple, low-cost intervention to improve feelings of caregiver burnout in which …

Decreasing The Fall Rate On A Medical Surgical Unit With An Enhanced Fall Algorithm In The Electronic Medical Record, Natali Sokolovski

Master's Projects and Capstones

This paper summarizes the quality improvement falls prevention project on a Medical-Surgical unit with an Enhanced Fall Algorithm incorporated in the Electronic Medical Record conducted by two Clinical Nurse Leader students of the University of San Francisco.

This project addresses the patient falls events in a San Francisco-Bay Area Hospital on a Medical-Surgical unit. The aim is to decrease the rate of falls on a Medical-Surgical microsystem unit by 50% with an Enhanced Fall Algorithm incorporated into the Electronic Medical Record by June 2021. The patient population consists of general medical surgical patients where many of the patients have an …

Eliminating Barriers To Chinese American Diabetic Patients: Implementation Of Diabetic Cantonese Group Visits, Sabrina Wong

Doctor of Nursing Practice (DNP) Projects

Problems: Asian Americans have higher incidence and prevalence of diabetes mellitus type 2 and less preventive care and higher complication rates than the rest of the American population.

Context: According to the National Healthcare Quality and Disparities Reports (2016), Asian Americans are more likely to be diagnosed with diabetes compared to non-Hispanic whites by over ten percent.

Interventions: A comprehensive group visit program was implemented in a clinic in Oakland, Chinatown catered towards Cantonese-speaking diabetic patients. The group visit included culturally and linguistically appropriate materials related to nutrition, exercise, and diabetes knowledge. Each cohort attended a ninety-minute group visit session …

In-Basket Teamwork: Divide The Work And Multiply The Success The Registered Nurse Role In Ambulatory Clinic Ehr In-Basket Management, James Smoot

Master's Projects and Capstones

Electronic Health Record (EHR) in-basket results (e.g., lab results, pathology reports, etc.) must be reviewed and acted upon in a timely manner by clinical staff in order to provide safe and effective care to ambulatory patients. Delays in reading results are significant contributors to medical errors. A large backlog of in-basket results that have never been appropriately filed is both a safety concern and a symptom of other clinical workflow issues. EHRs have shifted a greater proportion of administrative and triage roles onto providers, contributing to provider burnout. This paper synthesizes some of the best evidenced-based practices available for the …

Usp<800> Compliance: A Hazardous Drug Safe-Handling Quality Improvement Project For Ambulatory Care Infusion Nurses, Cynthia Huff

Doctor of Nursing Practice (DNP) Projects

Problem: The U.S. Pharmacopeia (USP, 2016) Convention Chapter 800: Hazardous Drugs: Handling in Healthcare Settings took effect on December 1, 2019. According to Polovich and Olsen (2017), " The implementation of the USP <800> Standards. will represent an important step forward to protect nurses and other potentially exposed healthcare workers (HCWs): (p.1).

Context: The Doctor of Nursing Practice (DNP) project implemented a hazardous drug (HD) safe-handling personal protective equipment (PPE) toolkit in accordance to USP <800>standards and hospital policies at an ambulatory cancer infusion center to improve nurses' adherence with PPE use.

Interventions: The project consisted of (a) a safe-handling PPE …

Transformational Leadership - An Integrated Evidence Review, Marta L. Hudson

DNP Qualifying Manuscripts

Abstract

For chief nurse executives to survive in contemporary healthcare organizations must cultivate nurse leaders who are poised to produce nurse job satisfaction and subsequently, patient outcomes, including quality and patient safety. The article describes an integrated evidence review of the relationship between transformational leadership and nurse job satisfaction. The author identifies implications for practice and further research.

Improving Clinicians’ Access To Patient Education And Va Resource Information, Ella Bermudez

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: In a western US Veterans Administration (VA) hospital system, patient education materials are provider-specific, not standardized, and not located in a central, readily available location.

Context: How does a patient education tool affect the clinicians' delivery of health education in increasing health literacy compared to written information alone in the US veteran population? An integrated literature review was performed using Cochrane, Joanna Briggs Institute (JBI), Scopus, CINAHL, and PubMed databases to address the PICOT question above and determine the impact of patient education tools on health literacy and patient engagement. The literature recommended improving patient education for better …

Academic Leaders And The Regulatory Orientation: New And Improved!, Annmarie Munana

DNP Qualifying Manuscripts

The purpose of this article is to describe the challenges and regulatory knowledge gaps present in academic nursing leaders, explore orientation as an evidence-based approach to support leadership transition, recommend guiding frameworks, and report on the usefulness of orientations to facilitate academic regulatory compliance knowledge.

During this time of yet another nursing shortage, and considering the aging population and nursing workforce, professional organizations and nurse leaders strive to develop innovative solutions to attract individuals to nursing. The shortage is also present amongst the ranks of nursing faculty and academic nurse leaders and the profession needs strong leaders at the helm …

Type 2 Diabetes Mellitus In The Pediatric Population, Lorna Santiago

DNP Qualifying Manuscripts

The incidence and prevalence of diabetes in youth in the United States is increasing. In particular, type 2 diabetes mellitus (T2DM) is becoming more common in individuals younger than 20 years. Nurse practitioners and other primary care providers that see children should be knowledgeable about the condition and confident in participating in multidisciplinary management. Screening should begin at age 10 or at puberty, whichever comes first. Providers should screen all children who are overweight or obese or of Native American, African American, Latino, Asian American, or Pacific Islander race or ethnicity. Children of these ethnicities have a greater risk for …

Patient Engagement: A Key Concept To Surgical Site Infection Reduction In Colorectal Patients, Vanessa Strieff

Master's Projects and Capstones

Abstract

Problem: Colorectal surgery is a procedure with one of the highest surgical site infection (SSI) rates; therefore, necessary efforts were implemented to reduce harm (Harris, 2018). Approximately 60% of these surgical infections are preventable (Ban et al., 2017). SSIs can have severe consequences, including extended length of stay, high morbidity and mortality rates, delayed recovery, and high healthcare costs (Harris, 2018). The financial burden of SSI is substantial.

Context: This project aimed to explore opportunities for enhancing patient engagement and awareness of SSI preventive measures. After an extensive microsystem analysis, a knowledge gap in patient education on …

Implementing Culture-Centered Diabetes Self-Management For The South Asian Population, Kalpana Prasai

DNP Qualifying Manuscripts

Type 2 diabetes is a chronic metabolic disorder that requires complex care and involves a variety of self-management decisions on a regular basis to manage the symptoms and avoid complications. The prevalence of type 2 diabetes among the South Asian population is six times higher than their European and white American counterparts (Gujral et al. 2013). Culturally sensitive education may be the key to overcoming the barriers related to standard diabetes patient education and culturally appropriate type 2 diabetes management. Research and evidence-based practices show Diabetes Self-Management Education (DSME) is associated with significant improvements in glycemic control and overall better …