Nursing Commons^™

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

Doctor of Nursing Practice (DNP) Projects

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

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

Manager Leadership: Beginning At Novice, Kathy Bay

Doctor of Nursing Practice (DNP) Projects

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

A video-based module system with active …

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

Doctor of Nursing Practice (DNP) Projects

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

Decreasing Environmental Health Risks In The Philippines: Implementation Of A Culturally Appropriate Screening Tool, Alyssa Samson

Doctor of Nursing Practice (DNP) Projects

Objectives: The purpose of this DNP project was to increase the knowledge of environmental health risk factors in the Philippines among nurses and doctors located within that healthcare system. The overall goal was to educate providers on local environmental health risks, provide training for the use of a screening tool (Tagalog Environmental Health and Safety Assessment Tool [TEHSAT]), and provide resources aimed at increasing screening of at risk populations and provide opportunities for education and health promotion.

Methods: This project included a two-part educational training session. The first part included a preliminary presentation on environmental health and the use of …

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

Doctor of Nursing Practice (DNP) Projects

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

Improvements On Fall Risk Assessment To Promote Patient And Employee Safety, Christopher Haupt

Master's Projects and Capstones

Cohort 22 of the University of San Francisco’s MSN, Clinical Nurse Leader (CNL) program conducted a study focusing on the implementation of the Hendrich II Fall Risk Model and the Patient Mobility Assessment Tool (PMAT) at an urban California Bay Area hospital. Assessments were performed on 74 patients (n = 74) between January 2018 and April 2018. Cohort 22 determined that the Hendrich II test with introductions took an average of 01:49 minutes to conduct. It was also determined that it took and average of 03:12 minutes to conduct the PMAT. 88.19% (66/74) patients correctly estimated their level of mobility. …

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

Master's Projects and Capstones

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

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

Master's Projects and Capstones

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

The Clinical Nurse Leader As Outcomes Manager: Optimizing Screening Mammography In An Outpatient Breast Center, Yao Luo

Master's Projects and Capstones

The Clinical Nurse Leader as Outcomes Manager: Optimizing Screening Mammography in an Outpatient Breast Center

Abstract

This clinical nurse leader (CNL) practice improvement project was conducted in an outpatient breast center that is part of a community safety-net hospital. The patient population consists of a large proportion of disadvantaged, low income, low English literacy, and high-risk women over 445 years of age. Recent observations and baseline data from the breast center and the mobile mammography van indicated that five to eight radiologic views were taken during a routine mammogram in a subset of screening patients which exceeds the standard set …

Increasing Early Mobility Of Patients In The Intensive Care Unit, Wendie Gilliam

Master's Projects and Capstones

Abstract

This project occurred in a 35-bed intensive care unit at a level II trauma center in central California. The purpose of this project was to strengthen the implementation of evidence-based initiatives promoted by the Society of Critical Care Medicine. The Society of Critical Care Medicine has a set of initiatives for the intensive care units nationwide to improve the outcomes for patients. One of the initiatives is the ICU Liberation, which includes six different bundles labeled: A, B, C, D, E, & F (Society of Critical Care Medicine ,2013). Their studies showed a significant improvement in the outcomes for …

Individualizing Care For Pediatric Patients With Autism Spectrum Disorder In Perioperative Services, Erin Scheller

Master's Theses

This research explores solutions for individualizing and improving care for pediatric patients with Autism Spectrum Disorder in the Perioperative Setting of an Outpatient Surgery Center. Specifically, it seeks to determine if providing parent and staff resources on Autism Spectrum Disorder is significantly helpful in increasing confidence in the staff by the parents and the staff themselves. Participants included thirty-five surveyed families who had pediatric patients visiting perioperative services and staff who work on the unit. Methods used include information dissemination with the use of printable and online evidence-based resources, an in-person education event for staff, and a pilot study of …

Assessing The Time Of Completion And Patients’ Perception Of Their Mobility To Accurately Score Fall Risk Assessments, Katherine Jones

Master's Projects and Capstones

This study aimed to examine the time to complete fall risk assessment tools, Hendrich II Fall Risk Assessment Model (Hendrich II) and Patient Mobility Assessment Tool (PMAT) in a San Francisco Bay Area hospital. In addition, this study examined the efficacy of patients’ perceptions of their own mobility, when asked as part of the fall risk assessment process. Data was collected and analyzed on seventy-four patients across four nursing units, Medical, Surgical, Telemetry, Medical-Surgical/Oncology. The data indicated that, on average, Hendrich II took 00:01:49 minutes and PMAT took 00:04:12 minutes when completed separately. When asked about their own mobility level, …

Hazardous Drug Administration In The Home Setting: Reducing Exposure Risks, Cynthia D. Huff Msn, Rn, Ocn, Crni, Cnl

Master's Projects and Capstones

Hazardous drug (HD) administration used to be contained in controlled-healthcare settings, however, the introduction of HDs for home administration has become a growing area of concern for home health agencies. The objectives of the Clinical Nurse Leader (CNL) project aims to improve homecare nurses' knowledge of HDs and improve competency with personal protective equipment (PPE). The microsystem provides short-term homecare services for acute and chronically-ill patients. One team leader, two home infusion coordinators, and twelve registered infusion nurses participated in learning about exposure risks and PPE use with HD administration. Kotter's 8-step change theory was used to develop behavior change …

Admission Criteria For The Pediatric Acute Care Unit To Reduce Length Of Stay In The Emergency Department, Peter G. Campbell

Master's Projects and Capstones

Abstract

The primary objective as outlined in this prospectus is to develop pediatric admission criteria to reduce length of stay (LOS) in the emergency department for patients being admitted to the pediatric acute care unit. The pediatric acute care unit is a 25-bed licensed bed at a tertiary hospital in San Francisco serving patients from 1 day to 21 years of age. Methods included both qualitative and quantitative data to determine relevance of quality improvement project related to LOS, patient safety, patient satisfaction, and nurse to physician communication. Data collected indicated that average LOS in the ED was significantly higher …

Improving Breast Health Care Through The Implementation Of A Nurse Navigator, Maria Watson

Master's Projects and Capstones

Abstract

In a rural Northern California setting, a Clinical Nurse Leader intern was implemented as a designated Nurse Navigator (NN) for a regional breast health population. The global aim of this project is to improve care for potential and actual newly diagnosed breast cancer patients by increasing access to care, decreasing barriers, and improving timeliness of care. Using evidence based on an extensive scholarly literature review, the designated NN will accomplish the aim through care coordination, thereby improving patient outcomes, decreasing outmigration of care, and increasing the financial viability of the breast health program. The ultimate goal of the breast …

Improving Pressure Ulcer Education, Fernando Romeo Zamarripa Guzman

Master's Projects and Capstones

An educational gap exists at the point of care with regards to pressure ulcer prevention for hospice clients. Medical personnel provide oral instructions, but they do not provide sufficient tools for future reference. This project consists of improving pressure ulcer education at the point of care. The nursing staff consists of ten nurses who act as case managers. They are a big part of client care within the hospice setting, which can vary from home care or care in a designated facility. To improve the current practice of providing just oral instructions to patients, an educational tool was created to …

Improving Hand-Off Communication Between The Skilled Nursing Facility And The Emergency Department, Dubravka Labovic

Master's Projects and Capstones

Abstract

The purpose of this project is to improve hand-off procedure between Skilled Nursing Facility (SNF) and Emergency Department (ED). Patient population consists of all retired veterans who currently reside in California Department of Veterans Affairs, Veterans Home of California (CalVet) – the state long-term care facility for elderly. The problem occurs when continuation of care is compromised due to poor exchange of information at the time of transfer to ED. Nurses in SNF need a step-by-step procedure that will improve the process of transfer and the intention of this project is to create a process that will become daily …

Reduing Hospital Readmissions: Ideal Discharge Planning For Heart Failure Management, Chun Mei Chen, Chun Mei Chen

Master's Projects and Capstones

Abstract

The objectives during this project were to achieve by the end of 2018 an overall reduction of 25% in HF readmissions within 30 days. By identifying root causes of readmissions and using needs assessment within the microsystem, literature highlights the elements defining interventions that can be used to improve transitions of care and reduce avoidable HF hospital readmissions. A plan was developed for integrating an evidence-based practice, IDEAL Discharge Planning, along with engaging patients and families at bedside from the first day of admission until discharge to more effectively assist staff in providing patient-centered education and self-care skills. The …

Standardizing And Magnetizing Improvement Projects, Brittany Kyle

Doctor of Nursing Practice (DNP) Projects

Abstract

Recent changes to healthcare reimbursement models have forced hospitals to improve their quality of care while reducing costs. John Muir Health has adopted the Performance Improvement philosophy to address these challenges. However, the current state for improvement project design is not standardized and does not guarantee that Magnet© standards will be followed. This design has caused confusion, inability to achieve project goals, and dissatisfaction among team members. The inability to achieve project goals has resulted in an ineffective use of resources and redundant work.

The objectives of this project were to standardize the way improvement projects are reviewed …

Improving Communication Competency In Perioperative Nurse Managers, Philomena Whelan

Doctor of Nursing Practice (DNP) Projects

Abstract

Aim: This paper outlines the project planning, implementation and evaluation of a project aimed at improving the communication competency of perioperative nurse managers. Leadership development consisted of providing education and simulation practice to managers of the operating room (OR), pre and post anesthesia recovery (PACU) area and sterile processing (SPD). The goal was to improve the OR turnover time, cost per OR hour, patient access and the perception of the participants in their ability and willingness to speak up.

Background: The literature shows that training is needed to improve the ability of teams to understand the factors influencing the …

Using Student-Produced Video To Validate Head-To-Toe Assessment Performance, Christina Purpora, Susan K. Prion

Nursing and Health Professions Faculty Research and Publications

BACKGROUND:

This study explored third-semester baccalaureate nursing students' perceptions of the value of using student-produced video as an approach for learning head-to-toe assessment, an essential clinical nursing skill taught in the classroom. METHOD:

A cognitive apprenticeship model guided the study. The researchers developed a 34-item survey. A convenience sample of 72 students enrolled in an applied assessment and nursing fundamentals course at a university in the western United States provided the data. RESULTS:

Most students reported a videotaping process that worked, supportive faculty, valuable faculty review of their work, confidence, a sense of performance independence, the ability to identify normal …

Improving Male Middle School Nursing Recruitment: A Comprehensive Approach For Students, Families, And Counselors, Robert M. Patterson

DNP Qualifying Manuscripts

Middle school students have been identified as the prime age group to begin nursing recruitment efforts (Matutina, Newman & Jenkins, 2010); however, the current practice of recruiting middle school, male students is ineffective in increasing the number of new nurses. Efforts are required to encourage young, male students to consider nursing as a potential career choice, but this can’t be accomplished without influencing their decision, by sharing the value of the profession. The purpose of this project was to develop and present a PowerPoint presentation to influence middle school, male students to improve their perceptions of nursing as a career …

An Informatics Solution For Operating Room Efficiency, Richard A. Barrow

Doctor of Nursing Practice (DNP) Projects

Problem: For most hospitals, a major cost is the operating room. Inefficiency increases costs and risks for adverse events. An efficient operating room can also be a major revenue generator.

Context: This evidence-based performance improvement project was conducted in a small rural Veteran’s Hospital, which belongs to an integrated health network in Central California. The facility has four operating rooms and is expanding services provided to their patients.

Intervention: The intervention was the use of analytics and evaluations to improve the operating room efficiency by five percent. The use of 3 separate queries which were combined to generate reports and …

Leadership Development, Succession Planning And Simulation: A Succession Plan For Organizational Success, Beth Eichenberger

Doctor of Nursing Practice (DNP) Projects

Future executive nurse leaders must be identified and prepared for the challenges of 21st century health care. The literature suggests a lack of existing standardized succession plans for these leaders. Senior leaders are often faced with the complex issue of how to develop and validate the competencies required for these leadership roles (Dyess, Sherman, Pratt, & Chiang- Hanisko, 2016). Therefore, in the absence of a succession plan, creating a leadership development program, which provides a pipeline of new executive leaders, would alleviate this gap. The motivating force is an effort to promote current talent and provide a higher level of …

Development Of A Nurse Practitioner First Assistant Orientation Program, Romoanetia Lofton

Doctor of Nursing Practice (DNP) Projects

The demand for surgical services continues to increase, creating a strain in our healthcare system and causing increasing backlog hours for the operating room. Allowing nurse practitioners (NP) to function in an expanded role in the perioperative environment requires additional training beyond the generic NP program. With this additional training, the NP can function as a first assistant, providing delegated medical functions in the perioperative environment. An in-house NP registered nurse first assistant orientation program was developed based on the adult learning theory as a conceptual framework combined with the AORN perioperative standards as a foundation. The cost of using …

Float Rns: Unit Specific Tools To Promote A More Positive Float Experience, Tarra Abdullah-Grayson

Doctor of Nursing Practice (DNP) Projects

Despite efforts to transition large portions of primary health care services to more community-based outpatient settings, federal projections say the rising complexity of acute care will increase demand for RNs in hospital settings by 36% in 2020 (American Association of Colleges of Nursing [AACN], 2017). Other projections indicate that by 2025, the U.S. registered nursing shortage will expand to more than 260,000 (Buerhaus, Auerbach, & Staiger, 2009). In an effort to address the ongoing challenges of nursing staff shortages, many hospitals have established a core of internal float pool RNs as a practical and cost effective solution to address the …

Increasing Faculty Knowledge And Empathy Related To Nursing Students With Learning Disabilities, Jodi Kushner

Doctor of Nursing Practice (DNP) Projects

The purpose of this paper is to provide a project overview for the implementation of a disability training module and simulation experience offered to university school of nursing faculty to increase faculty knowledge and empathy related to nursing students with learning disabilities. The number of students with learning disabilities in the postsecondary education setting has tripled in the past decade (Orr & Hammig, 2009). This growing student population makes faculty preparation essential in order to effectively meet the needs of these students. The literature indicated that best practices include disability training, faculty support, student support, inclusive strategies such as Universal …

Simulation Based Post-Partum Hemorrhage Training In Nigeria: A Pilot Project, Nneka Chukwu

Doctor of Nursing Practice (DNP) Projects

Postpartum hemorrhage (PPH) is one of the leading causes of mortality and morbidity among childbearing women globally (Ononge, Mirembe, Wandabwa, & Campbell, 2016). Although this outcome is preventable, it remains a significant cause of death among women, especially in underdeveloped countries. This paper examines an educational project that was aimed to increase the knowledge of student midwives and registered midwives in a rural academic setting in Nigeria.

Methods: A one-day educational pilot training which consisted of a didactic component and a case-based simulation training focused on identifying risk factors, assessment techniques, and management protocols for the PPH patient. There were …

The Development Of A Cardiovascular Competency Checklist For Chinese Nurses, Amy B. Xiong

Doctor of Nursing Practice (DNP) Projects

Cardiovascular disease is a global issue affecting millions of lives around the world. Today, countries like the U.S. and China have joined forces to take on the global issue. In the U.S., the American Heart Association is the largest organization dedicated to reducing the mortality rate of cardiovascular disease by requiring healthcare services to uphold standard cardiovascular guidelines. Astonishingly, within the last 10 years, the U.S. has reduced their cardiovascular mortality rate by 30%.

This quality improvement project sought to determine the gap between the United States and China’s standard nursing education and practices and to help Chinese nurses achieve …

The Clinical Nurse Leader: Improving Early Sepsis Identification On Inpatient Units, Denise G. Lopez

Master's Projects and Capstones

CNL students were invited to a large metropolitan hospital in an effort to create a quality improvement project related to sepsis in order to decrease cost, the length of stay, and improve patient outcomes. CNL students shadowed nurses in order to better un derstand the nursing culture and assess the microsystem. Chart audits were reviewed to determine whether nurses at the assigned units were completing sepsis screenings on time and used the appropriate vital signs and labs. Nurses’ questionnaires were provi ded to assess sepsis knowledge and their understanding of sepsis. Results showed a lack in compliance in completing sepsis …