Nursing Commons^™

Implementation And Evaluation Of An Oral Hygiene Program In Long-Term Care, Lawrence P. Lemos

Doctor of Nursing Practice (DNP) Projects

A review of the literature focusing on oral care within long-term care (LTC) suggests positive resident care outcomes occur when standardized practices are employed. Studies of staff education programs, trained oral hygiene aides, and dental hygienists working within LTC, have linked regular oral hygiene practices to decreased pneumonia rates. While these studies make the connection between good oral hygiene and reducing risk for pneumonia, best practices focused on implementing and sustaining an oral hygiene program in LTC facilities are lacking. The aim of this quality improvement project was to ensure that dependent residents in LTC receive assistance with daily oral …

Improving Staff Responsiveness To Patient-Initiated Call Lights, Doshia B. Williams

Master's Projects and Capstones

This Clinical Nurse Leader (CNL) project involves the nursing staff and patients of a 23-bed post-surgical medical-surgical nursing unit at a Bay Area community hospital. The goal of this project was to improve patient care, patient satisfaction and staff workflow. Assessment of the microsytem revealed that from July 2013 through July 2014, the nursing unit scored below the unit’s goal 10 out of the 12 months for the HCAHPS question related to patient’s receiving help as soon as they pressed their call button. The unit’s goal is 64%; however, the 12-month average was 50%, with one month as low as …

Using Video Simulation To Enhance Rn-Pca Communication, Boris Chang

Master's Projects and Capstones

The purpose of this project was to develop a video simulation exercise to enhance communication between Registered Nurses (RNs) and Patient Care Assistants (PCAs). From a general microsystem assessment initially performed on an urban hospital medical-surgical unit, 75% of respondents noted that the most pertinent issue to address was improving communication between RNs and PCAs. Literature review of evidence-based practices found several studies that support the use of human clinical simulation to promote teamwork and interdisciplinary communication. RNs (n = 24) and PCAs (n = 9) were then individually interviewed with surveys and responses scored based on the …

Improving Medication Administration And Patient Outcomes By Decreasing Avoidable Interruptions, Polly Nghiem

Master's Projects and Capstones

This Clinical Nurse Leader (CNL) project took place at a level I trauma center in the San Francisco Bay Area, on a 34-bed Medical Surgical, Behavioral Medicine and Acute Care for the Elderly (ACE) Specialty Unit. The goal was to improve the adverse events made during medication administration, which in turn reduces medical error costs and improves patient outcomes and patient safety. A review of the literature revealed several key points: (1) Medication errors are increasingly recognized as a significant, but preventable problem in our health care system, (2) Interruptions are implicated as a cause of clinical error, (3) Medication …

Emergency Preparedness On An Inpatient Hospital Unit, Hailee Marie Barnes

Master's Projects and Capstones

This paper will discuss the implementation of an emergency preparedness quality improvement project conducted by a University of San Francisco Clinical Nurse Leader (CNL) student on an inpatient cardiac unit, Unit H, at an urban teaching hospital in Northern California, Hospital B. An assessment of the current state of emergency preparedness, a diagnosis of Unit H’s area of greatest needs, the details of planning and implementing the quality improvement as well as the final evaluation will be discussed. The nursing process will be used for the structure of this paper as it was used as the structure of this project. …

Employee Engagement In The Pacu, Michelle Spadaro

Master's Projects and Capstones

A clear vision is a powerful tool that can help advance employee engagement within nursing units. There is a great need for a compelling vision for the operation of a safe, efficient, equitable, effective, and patient centered healthcare delivery system. It is crucial to identify what actions are needed to achieve this vision and what realistic strategies are necessary for success. The purpose of this vision statement is to achieve excellence in nursing by establishing a common identity and direction that responds to an ever-changing healthcare environment. The project was conducted on a 25 bed peri-operative and post anesthesia care …

Patient Satisfaction Related To Noise In The Coronary Care Unit, Anjanette S. Dominguez

Master's Projects and Capstones

Background The CCU staff recognized a department trend for low patient-satisfaction score related to environmental noise levels. Based on the Press Ganey score, the patient-satisfaction score plummeted in relation to noise level beginning in March 2014.

Purpose To improve patient satisfaction regarding noise level in the CCU to 100% by November 21, 2014.

Methods Senior & Fleming’s Hard System Model of Change guided this literature search of CINAHL and Fusion for articles published from 2009 to 2014. Specific terms used were noise, critical care, and sleep promotion. From September to November 2014, earplugs were offered to all alert/oriented patients entering …

Cardiovascular Intensive Care Unit Patient Transition, Jenna-Lynn Stewrat

Master's Projects and Capstones

With no designated cardiovascular step-down unit at Phoenix Children’s Hospital, patient transitions to acute care are inconsistent following admission to the Cardiovascular Intensive Care Unit (CVICU). We aim to improve CVICU patient continuum of care through transferring patients to a step-down telemetry unit starting October 13^th, 2014 exemplified by a 95% patient satisfaction of care provided by January 1^st, 2015. The progression of the project was influenced by Lippitt’s theory, which includes seven phases in the change process. To accommodate post CVICU patients, the acute care unit was transformed to include cardiac monitors, telepacks, a central …

Increasing Compliance Of Personal Protective Equipment S Election And Use For Isolation Precautions Among Rns & Nas On A Med-Surg Unit, Megan R. Alsmeyer

Master's Projects and Capstones

Background: Due to the high potential of transferring infectious diseases and/or organisms among patients, themselves, and the community, healthcare workers (HCWs) must be knowledgeable and confident in selecting the appropriate type of personal protective equipment (PPE), and the use in technique when putting on (donning) and removing (doffing) PPE based on the level of isolation precautions required for the patient being cared for.

Project Purpose: The purpose of this project is to determine whether assessing the knowledge and actual practice with observing, and utilizing an innovative approach of video and educational tools to isolation precautions would improve the consistency of …

Collaborating With The Unit Clerk To Decrease Avoidable Interruptions During Medication Administration On A Medical Surgical Unit, Christine Dimaano

Master's Projects and Capstones

Medical errors are the third leading cause of death in the United States. Medical errors also incur significant cost ramifications due to increased hospital length of stay and fines. Medication errors, a type of medical error, are one of the most common types of inpatient errors. Nurses are most often are responsible for medication administration, but safety during medication administration should be a priority of all hospital personnel. Avoidable interruptions during medication administration contribute to medical errors. Decreasing interruptions require increased nurse assertiveness during medication administration, interdisciplinary cooperation and unit culture change. This project identified that educating the unit clerk …

Development And Implementation Of A Patient Education Tool To Increase Fall Risk Awareness, Natalie Ybarra

Master's Projects and Capstones

The Clinical Nurse Leader (CNL) project is intended to identify a problem and implement an intervention that will change the current problem in a hospital setting. This project explores the reasons for patient falls on an inpatient unit at an urban hospital, referred to as Unit A and Hospital Y. Unit A is a 45-bed cardiac floor where patients are at high risk for falls due to diagnosis, medications, and treatment. Development and implementation of a patient education tool was conducted through an assessment of the microsystem and evaluation of the patient education tool. The foundation for this project is …

Ent Educational Patient Bedside Tool, Alina M. Toma

Master's Projects and Capstones

Early educational and discharge preparations are an advantage to patients, the interdisciplinary team, and hospital. It was determined that lack in communication and coordination among staff members led to inadequate patient teaching, therefore an educational tool that is kept at the bedside may facilitate accountability and smoother transition to home.

The aim of the project is to improve the education of patients with tracheostomies and laryngectomies, and enhance staff communication and coordination by December 2014.

Analysis methods used included Failure Mode Effects Analysis (FMEA), fishbone diagram, process map, and SWOT analysis. The social learning theory is the framework chosen for …

The Significance Of Timing Of Patient Daily Weights And The Barriers, Ann Pan

Master's Projects and Capstones

Background. Current unit practice is that patient daily weights are obtained in the afternoon or evenings. However, patient weights in the afternoon and evenings are not accurate dry weights. According to evidenced based research, to obtain an accurate patient daily weight, patients should be weighed every morning, after their first void and before they eat breakfast.

Purpose. The focus of the study was to compare the current practices of obtaining daily weights in the afternoon and evenings, compared to the evidenced based practice recommended in the literature.

Method. Through interviews and surveys with staff, the barriers to obtaining patient weights …

Improving Patient Outcomes Through Use Of The Teach-Back Method In The Post Anesthesia Care Unit, Kathleen Osullivan

Master's Projects and Capstones

The setting for this Clinical Nurse Leader (CNL) project was the Post Anesthesia Care Unit (PACU) at a level I trauma center in the Bay Area. The goal was to improve the discharge education performed by the PACU nurses to improve patient safety and decrease the chance of complications or readmissions to this hospital. With no clear instructions for how discharge teaching should be done, the nurses have many differing styles which leaves room for gaps in discharge planning. This influenced the implementation of the teach-back method during discharge planning in order to ensure proper education and increased patient understanding. …

Reducing Avoidable Interruptions During The Medication Administration Process, Lindsay A. Umeda

Master's Projects and Capstones

Background: Medication safety and preventing medication errors continues to be a high priority for hospitals and clinics, as medication errors are the most common and most costly errors in U.S. hospitals (Kliger, 2010, p. 690). Kliger (2010) reported that 450,000 medication errors occur annually, costing hospitals approximately $3.5 to 29 billion dollars a year. Furthermore, Ching, Long, Williams & Blackmore (2013) estimated that 770,000 injuries and deaths occur each year as a result of medication errors.

Purpose: To decrease medication errors by reducing the number of phone call and call light interruptions during the medication administration process.

Methods: Lippitt’s Change …

Increasing Patient Participation In The Medication Reconciliation Process, Andrea Idudhe

Master's Projects and Capstones

It is estimated, that ambulatory care settings have a 25% adverse drug events (ADEs) rate, and 39% of those event were preventable errors (Taché, Sönnichsen, and Ashcroft, 2011). Considering many adverse drug events are related to medication errors, preventing medication errors is fundamental to improving patient safety and outcomes. Medication reconciliation is the process of identifying and resolving medication discrepancies that occur, during transitions in care. Patient participation is a key component to the medication reconciliation process. With the intent to improve patient participation, a patient awareness intervention was implemented in the cardiology outpatient clinic. Data was collected using microsystem …

An Evidence-Based Approach To A Replacement Hospital Training Curriculum, Mark D. Beck

Doctor of Nursing Practice (DNP) Projects

Creation of a training and educational curriculum for a new or replacement facility is daunting in its own right, but without a repository of organizational knowledge cataloging the transfer of tacit to explicit knowledge from the organizations previous library of facility openings, the task becomes Herculean, with as many tasks and cast of characters as the original myths. Navigating the shoals, eddies and tides of the various aspects of this project revealed the need for a comprehensive knowledge management solution to training that is coupled with healthcare design principles and initiatives. This purpose of the DNP project is about the …

Onsite Integrative Clinics: Acupuncture, Positive Patient Outcomes, And Frequency Of Provider Office Visits, Sherry Shoemaker Phd

Dissertations

Purpose and Aims. There is limited information about outcomes of care, resource utilization, and associated costs for patients who receive acupuncture in integrative health settings. The purpose of this study was to address this gap through the following aims: To examine: (1) changes in patient pain levels pre/post acupuncture treatments; (2) relationships between receiving acupuncture treatments (number of treatments, length of time, select demographic factors, (age, gender), pain level pre and post acupuncture treatments; (3) relationships between number of treatments, length of time, age, gender, pain level (pre/post acupuncture treatments) and provider visits (pre/post acupuncture treatments); and (4) relationship between …

Evidence-Based Change In Practice: Development And Implementation Of Type Ii Diabetic Flow Sheet, Kathryn Grimleybaker

Doctor of Nursing Practice (DNP) Projects

Ten percent of the National Health Service annual budget goes to treat complications from diabetes (Lancet, 2010). The American Diabetes Association® (ADA, 2013) estimated that diabetics in the United States incur $176 billion annually in direct medical costs for treatment with hospitalization being the main component of the expenditures. California has the largest population of diabetics and the highest annual cost at $27.6 billion (ADA, 2013). The Healthcare Cost and Utilization Project (HCUP, 2008) found that the average cost of hospitalization in 2008 for a patient with diabetes was $10,937 in contrast to $8,746 for a patient without diabetes. The …

Exploring A Diabetic Registry For Cardiovascular Risk Factors, Mary C. Anziano Phd

Dissertations

Background: Cardiovascular disease is the leading cause of death in the United States. There were over 18 million people diagnosed with diabetes in 2002. These disease processes together combine for significant health burden on society (American Diabetes Association, 2008). The purpose of the study was to describe the relationship between select demographics, and clinical characteristics to determine risk factors for cardiovascular disease in a diabetic population. Methods: A retrospective descriptive study was conducted using a diabetic registry database containing patients diagnosed with diabetes from January 1, 2011 to December 31, 2012. Study variables included age, gender, socio-economic status, glycosylated hemoglobin …

A Descriptive Mixed-Methods Study Examining Resilience And Transitioning To Adulthood Among Emerging Adults With Disabilities, Jennifer E. Mannino

Theses & Dissertations

Transitioning to adulthood is not without challenges. The move away from family influence towards independence and self-determination is filled with uncertainty. As emerging adults (18-29) transition to adulthood they will encounter various challenges related to their new adult roles (Arnett & Tanner, 2005; Jensen & Arnett, 2012). Increased challenges and vulnerabilities in transitioning are evident among emerging adults with disabilities because they face additional challenges related to their disability over and above what all others of this developmental stage experience (Betz & Redcay, 2002; Blomquist, 2007; Faux & Nehring, 2010; King, Baldwin, Currie & Evans, 2005; Murray, 2003; National Research …

The Design, Development, And Analysis Of An Extraction Device For Retracted Catheter Needles For Multiple Reuses On Simulation Manikins, Travis Fisher

Morehead State Theses and Dissertations

A Thesis Presented to the Faculty of the College of Science and Technology, Morehead State University in Partial Fulfillment of the requirements for the Degree Master of Science by Travis Fisher on December 3, 2014.

The Case Of Reintegration Of Women Post Incarceration, Deana Raley Noble Phd

Dissertations

Women released from prison or jail face particular obstacles and challenges on reentry to the community, many of which are related to their childhood and to gender roles as women and mothers. This study relates the lived experience of one woman's successful transition to economic and mainstream societal reintegration and family reconnection after release from prison and the insights gained by the researcher. Case study methodology congruent with Miller's Relational-Cultural Theory philosophical framework was utilized in this in-depth, single case design and represents a unique case. The overall purpose of this descriptive and explanatory research was to explore precursors to …

Living With Hypertension: Experiences Of Black Men Related To Their Perceptions Of The Clinical Encounter At Diagnosis, Glenda Mccartney Feild

Doctoral Dissertations

Introduction: In the U.S., hypertension (HTN) is the most common primary diagnosis and HTN related illnesses are the number one cause of death. Being a member of the Black population increases the risk for developing HTN. Black males are reported to develop HTN earlier in life and have a high incidence of undiagnosed, untreated, and uncontrolled HTN. Sociocultural and gender barriers influence this population’s perceptions of medical experiences, which affects their participation in health-promoting behaviors such as eating a healthy diet, engaging in regular physical activity, avoiding tobacco, limiting alcohol consumption, and decreasing stress.

Purpose: The purpose of this study …

"I Saved The Iguana": A Mixed Methods Study Examining Responder Mental Health After Major Disasters And Humanitarian Relief Events, Suzanne Marie Boswell

Doctoral Dissertations

The purpose of this mixed methods study was twofold. The first was to use Hobfoll’s (1989) Conservation of Resources theory to predict psychological stress based on responders’ perceptions of resource adequacy. The second was to use qualitative interviewing to gain a more comprehensive understanding of the disaster/humanitarian responder experience.

The study is significant given the expanding role of nurses within disaster/humanitarian response organizations. Furthermore, psychological stress results in increased turnover of human resources in these organizations. This turnover is detrimental to humanitarian systems that already lack adequate coverage and sufficiency because funding and human/material resources grow at a slower pace …

Use Of Secure Messaging By United States Veterans And Significant Others, Claudia S. Derman

Theses and Dissertations

ABSTRACT

USE OF SECURE MESSAGING BY UNITED STATES VETERANS AND SIGNIFICANT OTHERS

By

Claudia S. Derman

The University of Wisconsin-Milwaukee, 2014

Under the Supervision of Professor Karen H. Morin, PhD, RN, ANEF, FAAN

The purpose of this study was to describe the topics discussed using secure messaging (SM), the pattern of use of SM, and whether the themes discussed and/or the pattern of use varied based on gender and age of the SM user. Secure messaging is an example of a technology that focuses on patient-centered communication. Secure messaging allows patients to communicate with their clinicians using the Internet and …

Exploring The Phenomenon Of Presence In An Online Educational Environment Through The Lived Experiences Of Graduate Nursing Faculty, John G. Rosselli

Theses and Dissertations

In this dissertation, the phenomenon of presence in an online educational environment is explored through the lived experiences of graduate nursing faculty who teach online.

Greater understanding of the phenomenon of presence in online educational environments may lead to better learner-instructor relationships, higher levels of inquiry and critical thinking on the part of faculty and students, and ultimately better student outcomes. Utilizing principles of Hermeneutic Phenomenology and deductive inquiry, and based on the learner-centric Being There for the Online Learner Model, the author conducted in-depth interviews with a purposive sample of 13 graduate nursing faculty members who teach online at …

Motivational Interviewing To Enhance Weight Loss And Eating Self-Efficacy In Overweight And Obese Adults, Theresa K. Buchanan Dr.

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

Greater than six in ten adults in the United States are overweight or obese which can lead to cardiovascular disease, Type II Diabetes, joint injury and some forms of cancer, costing billions of healthcare dollars each year. Weight loss is difficult, as is maintaining weight loss. The purpose of this project is to investigate if use of the evidenced based (EB) intervention, motivational interviewing (MI), will enhance weight loss and eating self-efficacy (ESE) in overweight and obese adults seeking weight loss at a weight loss clinic over the course of eight weeks. Participants who received MI in addition to current …

Determining Patient Activation Levels Among Patients Who Are Receiving Rehabilitation Services In A Rehabilitation Or Long-Term Care Facility, Danielle S. Vittatoe

Undergraduate Honors Theses

Research shows that one of the major contributors for an extended stay in a long-term care facility is lack of knowledge regarding goals for rehabilitation after being discharged from an acute care facility. It is important to determine patients’ levels of engagement because individuals who are actively involved in discharge planning and rehabilitation goals are able to manage their ongoing care more effectively, which results in increased quality of life. The data was collected using a survey method and the instrument used was the Patient Activation Measure or PAM which is a highly accurate and reliable tool. The 22 question …

An Evidence-Based Evaluation Of Medication Barcode Scanning Acceptance In A Community Hospital, Marie M. Vanderkooi

Doctoral Dissertations

Barcode scanning during medication administration is a powerful tool to prevent errors and support patient safety. In spite of the significant patient safety benefits, there is a lack of adoption and acceptance of barcode scanning. The purpose of this project was to implement an evidence-based assessment, utilizing a survey instrument based on the technology acceptance model, to understand adoption and acceptance of barcode scanning at a community hospital. Forty-four people, 38 nurses and 8 respiratory therapists, participated in the survey. Data analyses were performed using descriptive statistics, Kruskal-Wallis, Mann-Whitney U, and Spearman's rho tests. The subscales for the intention to …