Nursing Commons^™

Evidence Based Falls Management Program In The Nursing Home, Deloris Jacobs

Graduate Theses, Dissertations, and Capstones

The cost of fall injuries for both nursing homes and patients can be staggering. Facilities can incur large financial penalties following notices of severe deficiencies from regulatory agencies and will incur substantial legal fees in the event of a wrongful injury or death lawsuit. Patients injured in falls are at risk of increased financial costs for care in the nursing home as well as a lower quality of life. They are likely to incur co-pay or coinsurance costs for care by physicians and other professional services, and costs for rehabilitative services, out of pocket expenses, medical equipment, prescription drugs, and …

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 …

Avoiding 30-Day Readmissions Of Acute Mi Patients Utilizing Cardiac Rehabilitation, Patricia T. Forsberg

Doctor of Nursing Practice (DNP) Projects

A significant number of Acute Myocardial Infarction (AMI) patients were readmitted to an urban San Francisco Medical Center within 5-7 days post discharge this year. Two of the main identified causes were symptom management issues and medication instructions, both of which are part of the discharge instructions. It’s not surprising that 80% of all discharge teaching is forgotten by patients by the time they hit the parking lot. With the recommended timeframe for post discharge follow up appointments at 48 to 72 hours post discharge and as those appointments are not typically available within the recommended timeframe, patients are more …

Implementing And Evaluating A Clinical Information Interface Between An Electronic Medical Record And A Patient Classification System, Tanya Osborne-Mckenzie

Doctor of Nursing Practice (DNP) Projects

As a result of the Affordable Care Act and the Institute of Medicine’s initiatives, hospitals are challenged to improve outcomes as efficiently as possible. How does the national initiative of RNs partnering with other healthcare professionals to improve the quality of patient care at a lower cost, cascade down to individual organizations? One answer may come by focusing on nurse staffing in acute care hospitals. Considering the impact RNs have on patient quality outcomes and the bottom line of hospitals, appropriate management of the RN workforce is one of the most important areas hospitals can focus on in order to …

Specimen Labeling Improvement Project: Slip, Traci Hoiting

Doctor of Nursing Practice (DNP) Projects

Blood specimens are labeled at the time of acquisition in order to identify and match the specimen, label, and order to the patient. While the labeling process is not new, it is frequently laden with errors (Brown, Smith, & Sherfy, 2011). Wrong blood in tube (WBIT) poses significant risk. Multiple factors contribute to mislabeling errors, including lax policies, limited technological solutions, decentralized labeling processes, multi-tasking, distraction from the clinician, and insufficient education and training of staff. To reduce blood specimen labeling errors, a large academic medical center implemented an innovative technological solution for specimen labeling that integrates patient identification, physician …

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 …

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 …

Transformational Leadership In Nursing: A Pilot Nurse Leader Development Program, Audria G. Denker

Graduate Theses, Dissertations, and Capstones

Current research reveals that staff nurses are routinely placed into front-line leadership roles with little formal preparation. The purpose of this project was the development, implementation, and evaluation of a pilot nurse leader development program for nurse leaders at a small community hospital located in Clarksville, Indiana. This study consisted of a quasi-experimental design, with the intervention consisting of a leadership course delivered to a convenience sample of nurses in managerial positions. Leadership attributes was quantified, both pre/post interventions, through the administration of the Leadership Practices Inventory (LPI), a Likert-scaled survey. The LPI was administered to the nurse leaders, their …

Standardized Report Format: A Review Of The Literature, Madeline Kutzy, Kathleen Fitzgerald

Nursing Student Work

No abstract provided.

Comparison Of Housed And Homeless Patients With An Orthopedic Diagnosis, Susan M. Williams

Electronic Thesis and Dissertation Repository

Studies on homelessness have shown that people who are homeless are admitted to hospital more frequently, for longer periods of time, and at a younger age than people who are housed. Once admitted to hospital, discharge planning is difficult and resource intensive, often leading to discharge back to the streets or a shelter. This puts this population at risk for complications and readmission. Although people who are homeless are prone to orthopedic injuries, there is no research on the outcomes of patients who are homeless with orthopedic injuries. This retrospective, case control study, based on the social determinants of health, …

Comparing Generational Differences In Job Satisfaction And Retention (Anticipated Turnover) Among Nurses Working In Magnet Versus Non-Magnet Designated Hospitals, Laura E. Cima

Seton Hall University Dissertations and Theses (ETDs)

Background and Purpose of the Study: Experts in the nursing profession predict a catastrophic nursing shortage by 2025. Nursing shortages have devastating effects on hospitals from a quality of care, patient and family satisfaction and financial perspectives. Given these issues, the most logical approach to this shortage is retention of nurses rather than recruitment. The Magnet designation is one mechanism to retain nursing staff.

Another phenomenon exists within the work environment that makes this shortage different from others. Currently, there are four generations of nurses working in the healthcare environment. Each of these generational cohorts has different values and …

Designing The Plane While Flying It: A Case Study On Nursing Faculty Development During Academic Electronic Health Records Integration In A Small Liberal Arts College, Karen Elizabeth Maxwell

Dissertations and Theses

The expectation of graduating nurses today is to be knowledgeable and responsive to rapidly changing technology in the health care environment. Although federal mandates, Institute of Medicine (IOM) recommendations, and nursing program accreditation initiatives are pushing an "informatics" healthcare agenda by promoting the implementation of electronic health record (EHR) systems by 2014 in all healthcare facilities, very few US nursing schools provide students with access and training in, EHR systems. In addition, nursing faculty may not have a clear understanding of healthcare informatics; the use of information and technology to communicate, manage knowledge, mitigate error, and support decision-making. Nursing education …

Re-Engineered Discharge Planning In A Rural Mississippi Hospital To Reduce 30 Day Readmission Rates Among Heart Failure Patients, Roxie Mae Hogan

Doctoral Projects

The hospital discharge is a complex process that involves interdisciplinary efforts to avoid readmissions and decrease health care costs. The purpose of this capstone project was to take a leadership role in translating evidence into practice by successfully preparing NWMRMC discharge planning stakeholders to adapt Project RED for use with HF patients admitted to NWMRMC.

A comprehensive systematic improvement plan, Project RED is designed to improve the work flow process through the use of timelines and strategies. Project RED supports discharge planning, helps to prevent readmission, and facilitates knowledge transfer that promotes sustainable changes. Re-Engineered Discharge Planning (RED), 6 step …

Factors That Act As Facilitators And Barriers To Nurse Leaders' Participation In Health Policy Development, Nilufa Jivraj Shariff

School of Nursing & Midwifery, East Africa

Background: Health policies impact on nursing profession and health care. Nurses' involvement in health policy development ensures that health care is safe, of a high quality, accessible and affordable. Numerous factors influence nurse leaders' ability to be politically active in influencing health policy development. These factors can be facilitators or barriers to their participation. There is scant research evidence from Eastern African region that draws attention to this topic. This paper reports part of the larger study. The objectives reported in this paper were those aimed to: build consensus on factors that act as facilitators and barriers to nurse leaders' …

The Influence Of Resonant Leadership And Structural Empowerment On The Job Satisfaction Of Registered Nurses, Eunice Bawafaa

Electronic Thesis and Dissertation Repository

Abstract

There are longstanding and growing concerns about the demanding nature of work environments that affect nurses’ health, job satisfaction and provision of quality care. Specifically in healthcare settings, there is the need for leaders to create supportive work environments to avert these negative trends and increase nurse job satisfaction. The purpose of this study was to examine the influence of managers’ resonant leadership and nurses’ structural empowerment on their job satisfaction. A secondary analysis of data collected from a non-experimental survey design using a sample of 1216 registered nurses from nine provinces in Canada was conducted. Structural empowerment partially …

Patient Safety Culture And High Reliability Organizations, Jared D. Padgett

Walden Dissertations and Doctoral Studies

A 1999 evaluation of case studies performed by staff from the Institute of Medicine found that between 40,000 and 98,000 patients died from preventable errors, while 43,598 individuals died in car accidents that year. A 2011 report increased that estimate nearly 10 times. Widespread preventable patient harm still occurs despite an increase in healthcare regulations. High-reliability organization theory has contributed to improved safety and may potentially reverse this trend. This explorative single case study explored how the perceptions and experiences of nursing and respiratory staff affected the successful transition of a healthcare organization into a reliability-seeking organization. Fourteen participants from …

The Effect Of Shared Medical Appointments And Education On Hemoglobin A1c Levels, Gina L. Moore

Evidence-Based Practice Project Reports

Type II diabetes affects millions of people worldwide. Approximately 25.8 million or 8.3 percent of the United States (U.S.) population has type II diabetes. The number of adults in the United States developing diabetes has been projected to double by the year 2030 (World Health Organization, 2013). Diabetes is the leading cause of kidney failure and blindness, as well as the major cause of heart disease and stroke which is the 7th leading cause of death in the U.S. The purpose of this evidence-based project was to determine the effects of education during shared medical appointments with type II diabetic …

Nurses' Perceptions Of Structural Empowerment: A Practice Review Process Pilot, Andrea M. Lee-Riggins

Doctoral Projects

Nurses are professionally and morally obliged to monitor and evaluate nursing practice via active participation in review mechanisms that are designed to promote patient safety and care delivery, thereby improving patient care quality (American Nurses Association [ANA], 1988, 2001, 2004; O'Rourke, 2006). The purpose of this Doctor of Nursing Practice (DNP) project was to develop, pilot, and evaluate a nurse practice review process with frontline nurses within Fresno Heart & Surgical Hospital (FHSH), a small specialty hospital, affiliated with Community Medical Centers (CMC) in Fresno, California. A nurse practice algorithm was subsequently developed and structural empowerment was assessed with the …

A Novel Method For Assessing Medication-Related Adverse Outcomes In A Community Hospital, Christopher M. Patty

Doctoral Projects

The use of medications for hospitalized patients is universal, and unfortunately medication-related adverse outcomes are common. The accurate assessment of medication-related harm in hospitalized patients is foundational to the development of an effective hospital medication safety program. Every hospital has its own unique "fingerprint" of harm, accurate determination of the nature of medication-related harm specific to each hospital is necessary to facilitate prevention of that harm with specific and effective interventions. This project has provided a community hospital with its first systematic methodology for assessing medication-related harm. The methodology is adapted from that used in a recent national-level study.

Several …

Relationships Between And Among The Power Of Self-Care Agency, Perceived Structural Empowerment And Psychological Empowerment In Nurse Managers In Acute Care Hospitals With Magnet Designation, Patricia Anne O'Keefe

Seton Hall University Dissertations and Theses (ETDs)

Background: In today’s dramatically changing healthcare environment, the nurse manager’s role in an acute care hospital is critical to meet the increasing patient care demands and the goals of the organization. The literature provides consensus that optimal nurse manager role behaviors are essential to facilitate a successful unit based organizational structure that can sustain workplace success. These behaviors can be theoretically described as the result of a nurse manager’s ability as self-care agent to activate his or her power of self-care agency in order to engage in optimal role behaviors that will ultimately ensure that the goals of the …

Impact Of Nurse Managers' Leadership Styles On Staff Nurses' Intent To Turnover, Joseph Warren L. Perez

Nursing Theses and Capstone Projects

Nurse Managers have the unenviable responsibility of ensuring that nursing staff are engaged and perform their duties to the best of their abilities. Maintaining an environment conducive to maximizing nurses' potentials resulting in retention may be a by-product of an effective leadership style. The purpose of this study was to determine whether nurse managers' leadership styles have an impact on nurses' intent to turnover. Nurse Managers with more than one year of management experience were asked to complete the Multifactor Leadership Questionnaire (MLQ-5X). The 45-item questionnaire rates the participant's leadership style based on the answers provided. Results were then compared …

Patient Navigator's Role Definition, Joann Smith

Nursing Theses and Capstone Projects

Patient navigation as a care coordination model continues to evolve. Early programs focused on access to care for the underserved and uninsured. With no standard credentials, title, training or job descriptions, navigator programs are as varied as the people who perform these duties. The nurse navigator provides a holistic approach to care delivery and focuses on care coordination, education, and physical, social and emotional aspects of care. Workload for the navigators is increasing as a result of patient, facility, departmental, and national accreditation demands. The goal of this capstone project was to redefine the job descriptions of the Oncology Nurse …

Relationship Between Job Satisfaction And Nurse To Patient Ratio With Nurse Burnout, Kayla Teeter

Nursing Theses and Capstone Projects

There is evidence that the increase in patients per nurse ratio and job dissatisfaction are leading causes of nurse burnout in the United States; however, current research mostly focuses on the hospital setting which limits the generalization of the findings. Therefore, more research is needed beyond the hospital environment. The purpose of this MSN thesis was to examine the relationship between job satisfaction and nurse-patient ratio with nurse burnout among home health nurses. The hypothesis is that home health nurses who experience a higher nurse to patient ratio and greater job dissatisfaction will experience increased nurse burnout. A review of …

Analysis Of Medication Workflow In An Intensive Care Unit, Claire Roth

Summer Community of Scholars Posters (RCEU and HCR Combined Programs)

No abstract provided.

Interprofessional Simulations: Student Attitudes And Effects On Sbar Performance, Michele A. Pfaff

Nursing Theses and Capstone Projects

National healthcare organizations recommend innovative educational initiatives and fundamental changes in the way healthcare providers are educated. Educational strategies that incorporate collaboration have been shown to impact professional behaviors and competency. Improved student attitudes toward collaboration and increased understanding of professional roles are impacted by exposure to simulation and interprofessional education. The purpose of the Interprofessional Simulation Project was to determine whether the type of clinical simulation experience (traditional versus interprofessional) influences nursing students' knowledge and performance of skilled communication. Additionally, the project investigated attitudes toward collaboration in an educational setting. A quantitative pretest and posttest design was utilized to …

Non-Pharmacological Interventions Project: Treatment For Dementia, Mandy Richards

Nursing Theses and Capstone Projects

In response to the Office of Inspector General's research report on atypical antipsychotic off label treatment of elderly dementia residents in long-term care, the Centers for Medicare and Medicaid Services developed a non-pharmacological intervention known as the Hand In Hand training tool. This projects focus was on training the direct care nursing staff with the Hand In Hand tool and evaluating for decrease in behavior and psychological symptoms in their patients. A retrospective chart review was utilized for the Minimum Data Sets tool Brief Interview of Mental Status (BIMS) and Mood interview. Pre training and post training scores were analyzed …

Nurse Manager Role Perception In An Acute Care Facility, H. Gale Waters

Nursing Theses and Capstone Projects

The Nurse Manager role is a crucial part of the healthcare delivery system in an acute care facility, particularly in the current wave of healthcare reform. These are unprecedented times for nursing leadership as they develop and move in a new direction. The role of Nurse Manager is complex with numerous studies including: past roles, characteristics, innovation, outcome, education, and advancement. This study observed the role through the point of view of the Nurse Manager. The Nurse Managers participated in a survey in which they ranked themselves on a one to five scale, with one being a novice in the …

Partnership, Maine Medical Center

Annual Reports

Biennial Report on Nursing, 2013-2014

Invited Speech: Evidence Based Practice: Acuity Based Care And Research Practice Change, Carolyn Lindgren

All Publications

No abstract provided.

Nursing's Ethical Responsibilities In Value-Based Purchasing, Wendy B. Bailes, Marcia M. Rachel, Sheila Keller

Journal of Health Ethics

Healthcare changes have resulted in the development of reimbursement initiatives such as value-based purchasing. These initiatives are designed to improve quality of care, decrease healthcare costs and improve the perception of care. Many of the compliance mandates are related to care provided by the professional nurse. Ethical considerations of these mandates will be explored utilizing the American Nurses Association Code of Ethics.