Nursing Commons^™

Implementation Of A Warming Protocol To Prevent Inadvertent Perioperative Hypothermia In The Ambulatory Surgical Setting, Joan Abigail Slagle

Master's Projects and Capstones

The implementation of a standardized warming protocol aims to improve patient outcomes by preventing inadvertent perioperative hypothermia (IPH) and its complications in the ambulatory surgical setting. All patients, regardless of age or gender, are at risk for experiencing a 1-2° C drop in body core temperature within thirty minutes of anesthesia induction. The global aim of this project is to prevent IPH and its complications in the ambulatory surgical setting by implementing a warming protocol at a freestanding ambulatory surgery center. While an audit of the microsystem revealed a normothermia rate of 28%, a standardized warming protocol is expected to …

Decreasing Risk Of Delirium With Early Progressive Mobility, Donna J. Larson Mrs.

Master's Projects and Capstones

Abstract

The goal to consistently mobilize the mechanically ventilated patient to decrease the risk or progression of delirium is the primary focus of my project. This project took place in two, 12-bed critical care units. One is a cardiovascular, medical, surgical intensive care unit and the other is a neurotrauma critical care unit. The methods for implementation included writing the management of pain, agitation, and delirium policy based upon the recommended bundle from the Society of Critical Care Medicine referred to as the ABCDE bundle. As part of this bundle, the progressive mobility policy was revised so that a physician …

Barriers Encountered By Nurses And Nursing Assistants That Prevent Purposeful Rounding, Mar Joseph B. Odias

Master's Projects and Capstones

Purpose: The aim of the study was to identify barriers encountered by registered nurses (RNs) and nursing assistants (NAs) that prevent purposeful (hourly) rounding.

Background: The literature has shown that purposeful rounding improves patient outcomes and safety. However, few studies show the barriers encountered by nursing staff that hinder the purposeful rounding process.

Methods: A pre-post test design was implemented on a 25-bed oncology, urology medical surgical unit with a staff of 38 RNs, 9 NAs, and 4 Unit Secretaries (US). A pre-implementation needs assessment survey was completed by 55% (21/38) of RNs, 33% (3/9) of NAs, and 100% (4/4) …

Decrease Arrival To Ct Time To Improve Stroke Outcomes, Curt Peterson

Master's Projects and Capstones

Abstract Final

The specific goal of the project is to decrease the arrival to t-PA treatment times to <45 minutes in > 50% of the cases. The decreased treatment time will prove to shorten the average length of stay on average by two days (Audebert & Sobesky, 2014). The goal will be accomplished by decreasing the arrival to computerized tomography (CT) scan completion time by at least 20%. The specific population of patients will be all stroke alert arrivals to the process’s microsystem via EMS, an Advanced Primary Stroke Center in Sacramento California. Root Cause Analysis, Strength, Weakness, Opportunity, Threat (SWOT), and Plan, Do, …

Empowering Patients With Central Venous Catheters: Utilizing Evidence-Based Video-Assisted Education To Reduce Central Line-Associated Bloodstream Infections, Pritam C. Steiner

Master's Projects and Capstones

An evidence-based Central Venous Catheter (CVC) dressing change video was created to enhance patient independence, and to increase resource efficiency among nursing staff in an inpatient pediatric setting in which Central Line-Associated Bloodstream Infection (CLABSI) rates were rising. Pediatric oncology patients confer the highest risk of developing CLABSIs due to long-term CVC access, neutropenic effects of treatment regimens, and constant fluctuations between inpatient, outpatient clinic, and homecare settings. Use of video-assisted education is anticipated to standardize and improve patient care, decrease healthcare costs, and increase nurse productivity, and is widely supported by research. Qualitative data collection was conducted by surveying …

Improving Inpatient Influenza Compliance Rates With A Standing Orders Program, Marlee E. Gruber

Master's Projects and Capstones

Influenza vaccinations are recommended yearly as part of a primary care performance measure to prevent and control seasonal influenza. Rates of influenza are steadily increasing and can lead to severe negative impacts and even fatalities with patients. According to the Center for Disease Control (CDC)’s Morbidity and Mortality Weekly Report (MMWR), less than 40 percent of the U.S. population receives the flu vaccine yearly. It is suggested by the CDC that Annual vaccination is the most effective method for preventing influenza virus infection and its complications. The Department of Health and Human Services’ Healthy People 2020 includes a goal of …

Reducing Clabsi In The Nicu With Iv Tubing Competency, Tessa A. Toscano Ms

Master's Projects and Capstones

Central line-associated bloodstream infection (CLABSI) is a significant problem in a Level IV neonatal intensive care unit (NICU) on the West Coast of California. A clinical nurse leader (CNL) student joined a team consisting of the unit’s nursing manager, nursing educator, clinical nurse specialist (CNS), and CNS student. Literature review highlighted the association between the development of CLABSI and the practice of changing central line intravenous (IV) tubing. Five interviews of nurses and 15 observations of nurses performing IV tubing change revealed practice variations within six major steps of the procedure. The team revised the IV tubing change policy to …

Increasing Self Care Compliance With Follow-Up Appointments, Elsa T. Owens

Master's Projects and Capstones

The congestive heart failure patient faces many challenges after discharge from the hospital. Learning how to manage diet, medications, and other lifestyle changes needed for symptom management can lead to multiple readmissions and rapid progression of condition. Many patients feel overwhelmed at time of discharge from the hospital, and many miss key components in discharge instructions and education. The main objective of the organizations Heart Failure program is to educate patients who have been admitted into the hospital with systolic or diastolic heart failure. Within our team we set out to educate our patients and their families on reducing incidents …

Reinforcing Teach-Back Method Regarding Pain Management For Non-Verbal Patients And Their Families, Renee Krystle Doll Lazaro

Master's Projects and Capstones

Pain has been known to have physiologic, psychologic and emotional consequences. Education in pain management has been part for standard care for nurses. The purpose of this study was to reinforce teach-back techniques with nurses when delivering pain management education with non-verbal patients in order to improve patient outcomes in the adult ICU. By using the teach-back method, the nurse will be able to hone a more collaborative approach in dealing with pain, encourage autonomy and include the patient/family in making informed decisions regarding treatment for pain. Reinforcement regarding teach-back was focused on teaching points, and rewording teach-back cues to …

Implementing Emergency Bedside Backpacks In The Nicu To Improve Patient Outcomes, Melissa M. Garcia

Master's Projects and Capstones

Abstract

Planning for a disaster, by implementing a unit specific disaster plan, has become an essential recommendation for Neonatal Intensive Care Units. Emergent situations have resulted from past natural disasters proving the need for additional planning when it comes to units with fragile populations. Research has shown instituting a specialized disaster plan, increases patient safety resulting in improved patient outcomes. This prospectus aims to implement emergency bedside backpacks as the first step in the development of a NICU specific disaster plan. These backpacks are meant to be an addition to the current hospital emergency plan, with the goal being to …

Improving Patient Medication Reconciliation Participation And Compliance Through Education, Maria Elena Herrera

Master's Projects and Capstones

Abstract

The healthcare world is complex. At the center of this world are patients and their safety. Medication knowledge and medication reconciliation compliance are factors that influence patient’s safety and their overall health outcomes. This project explores the theme of patient safety by examining the relationship between patient education and health outcomes. The microsystem, located in the heart of San Francisco, is an outpatient clinic specializing in patients with renal impairment that each diverse and unique. A pre-implementation survey found that only 38% of patients were bringing their medications to appointments. A goal of improving compliance to 50% by December …

Improving Patient Satisfaction, Wait Times, And Access To Care In A College Health Setting; Expanding The Rn Role As Prescribing Agent With Standardized Procedures, Kimberly D. Perris

Master's Projects and Capstones

The CNL theme for this project is Nursing Leadership, Advocate for the Profession and is inspired by the Institute of Medicine’s call for all nurses to work to the maximum scope of their practice. The specific aim was to demonstrate RN confidence working independently, and proficiency using one RN protocol to provide hormonal contraception with an overall aim of improving patient satisfaction and access to care. This project took place in a rural university student health center where family planning and contraception services are the number one service provided.

The RN visit project has been multidisciplinary and collaborative in creating …

Enhancing Education Of Medication Side Effects To Improve Patient Outcomes, Kyle R. Woolley

Master's Projects and Capstones

Patient satisfaction scores regarding how effectively staff educates patients about possible side effects of new medications are not consistently above the national average at a large metropolitan hospital in California (MHC). The results of these patient satisfaction scores shed light on the need for evidence-based strategies to improve a patient’s perception of the medication education provided to them. The basis of the incentive to improve care is ultimately increased safety and better patient outcomes. From the Root Cause Analysis, it became apparent that a few common barriers need to be addressed, but the one most frequently reported by everyone that …

Triage Training: Improving Access To Care, Leslie D. Simpson-Crawford

Master's Projects and Capstones

Left Without Being Seen (LWBS) rates have been described as “the gold standard of metrics” for high acuity units. In this project, the aim is to increase patient access to care by decreasing both wait times for patients and the LWBS rate for the unit, which approaches 6%. As part of a military hospital, the unit provides for veterans, active duty service members, and their families, with ages ranging from infant to elderly, in a 24 hour acute care hospital setting.

Triage training was identified as a necessary first-step for improving the unit efficiency and increasing patient satisfaction. While the …

Aileen Ishuin Macmillan, Aileen Ishuin Macmillan, Kelsey Duinkerken

Jefferson Nursing Oral Histories

Aileen Ishuin MacMillan did not grow up wanting to be a nurse, but after two years of college in Montclair not knowing what she wanted to do, Ms. MacMillan decided by chance to pursue nursing at Jefferson. After graduating in 1976 from the Diploma program she took a job as a nurse in the maternity ward of Thomas Jefferson University Hospital. During her forty year career at Jefferson Ms. MacMillan also completed her BSN at Gwynedd Mercy University. She remains very involved in Jefferson Nursing, serving on both the Jefferson Nursing College Alumni Board and, as president, on the Diploma …

Testing The Reliability And Validity Of Tools Based On The Mayer-Salovey-Caruso Four-Branch Ability Model Of Emotional Intelligence With Psychiatric-Mental Health Nurses, Traci T. Sims

Doctorate of Nursing Science Dissertations

ABSTRACT

Testing the Reliability and Validity of Tools based on the Mayer-Salovey-Caruso Four-Branch Ability Model of Emotional Intelligence with Psychiatric-Mental Health Nurses

A lack of emotional skills may affect a nurse’s personal well-being and have negative effects on patient outcomes, particularly for patients with psychiatric-mental health conditions. Raising awareness of emotional intelligence (EI) among psychiatric/mental health nurses (PMHN) is therefore important. EI is a growing field in both nursing practice and nursing education but instruments to measure EI are costly or have not been validated for use with PMHN. The purpose of this descriptive correlationsal study was to measure the …

Karen Jordan, Karen Jordan, Kelsey Duinkerken

Jefferson Nursing Oral Histories

Born and raised in Philadelphia, Karen Jordan was a member of the civil rights movement in Philadelphia during the 1960s, first becoming involved with the fight to desegregate Girard College. After a semester at Cheyney University Ms. Jordan took time away from school before deciding to study nursing. She enrolled in the Jefferson Diploma Nursing program in 1973 and graduated in 1976. She would later go on to also receive her Bachelor’s in Nursing Science, also from Thomas Jefferson University. Ms. Jordan has spent her long career at Jefferson working as a medical-surgical, oncology, and neonatal nurse. In her free …

Nurses Utilizing The V.O.I.C.E.S. Hiv Prevention Intervention In The Black Church Community, Jason Richard

Theses and Dissertations

The Human Immunodeficiency Virus (HIV) epidemic is a significant problem in the United States, especially in the “Bible Belt” Deep South where the epidemic is hitting this region the hardest. The HIV epidemic in the state of South Carolina is very real, significant, and quite alarming. In fact, the Center for Disease Control and Prevention (CDC) labels South Carolina as an HIV “hot spot.” All racial and ethnic groups are susceptible and impacted by HIV. However, evidence shows that African Americans – especially young adults 18-35, bear the brunt of the burden to the extent that the “new face” of …

Student Nurse Behaviors And Barriers To Successful Completion Of The Traditonal Bachelor's In Science Of Nursing (Bsn) Program., Carri Shaw

Honors Theses

Change is often said to be the only constant in life. This holds true to the rapidly growing field of nursing. In order to meet the demands of new challenges that emerge in nursing, the way future nurses are educated also has changed. Not all nursing students find that the profession is for them. Therefore, some attrition from school is expected. This descriptive study will explore factors that the literature suggests are related to attrition at a mid-sized public university in the Midwest. A survey given to two different level nursing cohorts will give insight to pre-licensure nursing students’ experiences …

Videoconferencing For Improved Access To Care, Alana L. Hernandez

Master's Projects and Capstones

The aim of this project is to increase the amount of education visits completed by pharmacy nurses in an outpatient infusion clinic for patients receiving 5-fluoracil chemotherapy. Two approaches have been applied: securing additional nursing staff; and implementing a telehealth delivery system that utilizes asynchronous video and videoconferencing. The intervention will employ an internet-based application to secure a videoconferencing session between patients and nurses that are 25 miles apart; and offer a patient education video that will be used and an adjunct to videoconferencing. Microsystem data obtained by auditing schedules and patient charts showed pharmacy nurses completed 0% of pharmacy-patient …

Improving Bedside Shift-To-Shift Nursing Report Process, Nina Herceg

Master's Projects and Capstones

The aim of the bedside shift-to-shift nursing report project is to increase patient satisfaction, improve patient safety and strengthen team work by improving the process of communication during shift change on the orthopedic unit. The goal is to put in place a standardized approach to hand-over communication between the staff at the change of shift. The project includes staff education sessions consisting of video, role playing, various print materials such as articles and a guide that includes key components of the bedside report. It will be implemented on a 48 bed orthopedic unit in a West Los Angeles hospital. Microsystem …

Unexpected And Interrupted Transitions Among Newly Licensed Registered Nurses: Perspectives Of Nurse Managers And Preceptors, Sheri S. Webster

Theses and Dissertations

Successful retention of newly licensed registered nurses (NLRNs) into practice is critical to ensure the nursing workforce required to meet current and future health care demands. NLRN turnover rates result in loss of revenue due to high orientation costs and further hinder the development of a stable workforce. For nurse educators and administrators to effectively address early attrition among NLRNs, they must have a clear understanding of the factors that contribute to NLRNs leaving employment. The aim of this qualitative descriptive research was to explore NLRN transition to professional practice from the experiences and perspectives of nurse managers and preceptors …

The Effect Of Education On Portal Personal Health Record Use, Imke Casey Dnp, Crna, Rhit

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

Abstract

The purpose of this study was to assess the computer-use attitudes among chronically ill adult primary care practice (PCP) patients. The goal was to examine the rate of portal personal health record (PHR) use of middle-aged and older adults, to evaluate the effectiveness of an educational intervention in improving PHR adoption, and to identify patients’ thoughts about the PHR. The quasi-experimental, pre-test/post-test design with a paired matched set was performed with a convenience sample of 50 subjects from a primary care group practice in Central Florida.

Participants were recruited on the day of their provider appointment. After participant’s consent …

Improving Management Of Inpatient Blood Glucose, Rachael K. Misitano

Master's Projects and Capstones

Epidemiologic studies indicate blood glucose management in the hospitalized patient population is not adequate; with approximately 30% of patients reporting values >180mg/dl. Patients with increased blood glucose levels pose a higher mortality risk as well as increased risks for dehydration, hypotension, renal injury, decreased wound healing, immunosuppression, and an overall increase in hospital length of stay (AACE, 2015). This project aims to improve inpatient management of blood glucose levels by facilitating MD-RN communication through a reduction in the current reportable blood glucose level. This project took place on a 17 bed adult medical-surgical unit at a large academic hospital in …

The Effect Of Hiv Knowledge And Hiv Attitudes On African American Women’S Decision To Hiv Test, Lisa Ann Green

Dissertations

Centers for Disease Control (2011a) Surveillance report revealed African American women comprised 63% of new HIV cases among women; 65% of African American women were infected with HIV transmitted by heterosexual sex; yet represent 13% of the female population in the United States. An existing data set was examined from a sample of 761 African American women with a history of drug use at high risk to acquire or transmit HIV and/or STDs to determine 751 women’s knowledge and attitudes about risky sexual behaviors, factors influencing a decision to HIV test, and the influence of sex trading on the decision …

Decreasing The Incidence Of Postoperative Delirium In The High Risk Elderly Population: A Plan For Translating Best Practice Guidelines Into Anesthesia Practice, Meredith Gomes

Doctoral Projects

Postoperative delirium is a potentially life-threatening change in cognition that occurs approximately 24 to 72 hours after surgery and is a frequent complication affecting the elderly population. The development of this postoperative complication has been found to increase mortality and morbidity, prolong hospital stays, and has also been associated with a steady decline in cognition. With the number of individuals 65 years or older predicted to increase over the next two decades and the incidence of postoperative delirium potentially affecting over 50% of postsurgical elderly patients, preventive anesthetic methods must be investigated. In early 2015 the American Geriatric Society published …

The Incidence Of Early Stage Postoperative Nausea And Vomiting Following The Use Of Nitrous Oxide And Prophylactic Antiemetic Therapy: Implications For Clinical Practice, James Sullivan

Doctoral Projects

Nitrous oxide (N₂O) is a volatile agent currently used during the induction and maintenance of general anesthesia. Since it’s discovery in 1786 by Dr. Priestly, it is the oldest volatile agent to find continued use in current practice (Kossick, 2014). In conjunction with its extensive history is the debate regarding its emetic properties. Numerous studies have investigated the effect of nitrous oxide to produce postoperative nausea and vomiting (PONV) with varying and often conflicting results. Generally speaking, nitrous oxide is theoretically an emetic and is believed to be associated with PONV (Tramer, Moore, & McQuay, 1996). This has …

The Use Of Peer Mentoring To Decrease Stress In Student Registered Nurse Anesthetists, Elise G. Head

Doctoral Projects

Nurse anesthesia programs throughout the nation are extremely competitive with strict admissions criteria and demanding curriculum. Students enrolled in these programs, termed Student Registered Nurse Anesthetists (SRNAs), experience high average daily stress levels throughout their enrollment in a nurse anesthesia program (NAP). This quantitative study examined whether there is a decrease in SRNA average daily perceived stress when peer mentoring is employed. Inclusion criterion was all SRNAs enrolled in a single 3 year, post-baccalaureate Doctor of Nursing Practice (DNP) NAP at a comprehensive Carnegie research university with Southern Regional Education Board-Level 1 designation. Fifty-six SRNAs were surveyed using a modified …

Using A Cost Benefit Analysis To Support The Development Of A Comprehensive Business Model For A Pre-Filled, Pre-Labeled, Pre-Diluted, Sterilely Packaged, Ready-To-Use, Syringe-Based Anesthesia Delivery System, Lance B. Kennedy

Doctoral Projects

The foundation of Certified Registered Nurse Anesthetists’ (CRNAs) entire profession is built on the ability to provide anesthetic services using a variety of medications in the safest, most efficient, cost-effective way possible. The purpose of this capstone is to address, via a comprehensive cost benefit analysis, whether pre-filled syringe drug trays are a more cost-effective way to address problems as compared to vial-filled drug trays and to implement the necessary transitions in order to improve outcomes. There are a number of identifiable problems related to anesthesia medication delivery via vial-filled medication, including increased cost of healthcare, decreased patient safety to …

Is Dexamethasone 4mg A More Effective Anti-Emetic Than Dexamethasone 8mg For The Prevention Of Early Post-Operative Nausea And Vomiting In Women Undergoing Laparoscopic Gynecological Surgery?, Steven B. Doyle

Doctoral Projects

Postoperative nausea and vomiting (PONV) is a common problem in the surgical setting. It affects as much as 20 to 80 percent of patients undergoing surgery (D'souza, Swami, & Bhagwat, 2011). PONV can lead to increased patient costs and recovery time by causing the patient to stay in the healthcare facility for a longer period of time. A retrospective cohort study was completed to examine whether or not there was a significant difference between patients who received 4mg and 8mg of dexamethasone in the incidence of PONV. All patients studied received ondansetron intraoperatively as their primary anti-emetic. English speaking patients …