Nursing Commons^™

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 …

Improving Early Sepsis Identification On Inpatient Units, Yee Yang

Master's Projects and Capstones

Sepsis is a serious complication caused by an overwhelming immune response to infection that affect millions of people worldwide each year. Sepsis is a time sensitive illness that requires early identification and quick interventions to improve patient outcomes. This quality improvement project includes a team of clinical nurse leader (CNL) students and gathering information on the nursing compliance of the sepsis protocol at a large metropolitan hospital. The observations on different inpatient units and chart review conducted at the large metropolitan hospital led to increased awareness of gaps that prolong the identification of sepsis among patients; also to the creation …

Lost In Translation, Daniel Pena

Master's Projects and Capstones

At the conclusion of a patient’s hospitalization the Registered Nurse (RN) will review all discharge instructions in the patients room in their preferred language. Plan time for the discharge and facilitate a calm quiet environment, such as the patient’s room with the door closed, if possible. Get the discharge instructions printed out in their preferred language and a set for yourself in English would be best so you are able to review the instructions line by line with them. When the patients medical team, such as but not limited to, medical doctors, pharmacists, physical therapists, and social work have completed …

Discharge By 11:00 Am And The Effects On Throughput, Gena Bravo

Master's Projects and Capstones

This Clinical Nurse Leader project aims to improve the discharge process to increase the percentage of patients discharged before 11:00 AM on the Progressive Care Unit (PCU). One evidence-based approach to help alleviate capacity constraints in the hospital is to create an effective and timely discharge process. The goal of this project is to educate the front line staff, care coordinators, and providers to a standardized discharge process. The PCU is a cardiac telemetry unit with 30 private rooms. The patients on the PCU are post-cardiac surgery with some overflow medical patients throughout the unit. Kotter’s theoretical framework was chosen …

Fall Prevention, Linda Fang

Master's Projects and Capstones

Fall Prevention Abstract

Background: According to the CDC, the medical cost for falls was approximately $30 billion in 2012. When a patient falls, and gets serious injury, these costs could sum up to $14,056 per patient. As a result, hospital stays per patient are observed to increase by approximately 6.3 days longer than those patients who haven’t encountered falls.

This study focused on identifying high fall risk patients, and developing a plan of care to reduce the occurrence of falls in a hospital setting. Nurses using safe fall interventions techniques have been proven to inspire fall preventions.

An assessment of …

Interdisciplinary Team Approach In Fall Prevention: Physician Perspective Focus, Anna Gryn

Master's Projects and Capstones

An in-hospital fall is a devastating event for patients and care providers resulting in injuries, physiological and psychological patient declines, and sometimes deaths. Furthermore, fall related costs greatly increase hospitals’ expenses and cause massive distress to caregivers and health providers. Many patient-specific, organizational, and seemingly erratic factors contribute to the occurrence of in-hospital falls. Despite this, hospitals must undertake consistent evidence-based measures to prevent fall occurrences as much as possible.

The traditional nursing approach to falls prevention is not sufficient to control fall rates because the issue is too complex and must be approached from multiple perspectives rather than just …

Improving Early Sepsis Identification On Inpatient Units, Courtney Sumanqui

Master's Projects and Capstones

Sepsis is a medical emergency that if left untreated can rapidly cause death for many patients due to effects that this systemic infection has on the human body. Millions of Americans nationwide are affected by sepsis on an annual basis. To reduce the number of patients who decline to sepsis in the hospital, efficient sepsis protocols must be effectively implemented throughout the hospital. Healthcare organizations must dedicate themselves to providing high quality patient care from the time of admission to discharge. This quality improvement project focused on improving early sepsis identification on inpatient units.

Nurse practices, knowledge, understanding related to …

Improving Early Sepsis Identification On Inpatient Units, Leslie Virtudazo

Master's Projects and Capstones

Sepsis is a life-threatening condition that arises from a complication of severe infection characterized by a systemic inflammatory response (SIRS). As a time critical illness requiring early identification and treatment, delayed recognition of sepsis can lead to organ failure and death. Effective sepsis protocols need to be established and implemented to reduce the number of patients declining to sepsis in the hospital setting. For this project, nursing practice and knowledge of SIRS and sepsis protocol were assessed to obtain a baseline measure of the nurses’ knowledge.

A root cause analysis was used to identify existing barriers to performing timely sepsis …

Gerontological Community-Academic Partnership For An Msn Internship, Francine Serafin-Dickson

Doctor of Nursing Practice (DNP) Projects

The growing population of older adults beckons nursing education to evolve and prepare the future nursing workforce with skills and knowledge to coordinate care for the community-dwelling older adult (gerontological) population. The purpose of this project is to develop, implement, and evaluate academic partnerships with agencies serving community-dwelling older adults for the Master of Science in Nursing (MSN) Clinical Nurse Leader (CNL) students. The formation of Community-Academic Partnerships (CAP) offers the opportunity for an experiential learning internship in combination with a gerontological curriculum. The curriculum is integrated into the CNL role courses and internship, focusing on person-centered interactions with older …

Improving Early Sepsis Identification On Inpatient Units, Corrina Lau

Master's Projects and Capstones

Background: On October 1, 2015, the United States Centers for Medicare and Medicaid Services (CMS) issued a core measure addressing the care of septic patients. Now that care for sepsis patients is a core measure, it is important that all healthcare providers are knowledgeable in how to treat and identify sepsis.

Purpose: The Purpose is to be a “values-driven integrated healthcare delivery system in collaboration with those who share our values.” Patients observed were ages 18-years-old and older from five inpatient units. The professionals in this hospital consisted of a multidisciplinary approach that included, but not limited to, a team …

A Multi-Prong Fall Awareness Program To Reduce The Occurrence Of Falls In A Skilled Nursing Unit, Cheri Labrador

Master's Projects and Capstones

Abstract

A multi-prong falls awareness program to reduce the occurrence of falls in a skilled nursing unit

Keywords: Fall awareness program, skilled nursing unit, fall rate

The project goal was to reduce the patient fall rate by 20% by implementing a fall awareness program for clinical staff. The program had two prongs and began with a pre-survey to determine current fall prevention knowledge. The staff was encouraged to participate in the training by providing risk factors that contribute to falls and simple strategies to prevent falls based on their knowledge of the patients (Boushon et al, 2012). A post-survey was …

Assessment Of Falls Protocol Use On Medical-Telemetry Units, Fanny Ku

Master's Projects and Capstones

Purpose: The purpose of this quality improvement project is to identify a root cause analysis for an increase in falls at a large, metropolitan hospital and implement interventions designed to reduce the incidence of falls on the medical-telemetry unit.

Background: Falls, regardless of severity, may inflict irreparable consequences on patients, families, and hospitals. Approximately 20-30% of falls result in physical or emotional harm, including minor bruises, emotional trauma, and fractures (“Falls,” 2004). When falls occur, hospitals are generally responsible for all costs incurred from the sentinel event, and do not receive re-imbursement from insurances for services provided. In the large, …

Development Of A Formalized Mentorship Program For Newly Licensed Registered Nurses At A Large Community Medical Center, Quynh-Hoa Nguyen

Master's Projects and Capstones

Retention, competency, job satisfaction, and lateral violence are issues facing the nursing workforce, especially newly licensed registered nurses (NLRNs). The United States is facing a nursing shortage; therefore it is important to develop strategies to retain qualified registered nurses (RNs). The Master of Science in Nursing/Clinical Nurse Leader (MSN/CNL) student team conducted a literature review on how to address these issues. A mentorship program is the proposed intervention to assist novice nurses during their transition into the nursing role. The student team performed a needs assessment through surveys and interviews to gain valuable data on the medical center. The assessment …

Development Of A Formalized Mentorship Program For Newly Licensed Registered Nurses At A Large Community Medical Center, Javier Moreno

Master's Projects and Capstones

With mentorship being a key to addressing several issues at a large community medical center, the leadership of the institution engaged with students of a Clinical Nurse Leader (CNL) Program to conduct a thorough assessment. This paper addresses the charge for a standardized and formalized evidence-based approach to a nurse mentorship program to address key areas that enhance not only the work environment but also the quality of care. These key areas include the 1) promotion of professional development and engagement via 2) acquisition of skills necessary to achieve nursing competence, 3) address lateral violence, 4) increase in staff retention …

Homecare Portacath Protocol In Ivig Administration, Cindy Watson

Master's Projects and Capstones

Homecare Portacath Protocol in IVIg Administration

The objective for this CNL internship project was to close a practice gap that was discovered while evaluating my microsystem for system improvements. My microsystem is a medium sized Home Health Agency with a specialty of in home infusion therapy. While evaluating protocols for immunoglobulin (Ig) infusion I found that there was no protocol for the administration of Ig by portacath. After consulting with the Director of Nursing (DON) and my colleagues on the Infusion Team, it was agreed that a current evidence based protocol was needed to close the practice gap. The methods …

To Asq Or Not To Asq: A Suicide Risk Screening Improvement Project, Gina Mumper

Master's Projects and Capstones

Abstract

Suicide is the second leading cause of death in children between the ages of 10-19 years. Most people who die by suicide have visited a healthcare provider within the prior year. Inpatient healthcare providers, particularly clinical nurse leaders (CNLs), are in a strategic position to assess adolescents for suicide risk regardless of their admitting diagnosis. “To ASQ or Not to ASQ” is an evidence-based project aimed at improving compliance with the Ask Suicide Screening Questions (ASQ) in an eight-bed medical-surgical adult and pediatric overflow intensive care unit (MSICU) in a large tertiary 629-bed academic medical center. Methods included convenience …

"All Set Togo Home":Improving Discharge Planning For Patient's Safe And Timely Discharge, Jasmin Milana

Master's Projects and Capstones

Abstract

The project focuses on the improvement of the discharge planning for patient’s safe and timely discharge in the medical oncology and telemetry unit at the county hospital. The facility has 54-bed capacity with an average daily census of 35 to 40 specializing in cancer, end-stage diseases, cardiac issues, HIV/AIDS, sepsis, palliative and comfort care, diabetes, respiratory diseases, psychiatric and placement patients. The unit has no discharge coordinator. Nurses are responsible for the quality and safe discharge of patients. These nurses experience frustrations due to fragmented system of the discharge process, nurses’ heavy workload, and prioritizing patients with higher acuity. …

Sexual Health Education In New Mexico Public Secondary Schools, Elizabeth Dickson

Nursing ETDs

Previous research has shown that comprehensive sexual health education (SHE) can significantly reduce risky sexual behavior and can increase protective behavior in adolescents. While an important component for all adolescents, this is particularly important for adolescents at high risk for adverse health outcomes, such as unplanned adolescent pregnancy and sexually transmitted infections. The aims of this descriptive study were to explore the content and delivery of SHE in New Mexico and to describe influences on decisions pertaining to implementation of state SHE policy. The social ecological model (SEM) was used as a theoretical framework to better understand levels of influence …

Coping With Labor Education For Nurses, Donna Vo

Master's Projects and Capstones

The “Coping With Labor Education for Nurses” education plan is substantiated by data from the California Maternal Quality Care Collaborative (CMQCC) vaginal birth initiative toolkit and other research. Evidence-based data from multiple sources indicates that improving how labor support is offered at the bedside for the laboring patient can potentially decrease cesarean rates, reduce expenses, and increase savings. The objectives of this plan are to improve patient advocacy and the level of labor support interventions labor and delivery nurses will provide for patients to improve patient satisfaction score above 80%, decrease or maintain cesarean rates below 24.9%, and improve patient …

Reducing Intraventricuar Hemorrhage, Nakia Green

Master's Projects and Capstones

Abstract

Global Aim:

Between September 2017 and September 2018 we aim to reduce the rate of grade III and grade IV intraventricular hemorrhage (IVH) in infants less than or equal to 32 weeks gestation, or less than or equal to 1500 grams from 11% to 5%.

Project Aim:

Develop a best practice bundle for the Prevention of Intraventricular Hemorrhage with implementation of best practice of midline head positioning for infants less than or equal to 32 weeks gestation or less than or equal to 1500 grams by October 2017.

Setting:

Level III, 64 bed Neonatal Intensive Care Unit

Quality …

Surgical Site Infection Reduction Through Nasal Decolonization Prior To Surgery, Melissa S. Schmidt

Master's Projects and Capstones

Surgical site infections (SSIs) are the most common and expensive healthcare-acquired infection. The objective of this nurse-driven process improvement project was to implement a cost-effective and practical decolonization protocol to improve outcomes for high-risk veteran populations undergoing surgery at a large veteran’s hospital in the Pacific Northwest. Prior to the implementation, a decolonization protocol was used for cardiac and orthopedic preoperative patients. The process involved screening for methicillin-resistant Staphylococcus aureus (MRSA) colonization via nasal swab preoperatively and treating positive patients with mupirocin ointment to nares BID and chlorhexidine showers for five days prior to surgery. Adherence to the protocol was …

Improving Oral Care Practices And Aspiration Risk Assessment To Mitigate Risk Of Hospital Acquired Pneumnia, Jeniffer Baker

Master's Projects and Capstones

Abstract

The aim of Improving Oral Care Practices and Aspiration Risk Assessment to Mitigate Risk of Hospital Acquired Pneumonia is to decrease rates of hospital acquired pneumonia (HAP) on a 16 bed Transitional Care Unit (TCU) with a mixed skill staff. The theme of the project is risk reduction with improved patient outcomes and cost reduction as reasons for implementation. Fourteen cases of HAP were reported in the last 5 quarters which accounts for 48% of all in-patient acquired infections. Through policy development, standardization of oral care technique, and improved risk factor assessment, the project goal is to decrease rates …

Fall Prevention Protocol In Acute Care Setting, Allie Di Angelo

Master's Projects and Capstones

Purpose:

Purpose: The purpose of this quality improvement project is to implement a falls intervention to improve falls on the Medical Telemetry unit in the large metropolitan hospital.

Background: Between 700,000 and 1,000,000 falls occur in hospitals every year. Furthermore, approximately 30-35% of these falls result in injury and 11,000 falls result in death (Health Research & Educational Trust, 2016). Falls harm patients, families, and providers. They are also a high cost, as many insurance companies will not reimburse care when a patient falls. As a hospital organization it is important to ensure funds are going to the appropriate places. …

Assessment Of Falls On A Medical-Telemetry Unit, Sahar Taravati

Master's Projects and Capstones

Purpose: The purpose of this quality improvement project is to implement a falls intervention to improve falls on the Medical-Telemetry unit.

Background: Between 700,000 and 1,000,000 falls occur in hospitals every year. Furthermore, approximately 30-35% of these falls result in injury and 11,000 falls result in death (Health Research & Educational Trust, 2016). Falls harm patients, families, and providers. They are also a high cost, as many insurance companies will not reimburse care when a fall occurs. As a hospital organization, it is important to ensure funds are going to the appropriate places. Currently the metropolitan hospital had …

Aim High, Win Big: Optimizing The Or Nurse's Skills To Improve Surgical Outcomes, Ammie Rose Agbuya-Gates

Master's Projects and Capstones

Abstract

Operating room nurses are constantly challenged with new surgical procedures and technology that affect the delivery of safe patient care. A deficiency in skill sets was identified among 50% of OR nurses in this microsystem. A structured scrub training program will improve the performance of novice and advanced beginner nurses to prevent the occurrence of adverse events. This program includes 320 hours of exposure to scrub the top ten procedures of two specialty services after the nurse learns how to circulate. The ability to circulate and scrub is an indication of high performance. It is expected that the OR …

Fall Prevention In The Ed, Ninojoseph Lacap

Master's Projects and Capstones

This project focuses on the prevention of patient falls in the emergency department (ED). Kaiser Santa Clara Hospital is an academic medical facility in the heart of Silicon Valley. The facility has a 46 bed ED with an average daily census of 220, specializing in stroke, pediatrics, heart, and left-ventricular assist device (LVAD) patients. For the calendar year of 2016 there were thirty-reported patient falls in the ED. The global aim is to reduce the patient fall rate by 35% for the 2017 calendar year. The project’s objective is to continue the road to patient safety and to have less …

Clostridium Difficile: An Investigation On A Medical Surgical Unit, Neftali Cabezudo

Master's Projects and Capstones

The objectives for this CNL Internship Project were to: (1) identify the strongest contributors to the rising trend of Clostridium difficile cases on this medical-surgical unit, (2) review all Clostridium difficile cases for correlational factors that are of significant relevance, (3) examine current unit practices and adherence to established policies, and (4) provide recommendations for enhancing existing prevention strategies. The population examined included male adults between 56-83 years old being treated for other medical conditions. The methods used to address this clinical issue included a joint venture between nursing and housekeeping staff to ensure proper terminal cleaning and a renewed …

Increasing Patient Safety During Medication Administration, Vivien Tso

Master's Projects and Capstones

Medication administration error is one of the crucial medical errors that compromises patient safety in hospitals each day. Direct observations were conducted to assess medication administration (MA) accuracy and practices in order to determine the root cause(s) of errors at a community-based, non-profit hospital. Failure to scan patients’ wristbands, to verbally verify patients’ identity with two identifiers, and to verbally verify patients’ allergies, were some practices that were found to lead to medication administration errors. Implementation tools such as an informative video and reminder signage at bedside computers were piloted at the oncology unit of the hospital to improve nursing …