Nursing Commons^™

Reduction In Delayed Patient Care On The Medical-Surgical Unit, Lina Tran

Master's Projects and Capstones

The focus of this project is to improve daily bedside rounds through utilizing the BRT, which could enhance patient safety and satisfaction by reducing delayed patient care on 3 North medical-surgical department at CPMC. The data retrieved from nurses in the past 3 months has shown that 30% of the patients had delayed care due to daily bedside rounds. By utilizing late medication as an indicator, my goal is to observe a reduction in late medication documentation due to daily bedside rounds by 10% by the end of August 2017. CPMC Davies campus adult medical-surgical department holds 44 inpatient beds. …

A Demonstration Project To Address Juvenile Drug Addiction, Mary Ellen Broaddus

Graduate Theses, Dissertations, and Capstones

The rise in adolescent drug use and addiction is becoming a worldwide phenomenon. An eleven year study of youth in European countries found drug use widespread and increasing (Molinaro, Sicilian, & Curzio, 2011). In 2013 there were over 2.8 million new users of illicit drugs, over half of whom were under 18 years of age (‘Drug Facts’, 2015).

Adolescents are at unique risk because biochemical distinctions in their brains, when compared with adults, prompt more risk-taking behaviors (Gallager, 2014). Health risks are considerable and include hypertension, stroke, convulsions and seizures, and liver disease such as cirrhosis and hepatitis. In 2013 …

Mentor Program, Nicole Van Aken

Master's Projects and Capstones

Stanford Health Care- Valley Medical Oncology Consultants (SHC-VMOC) treats patients diagnosed with cancer or hematology disorders at multiple doctor’s offices and infusion centers across the Bay Area. Presently all five locations with nurses employed in the infusion centers are understaffed. The mentor program was created to train nurses to become mentors. Additional to train new hires and foster relationships between new hires and established nurses while investing in each individual. The clinical nurse leader theme that is being addressed is organizational and system leadership. The first step to implementing the program was to talk to management about the additional cost …

Improving Stress Echocardiogram Access For Patients With Low-Risk Chest Pain In The Emergency Department Clinical Decision Unit, Rosalie Geronimo

Master's Projects and Capstones

This paper attempts to demonstrate improved stress echocardiogram scheduling access for patients with low-risk chest pain in the Emergency Department Clinical Decision Unit.

Improving Patient Care Outcomes By Standardizing Change Of Shift Report, Marie Gutierrez Msn, Bsn, Rn

Master's Projects and Capstones

The change of shift is one of the most crucial times during a nurse’s day. It is a time where vital patient information is passed off from one nurse to the next. There is evidence that the root cause of many sentinel events and poor patient outcomes in related to communication breakdown during the change of shift report process. The Joint Commission has identified communication as the primary cause for preventable medical errors with handoffs accounting for 80% of these instances. Change of shift is an elaborate communication process that involves the transition of care between nurses as well as …

Fall Prevention In The Inpatient Setting, Verna Bautista

Master's Projects and Capstones

Fall Prevention in the Inpatient Setting Abstract

This project focuses on patient and family fall prevention education through an educational brochure. 4South is a mixed medical/surgical and medical/surgical-telemetry unit, specializing in dialysis and stroke patients. Since January 2017, there has been eight falls on the unit. The project’s objective is to decrease the number of falls in 4South by 50% by the end of the 4^th quarter 2017.

An identified weakness was inconsistent patient and family education. The CNL roles of data analyst and clinician were utilized. With the feedback from the Fall Task Force committee, an educational brochure …

Creating A Culture Of Mobility: A Quality Improvement Project, Vincent K. Samuel

Master's Projects and Capstones

Abstract title: Creating A Culture of Patient Mobility in An Acute Care Setting.

Unit: Medical Surgical unit.

Author: Vincent Samuel RN, BSN

Institution: University of San Francisco; Kaiser Permanente Nurse Scholar Academy; Kaiser Permanente Hospital, San Francisco (CNL practicum site).

Background Information

The medical/surgical unit had the average ambulation score of 54% in the year 2015, much below the benchmark of 65% set for the year. The direct impact of low ambulation score was the increase in patient’s length of stay. The micro-system analysis revealed various factors that contributes to this problem such as, inadequate staffing, unit culture, unavailability of …

Understanding The Blogging Practices Of Women Undergoing In Vitro Fertilization (Ivf): A Discourse Analysis Of Women’S Ivf Blogs, Elizabeth Orr, Susan M. Jack, Wendy Sword, Sandra Ireland, Lois Ostolosky

The Qualitative Report

Infertility and its associated treatments, including in vitro fertilization (IVF), can have a profound impact on the emotional health and well-being of women desiring to become mothers. Researchers have measured the impact of infertility and described the experience of infertility and its treatment, leaving the rich descriptions of the IVF experience as captured in women’s blogs to be explored. This discourse analysis describes the blogging practices of women undergoing IVF, exploring both the content and function of the IVF blog discourse. Data were collected from the text of seven women’s blogs (n=1,149 blog posts) and resulted in four main functions …

Early Progressive Mobility In The Intensive Care Unit Adult Patient Population, Kimberly Henry

Master's Projects

No abstract provided.

Evidence-Based Protocol: Decreasing Falls And Falls With Injury In A Nsdu, Jennifer J. Komm

Master's Projects

Patient falls in acute care tend to be the most common adverse events reported. The Centers for Medicare and Medicaid Services report that fall-related injuries are classified as hospital-acquired conditions and no longer reimburses for the diagnosis and treatment of injuries incurred from falls during hospitalization. Falls are decreasing at too slow a rate even with a variety of fall prevention guidelines being available. Falls are a complex problem within hospitals and the prevention of falls is challenging. Literature supports the individualization of fall prevention interventions based on the risk factors exhibited by a patient. Tailoring interventions to specific fall …

Business Intelligence Competencies: Making Healthcare Data Come Alive, Christina Bivona-Tellez

Doctor of Nursing Practice (DNP) Projects

Business Intelligence Competencies: Making Healthcare Data Come Alive While a wealth of healthcare related data exists, nurse leaders (NL) have yet to understand its implications and adopt analytical skills to lead in the transformation of care delivery. Information science is at a new frontier for nursing to embrace. It is critical for nursing leadership to advance and support business intelligence (BI) and interactive data visualization (IDV) skills across the organization and advocate for greater engagement of nurses in health system decision making. With these new tools and competencies, nursing and other health professions can innovate best practices, providing enhanced quality, …

Cultivating A Culture Of Compassion Among Newly Graduated Registered Nurses: An Evidence-Based Mobile Learning Toolkit, Benson Yeung

Doctor of Nursing Practice (DNP) Projects

Empathy, kindness, and compassion are some of the humanistic values essential to nursing practice particularly in today’s patient and family-centric healthcare environment. A genuinely empathetic and caring relationship between a nurse and a patient not only enhances the quality and safety of care but also contributes to patient satisfaction, compliance to treatment, and overall health outcomes. Debate amongst educators and researchers continues to grow as to whether these uniquely humanistic values are innate or if they can be taught. How do nurses acquire the knowledge, skills, and attitudes towards the delivery of compassionate patient care? What strategies are best suited …

Chest Pain Protocol Order Set, Andrey Kulikov

Master's Projects and Capstones

The goal of this project is to implement a chest pain protocol order set in order to increase the nurse-initiated chest pain protocol by 50%. The project was implemented in a Emergency Department (ED) that has problems with understaffing and patient crowding. RN-initiated chest pain orders are implemented 11% of the time and 89% by physicians. RNs initiated orders in less than 10 minutes while 50% of physician orders are initiated over 30 minutes. This results in delayed care and decreases patient flow. A chest pain protocol order set was designed based on the approved nursing protocol policy. 90% of …

Cesarean Section Surgical Site Infection Prevention Evidence-Based Practices And Implementation Plan, Amanda K. Smith

Master's Projects

The Cesarean section (C-section) surgical site infection prevention implementation plan has been designed as a quality improvement project. The project included a microsystem assessment, identifying the problem, literature review, application of a nursing theory and conceptual model, and development of an implementation plan. The microsystem assessment involved a Labor and Delivery Unit who had initiated a new surgical site infection (SSI) prevention bundle developed by an interprofessional team utilizing evidence-based practices and other hospitals protocols. The problem defined was the elevated rates of SSIs due to gaps in the SSI bundle risking the sustainability of the bundle. A literature review …

The Clinical Nurse Leader As Risk Anticipator: Optimizing The Completion And Accuracy Of The Code Blue Recorder Sheet, Catherine Morano

Master's Projects and Capstones

Abstract

• A small community hospital in northern California implemented a practice improvement project in critical care units to optimize best practices surrounding a “code blue” event. In-Hospital Cardiac Arrest (IHCA) is a high-risk process of care that requires tremendous resources to deliver an efficient, safe, and cost-effective service. The code blue recorder sheet summarizes the whole patient care event; this necessitates careful documentation. As a risk anticipator, the unit clinical nurse leader identified suboptimal variation in documentation after a microsystem assessment. This led to a practice change project and targeted educational intervention for code blue recorders. Fifteen staff members were …

Implementing Risk Tools To Prevent Hospital Readmission, Tara O'Connor

Master's Projects and Capstones

Implementing Risk Tools to Prevent Hospital Readmission

Tara O’Connor

Abstract

Background: Readmission reduction is one of the most important opportunities for reducing cost in today’s health care system.

Global Aim: To operationalize risk tools to reduce hospital readmissions by 5 percent by the end of 2017.

Project Aim: To develop new transitions program (TP) processes that operationalizes the risk tools and ensures 70 percent of all readmission risk score patients referred receive a post discharge phone call within 48 hours, and are assessed for their risk of medication management issues as part of their initial assessment, by August 1^{st, …}

Cnl As Educator In The Emergency Department: Improving Hand Hygiene Outcomes, Michelle Batz

Master's Projects and Capstones

Prevention of hospital acquired infections (HAI) is a National Patient Safety Goal. Proper and frequent hand hygiene (HH) prevents HAI and various cross-infections in any setting. Audits of visual adherence for HH generates low compliance scores. During a yearlong improvement project, low monthly compliance scores of 52% in the Emergency Department (ED) of a community hospital, were reported by hospital auditors and found to be inaccurate by ED staff due to lack of visibility of HH actions because they occurred behind curtains or closed doors. Low scores and challenges were associated with behavioral change among ED team members, requiring multiple …

Improving Pain Management In The Cardiac Procedure Unit, Marisol Aquino

Master's Projects and Capstones

Abstract title: Improving Pain Management in the Cardiac Procedure Unit (CPU)

Unit: Cardiac Procedure Unit

Author: Marisol Aquino RN, BSN

Institution: University of San Francisco; Kaiser Permanente Nurse Scholars Academy; Kaiser Permanente Hospital, San Francisco (CNL practicum site).

Background Information

Cardiac Procedure Unit (CPU) specializes in the care of patients who are undergoing various cardiac procedures. The day-to-day operations are composed of Registered Nurses (RNs), Patient Care Technicians (PCTs), Unit Assistant (UA), and Nurse Practitioners (NPs) with an oversight from the Medical Director and Department Managers.

Patients’ perception of pain in the CPU has continually followed a “see-saw” pattern and …

Pursuing Equity In Diabetes Population, Aisha Rawlinson

Master's Projects and Capstones

Abstract

Background

Poor glycemic control (HbA1c >8) overtime leads to microvascular and macrovascular complications after the first and third years respectively, ultimately resulting in death after five years (Karter, 2016). Current Kaiser Permanente (KP) data stratified by race, ethnicity, age, and gender shows a significant disparity gap between Hispanics/Latino and Caucasian populations. The Pursuing IHI initiative is over a 2-year period completed at a microsystem that is focusing on health equity practices to reduce disparity gaps.

Project aim

KP Riverside, microsystem selected has a large population of Hispanic/Latino KP members, with focus on health equity. The project aim is to …

Newborn Kangaroo Care Immediately After Cesarean Birth, Sarah Abdolcader

Master's Projects and Capstones

Newborn Kangaroo Care Immediately after Cesarean Birth

Sarah Abdolcader

Global Aim: Improve exclusive breastfeeding rates from 76% to 80% in the Perinatal Unit during the newborn’s hospital admission by February 2018.

Project Aim: Improve the percentage of mother/baby skin-to-skin (kangaroo holding) from a baseline of 55% to 65% by August 2017.

Setting: Perinatal Units

Participants: Newborns birthed via cesarean section

Evidence: According to the World Health Organization (2003), hospitals should have a goal of >80% exclusive breastfeeding rates for all newborns during their acute hospital stay and it begins with skin-to-skin contact (SSC), newborn’s bare chest placed on mom’s bare …

Early Ambulation For Colorectal Enhanced Recovery Patients In A Surgical Specialties Unit, Jessica P. Pelletier

Master's Projects

Early ambulation is a key concept in surgical recovery and overall improvement of medical conditions. The initiation of Enhanced Recovery programs (ERP) for surgical procedures have used evidence-based research to bundle best practices for a quicker and more effective recovery.

The author evaluated the consistency of early ambulation on a surgical specialties unit using the ERP method. Through process improvement methods, data and practice were evaluated to show inconsistencies in documentation, data report abstraction, and understanding of complete collaborative bundle components.

Impacting Adherence To Infant Safe Sleep Practice, Danielle M. Hartig

Master's Projects

This paper provides a complete microsystem assessment of a pediatric unit. The assessment includes identification of a process problem with infant safe sleep practice in the hospital setting. The paper explores six different published articles regarding clinical practice guidelines, best practices, and evidence-based interventions. The literature review indicates agreement amongst various authors following infant safe sleep guidelines in the hospital setting. The literature review also indicates that caregiver role modeling while in the hospital setting is the most influential component that affects parents’ practices upon return to the home setting. The clinical project will include baseline needs assessments of both …

Pulmonary Embolism, Tonya Day

Nursing Student Class Projects (Formerly MSN)

The pathophysiological topic of acute pulmonary embolism was chosen to increase the knowledge base and provide additional information to assist with moving forward from a registered nurse to an Advance Practicing Nurse. Working as a full-time registered nurse in the emergency department, the working diagnosis of acute pulmonary embolism is something that is ruled out on many patients with complaints of shortness of breath, chest pain, or decrease in pulse oximetry. Since a patient with an acute pulmonary embolism can have both typical and atypical symptoms, the death rate can be very high, if not caught earlier enough. An acute …

Improving The Supply Process In An Interventional Procedures Unit, Megan M. Rose

Master's Projects

In the combined cardiac catheterization and interventional radiology unit of an urban Midwestern hospital, having supplies when and where they are needed is necessary for efficiently and safely completing a wide variety of procedures. Due to the complexity of the supply chain process in this setting, baseline data collection revealed many missing supplies, overnight shipments, and expired items. In this project, the MSN student sought to determine whether a Clinical Nurse Leader driven Lean Six Sigma based approach to supply chain interventions in the interventional procedures setting would improve outcomes and lead to financial savings by decreasing waste and variation. …

Von Willebrand Disease, Hannah Smith

Nursing Student Class Projects (Formerly MSN)

von Willebrand disease is a complex disease requiring a complex diagnoses and treatment. The family nurse practitioner must be familiar in the care of this population. The most common signs and symptoms are heavy menses and epistaxis (Abshire et al., 2015, p. 1585). The pathophysiology differs based on what type of von Willebrand disease (VWD) the patient has. VWD has many different inheritance patterns. Type 3 (the most severe) usually happens when the gene is passed from the mother as well as the father. If the inheritance pattern is recessive, and neither parent phenotypically has the disease, then the child …

Evaluation Of A Pilot Multidisciplinary Debriefing Program: Promoting Pediatric Provider Emotional, Social, And Spiritual Wellbeing, Allison E. Reynolds

Doctoral Projects

Regular exposure to trauma, such as the act of bearing witness to intense suffering and pain of pediatric patients and families, has a significant effect on healthcare professionals. Despite the fact that traumatic situations in pediatrics are a reality, there is little education and few interventions focused on how to prepare and support healthcare providers to care for dying children and families or for other clinically challenging situations. Pediatric residency program directors within a large, freestanding children’s hospital identified a subjective need for support for their pediatric residents in dealing with clinically challenging situations faced during residency, motivating residency program …

Evidence-Based Protocol: Standardizing Handoffs To Improve Outcomes, Melissa L. Rykse

Master's Projects

Nurse to nurse handoffs were identified as an area for improvement in an acuity-adaptable, progressive care (AAPC) unit in a Midwestern hospital. By using the Plan, Do, Study, and Act (PDSA) quality improvement framework, the content of handoffs was standardized by the creation and use of a handoff tool, organized in a Situation, Background, Assessment, Recommendation (SBAR) manner. Outcomes of nursing satisfaction and incidental overtime were improved after the implementation of the handoff tool. This cost neutral project has a cost savings potential of $2000/year with the reduction of incidental overtime.

Diverticulitis, Amanda Fantino

Nursing Student Class Projects (Formerly MSN)

Diverticular disease affects approximately 2.5 million people in the United states and it accounts for more than 280,000 hospitalizations per year (Mulligan, 2015). In 2004, the treatment cost for diverticular diseases was approximately 3.6 billion dollars, this is a huge expense for health care in this country (Schneider et al., 2015). “Diverticulosis is the presence of diverticula in the absence of inflammation” (Wilkins, Embry, & George, 2013). In the United States one study found that those with diverticulosis have a twenty-five percent chance of developing diverticulitis in their lifetime (Wilkins, Embry, & George, 2013). The number of patient in the …

Essential Hypertension, Melinda Rodriguez- Tercius

Nursing Student Class Projects (Formerly MSN)

Hypertension effects 30% of the total population with incidences higher in socioeconomically deprived areas. This nurse will research the pathophysiology of essential hypertension to gain a thorough understanding of the disease and provide evidence based guidelines to assist the patient population in care and maintenance of hypertension. Control of this disease will decrease the incidence of complications that increase morbidity and mortality including cerebrovascular accidents and myocardial infarctions.

Hypertension is known to be the most common modifiable risk factor for cardiovascular related deaths in the United States (Fontil, Bibbins- Domingo, Nguyen, Guzman, & Goldman, 2017). Although hypertension is a largely …

Von Wlillebrand Disease, Deanna Miller

Nursing Student Class Projects (Formerly MSN)

VWD is one of the most prevalent inherited bleeding disorder (James, 2017). This disorder is the result of a low levels of von Willebrand factor (VWF). VWF is a protein that binds to factor VIII; an essential clotting protein and platelets in the blood vessel walls that aids in production of a platelet plug during the clotting process (National Hemophilia Foundation, n.d.). This disorder was first described in 1926 by Erik von Willebrand. He distinguished that it differed from hemophilia and named it “pseudo hemophilia” (Leebeek, Eikenboom, 2016, p. 2067).

There are three main types of VWD, which is based …