Nursing Commons^™

Reducing Delays In Follow-Up Care Through Process Optimization, Liam Malpass

Master's Projects and Capstones

Primary care follow-up after an emergency department (ED) visit is an important component of comprehensive healthcare, contributing to both improved patient outcomes and reduced readmissions to emergency care. In alignment with the Clinical Nurse Leader (CNL) roles of risk anticipator and lateral integrator of care, this project aimed to support improvement in care continuity for patients at a large primary care clinic in London. At this clinic, a team of physicians, nurses, and support staff care for a diverse population of adult and pediatric patients who account for nearly 3,000 ED visits annually. Assessment of the clinical review process used …

Mentor-Based Orientation Program, Sheryl Pinugu Bano

Master's Projects and Capstones

The intention of this quality improvement project is to improve the process of staff development in a 16-bed, acute rehabilitation unit by implementing a mentor-based orientation program. Rehabilitation nursing is a specialty that requires knowledge of the rehab philosophy and milieu. The lack of a rehab-specific educational component of the orientation process causes the new nurses anxiety and dissatisfaction which negatively impacts nurse retention. The project aims to improve the confidence and competence of new nurses, decrease nurse turnover rate, and increase nurse retention by providing a rehab-specific, orientation class. The MiRehab booklet and a PowerPoint presentation were …

Developing Ostomy Educational Tools To Decrease Hospital Length Of Stay, Morgan Whitmore

Master's Projects and Capstones

A quality improvement project “Developing Ostomy Educational Tools To Decrease Hospital Length Of Stay” is aimed at reducing length of stay (LOS) for patients undergoing elective ostomy surgery from the current twelve days (Kirkland-Kyhn, 2017), to less than five days. Methods included use of a Pre-Ostomy Survey, which was distributed and completed by the nursing staff. Pre-survey analysis identified the need for three ostomy educational tools which were developed using a set of evidenced based patient care “milestones” and included: a Colostomy and Ileostomy Nursing Resource Binder, Patient Milestone Checklist, and the R.N. Postoperative Process For Ostomy Patients. The evidenced …

Assessment Of Fall Protocol Use On A Medical-Telemetry Unit, Ashia Mar

Master's Projects and Capstones

Purpose: This quality improvement project serves to implement a fall prevention plan to decrease patient falls on the medical-telemetry unit of a large metropolitan hospital.

Background: Patient falls are a persistent nationwide problem in the acute care setting. Between 700,000 and 1,000,000 falls occur in hospital every year and approximately 30-35% of these falls result in injury and 11,000 falls result in death (Health Research & Educational Trust, 2016). Falls always cause harm to the patient, whether it is emotional or physical; but, falls can also cause harm to the providers, family, and organization. Patient injury, additional hospital expenses, and …

Improving Early Sepsis Identification On Inpatient Units, Monica Schurle

Master's Projects and Capstones

Sepsis is a serious complication, which is initiated by the body’s extreme response to an infection. If sepsis is not identified and treated promptly, it can rapidly lead to tissue damage, organ failure and death. In order to reduce the number of patients who decline to sepsis in hospital, an efficient sepsis protocol needs to be implemented. Nursing practices, knowledge, and early recognition of systemic inflammatory response syndrome (SIRS) were assessed and measured in order to implement effective interventions. A root cause analysis was conducted to identify any discrepancies with compliance performing the sepsis screening in a timely manner, identify …

Reducing Turnover Time To Improve Efficiency In The Operating Room, Myrna Jafari

Master's Projects and Capstones

Abstract

The purpose of this project is to improve efficiency by reducing turnover time in the operating room (OR) that can consequently enhance patients’ and physicians’ satisfaction, promote teamwork, and decrease the cost of operating room delays. The increasing trend of turnover time (TOT) requires attention for microsystem improvement in the OR of Santa Rosa Memorial Hospital. The intervention to improve efficiency is to educate the OR team members on roles and responsibilities to establish a standard workflow which can promote accountability and teamwork during the turnover process. Havelock’s theory of change is used as a framework for the action …

Saving The Brain Matter(S): Improving Stroke Outcomes Utilizing A Direct To Ct Workflow, Robert Schambach

Master's Projects and Capstones

Saving the Brain Matter(s): Improving Stroke Outcomes Utilizing a Direct to CT Workflow was a project implemented to improve outcomes for acute ischemic stroke patients arriving at a rural emergency department. The project focused on a revision of the emergency department workflow for acute ischemic stroke patients with an aim of lowering the door to needle time to under sixty minutes. An interdisciplinary team used lean methodology and the PDCA cycle to examine and revise the workflow. The workflow was revised to eliminate testing no longer required under the national clinical practice guidelines for the treatment of ischemic stroke. Within …

Pregnancy Loss In The Emergency Department, Gudrun Reiterhiltebrand

Master's Projects and Capstones

Abstract

The aim of this project is to improve the care for patients experiencing pregnancy loss in the emergency department (ED). Objectives are to enhance understanding of staff about the patients’ experience and their knowledge on how to best care for emotional needs, thus improving quality of patient care, work satisfaction, knowledge, confidence and comfort levels, while decreasing experienced stress. The project was implemented in a midsized community hospital with 117 beds, which discharged 74 patients with “interrupted pregnancies” over the previous year from the ED. The project was directed toward nurses, doctors, care partners, chaplains, and social workers. The …

Data Aggregation Reporting Tool For Implementation In Home Health Fall Reduction Program, Jose Alberto Cruz

Master's Projects and Capstones

Abstract

Falls are a major preventable problem in healthcare that affects people of all ages but disproportionately affects the frail and elderly. Fall reduction programs play a significant role in reducing falls and fall related injuries and are a critical component in Home Health settings. This project takes place in a home health and hospice services agency. The purpose of the project consisted of aggregating fall data for benchmarking metrics to bring the agency’s Fall Reduction Program closer to compliance with state and national fall prevention guidelines. Two hundred and three fall event reports were analyzed and a problem arose …

Baseline Prevalence Study Of Hendrich Ii Fall-Risk Assessment Tool At A Local Community Hospital, Emanuelle Vasconcelos Barbosa Borba Pontual

Master's Projects and Capstones

Each year, 700,000 to 1,000,000 people in the United States fall in hospitals; 30%–35% of those sustain injuries, and 20% of falls will cause serious traumatic injuries. Yet, research shows that close to one-third of these falls could be prevented. This paper presents the analyses of two fall-risk tools, Hendrich II fall risk model (HFRM II) and PMAT, in a local community hospital. Extensive review of literature and statistical analysis of 106 patients’ assessments practices were used to determine the current assessment skills for falls and PMAT. The aim was to understand if RNs are using the tools appropriately and …

Development Of A Formalized Mentorship Program, Rozlyn Bauer

Master's Projects and Capstones

The purpose of this project is to help increase retention of newly licensed registered nurses (NLRN) at a large community medical center. The medical center loses approximately 20 NLRNs per year which is costly for the medical center. The loss of NLRN can be attributed to decreased job satisfaction, poor nursing competence and lateral violence between the nursing staff. Evidence shows that mentorship is a proven, evidence-based approach to solving these issues and more (Hodgson & Scanlan, 2013).

Not only can mentorship help increase retention, address lateral violence, increase job satisfaction and nursing competence but, it can also help enhance …

Improving Early Sepsis Identification On Inpatient Units, Eva M. Diaz

Master's Projects and Capstones

Sepsis is a medical emergency resulting from an infection. Its systemic effects can quickly lead to death if it is left untreated. The condition is extremely costly in regard to human life and national healthcare costs. In an effort to combat rising rates of sepsis effective protocols must be implemented into hospitals. Assessments were performed to ascertain the level of nursing knowledge regarding sepsis criteria, treatment, and hospital protocol. A microsystem assessment was performed using the Five Ps Assessment Tool, which addresses purpose, patients, professionals, processes, and patterns. A root cause analysis (RCA) helped identify factors affecting adherence to the …

Maternal Life Course Adversity: The Intersection Of Psychosocial And Biobehavioral Adaptive Response In Pregnancy, Crystal Modde Epstein

Theses & Dissertations

The link between life course adversity and adverse health outcomes is well established, particularly early life adversity (ELA). There is also evidence that the physiologic adaptations associated with stress, depression and ELA can be transmitted intergenerationally via long-term set-point changes within the maternal hypothalamic-pituitary-adrenal axis (HPA). It is unknown how the type and timing of maternal stress and adversity influences HPA regulation during pregnancy and whether maternal coping attenuates this relationship. Manuscript 1 was an integrative review of studies examining the association between maternal ELA and HPA regulation during pregnancy. In manuscripts 2 and 3 the findings of the dissertation …

Exploring Perceptions And Experiences With Resources Among Rural Alzheimer's Dementia Family Caregivers In The Midwest, Rita M. Million

Theses & Dissertations

Exploring PERCEPTIONS AND EXPERIENCES WITH RESOURCES AMONG RURAL Alzheimer’s Dementia Family Caregivers in the Midwest

Rita M. Million

University of Nebraska, 2017

Supervisor: Karen Schumacher, Ph.D., RN

Background. Despite vast amounts of research on informal caregiving in the Alzheimer’s dementia (AD) population, research on the experience and perceptions of rural caregivers is limited. A better understanding of rural caregivers’ knowledge, use, and nonuse of resources is essential to offset the impact of caregiving. Purpose. This study explored Alzheimer’s dementia family caregivers’ experiences and perceptions with resources in rural Midwest communities. Design. A descriptive qualitative approach with one-time semi-structured interviews was …

Self-Efficacy For Symptom Management In Adult Hematopoietic Stem Cell Transplant Patients, Lynn White

Theses & Dissertations

Hematopoietic stem cell transplant (HSCT) is a treatment for hematologic cancers and other hematologic conditions that causes severe treatment-related symptoms. The first 30 days after HSCT, or the acute phase, is when symptoms are most intense. During this time, the ability of patients to manage their symptoms, in collaboration with their health care providers, is crucial to reduce the distress caused by the symptoms. Self-efficacy is the person’s confidence in their ability to perform a behavior, such as symptom management. This body of work describes the concept of self-efficacy for symptom management (SESM), presents an integrated literature review on self-efficacy …

Parent Education On Childhood Vaccinations: Implications For Nursing Practice, Kristen Sevier

The University Honors Program

Early childhood vaccination rates in Ohio have been stagnant in the past couple of years. The purpose of this project was to use current evidence regarding early childhood vaccination rates to identify how nurses can effectively educate parents to increase childhood vaccination rates. The findings from this project helped establish an educational brochure for pediatric nurses as a nurse-led intervention to address vaccination adherence among parents at the point of care. The ultimate goal is to improve vaccination coverage among early childhood populations in Yellow Springs, Ohio. The educational brochure was created and presented to pediatric nurse faculty at Wright …

Fall Reduction On The Medical-Surgical Unit, Folasayo Akinwotu

Master's Projects and Capstones

The objective of this project is to reduce patient falls by 25% at the end of September 2018 on the medical-surgical unit. Another objective is to retrain staff on fall prevention measures. The medical-surgical unit provides care to patients who are acutely ill with a wide variety of medical issues. The project started with a staff survey where the staff state their top safety concerns. Results show that 75% of the staff felt that patient falls was a top safety concern. Based on the survey findings, I began to research CINAHL Complete and PubMed databases, along with Google Scholar to …

Evidence Based Protocol: Improving Nutrition Monitoring In Hospitalized Adults, Philip W. Jackson

Master's Projects

Malnutrition affects a large number of adult inpatients. For these patients, the implications of the high rate of malnutrition include impaired wound healing, higher rates of infection, and an increased risk of death. These complications contribute to increased healthcare costs and longer lengths of stay. The level of monitoring and documentation of patients’ meal consumption was acknowledged to be below expectations in an acuity-adaptable neurosciences unit situated in a downtown hospital located in the Midwestern United States. The define-measure-analyze-improve-control (DMAIC) quality improvement framework guided the quality improvement team to develop a standard process for meal related activities. The rate of …

Vietnamese American Women’S Beliefs And Perceptions On Cervical Cancer, Cervical Cancer Screening, And Cancer Prevention Vaccines: A Community-Based Participatory Study, Connie Kim Yen Nguyen-Truong, Kim Quy Vo Nguyen, Thai Hien Nguyen, Tuong Vy Le, Anthony My Truong, Keara Rodela, Rachael Allan

Asian/Pacific Island Nursing Journal

Cervical cancer remains commonly diagnosed in Vietnamese American women. Despite efforts to increase cervical cancer screening among Vietnamese American women, participation rates are persistently lower than the national goal. The objective of this study is to explore beliefs of Vietnamese American women about cervical cancer, cervical cancer screening, and cancer prevention vaccines. A qualitative descriptive investigation captured group perceptions about meaning and beliefs of cervical cancer, screening, and cancer prevention vaccines, and participants’ stories using a community-based participatory research approach.

Forty Vietnamese American women were recruited from the Portland, Oregon metropolitan area into four focus groups. Using a process of …

Test Anxiety And Undergraduate Nursing Students: The Concept, Impact, And Interventions, Sarah Macadam

The University Honors Program

Test anxiety in undergraduate nursing students negatively impacts test scores and overall academic success. This project utilizes current literature to identify the concept of test anxiety, the impact of test anxiety on undergraduate nursing students, and interventions to help reduce test anxiety. Literature findings will then be included in an educational PowerPoint presentation given to an undergraduate nursing course at Wright State University.

The Lived Experiences Of Parents With Chronic Sorrow Who Are Caring For Children With A Chronic Medical Condition, Lori L. Batchelor

Nursing Theses and Dissertations

Caring for the millions of children living with a chronic medical condition creates multiple parental burdens. Parents whose children have a diagnosis of a chronic medical condition may experience an ongoing, unresolved grief or sadness phenomenon known as chronic sorrow. This may impact parental ability to manage their child’s health care needs and may lead to negative health outcomes for the parent caregiver, affected child, and the family.

The aim of this interpretive phenomenological study was to understand the nature and meaning of the lived experiences of parents with chronic sorrow who are caring for a child with a chronic …

Effectiveness Of An Open Access Scheduling System In A Community Mental Health Center, Callie Crockett

Doctoral Projects

Abstract

Open Access Schedule (OAS) systems are a new way to schedule patient appointment in an outpatient medical setting. In theory these systems will provide many benefits that are not seen in a traditional scheduling model, such as decreased wait times to see a provider and more provider flexibility. However, little research has been done to examine how effective these systems are once they are put into practice, particularly in the mental health setting. The purpose of this project was to examine a recently implemented open access scheduling system in a community mental health center in rural Northeast Tennessee and …

Korean Sibling Caregivers Of Individuals Diagnosed With Schizophrenia, Mijung Park, Kwang-Ja Lee

Asian/Pacific Island Nursing Journal

Siblings of individuals diagnosed with schizophrenia are an important source of family caregiving. Unfortunately, limited information is available about sibling caregivers because existing studies have focused on other family relationships such as parents, spouses, and children. To fill the knowledge gap, the purpose of this study is to describe Korean sibling caregivers’ experience with individuals diagnosed with schizophrenia.

Guided by Colaizzi’s descriptive phenomenological methodology, we conducted in-depth, semi-structured, face-to-face interviews with eight individuals who have a sibling (1) diagnosed with schizophrenia and (2) hospitalized in an inpatient psychiatric unit. We discerned six key themes: sorrow, burnout, shame, different perspectives in …

Clinical Practice Update On A Temperature Guideline To Decrease Intraoperative Hypothermia In Patients Undergoing General Anesthesia, Ashley Rigdon

Doctoral Projects

Intraoperative hypothermia is a common problem within the operating room. Anesthesia inhibits the body’s normal thermoregulatory response to hypothermia, redistributing heat from the core to the periphery (Brandt et al., 2009). In the event of hypothermia, the incidence of infection triples as there is an increased risk for blood loss, increased risk for cardiac complications, and the thermal discomfort of patients (Brandt et al., 2009). Following a recent clinical practice guideline can help prevent hypothermia.

A descriptive project was organized utilizing current literature. The sample for this study is 45 CRNAs practicing at a multiple system healthcare facility in the …

Administering Dexamethasone Prior To Peripheral Nerve Blocks, Jacob Millwood

Doctoral Projects

Post-operative pain creates burdens for the patient and their family members while also drastically increasing the price of cost to the healthcare system. The Institute of Medicine Committee on Advancing Pain Research, Care, and Education states that the annual economic cost of chronic pain in adults is $560-630 billion (IOM, 2011). Regional anesthesia has been shown to provide potent analgesia that often times leads to a reduction in systemic analgesic requirements, opioid related side effects, general anesthesia requirements, and possibly the incidence of chronic post-operative pain. There are several adjunct medications that can be combined with peripheral nerve blocks to …

Increasing Student Registered Nurse Anesthetists Clinical Self-Efficacy Using Peer Mentoring, Megan Christine Bass

Doctoral Projects

The purpose of this project is to determine if clinical self-efficacy is increased in SRNAs at The University of Southern Mississippi after participation in the peer mentoring program. The project was a one-group pre and posttest design in a sample of SRNAs who received peer mentoring. To evaluate the students’ perceived clinical self-efficacy before and after the peer mentoring educational intervention, the Rowbotham and Schmitz Student Self-Efficacy scale (SSE) (2013) was adapted and administered to second-year SRNAs (N=17). Clinical performance, skill and knowledge development, social interaction with clinical faculty, and coping with clinical stress are the four areas evaluated by …

Implementing Computerized St-Segment Analysis Utilizing 5-Lead Ecg Cables During The Perioperative Period For Myocardial Ischemia Detection In Patients At Risk For Cardiovascular Disease, Lauren Robertson

Doctoral Projects

Cardiovascular disease (CVD) is one of the leading causes of death in the United States (U.S.) annually (Centers for Disease Control and Prevention, 2011). Mississippi has a disproportionately higher percentage of citizens likely to have CVD (Mississippi State Department of Health [MSDH], n.d.). The numerous stressors related to surgery are alone enough to increase the demand of the heart and lead to ischemia of the myocardium. Surgical stressors combined with preexisting CVD can exponentially increase the risk of ischemia. It is estimated that over a third of all surgical patients have ischemic heart disease. Puelacher et al. (2015) reported 40% …

Evaluation Of Delivery Methods Of Chemical Dependency And Wellness Education, Marissa Coggin

Doctoral Projects

Anesthesia practice is learned in a stressful environment, and these stressors may lead to the students’ development of maladaptive coping mechanisms. Despite significant improvements in our understanding of addiction and our approaches to combat this problem, the risk of substance misuse remains high in nurse anesthesia students. Education and intervention are imperative when taking preventative measures. The purpose of this Doctor of Nursing Practice (DNP) project was to determine whether delivery method of chemical dependency/wellness educational program effects the level of understanding of anesthesia providers and substance misuse and the development of healthy coping mechanisms.

In determining whether the delivery …

Non-Invasive Positive Pressure Ventilation In The Obese Patient Population An Intervention To Enhance Oxygenation: A Quality Improvement Project, Justin Smith

Doctoral Projects

Obesity is a comorbidity that can be challenging to the anesthetist. Patients who are obese are at risk for rapidly desaturating after becoming apneic during the induction of a general anesthetic. This rapid desaturation is mainly attributed to their decreased oxygen reserve that is a result of their obesity. Mississippi is known to have a disproportionately higher percentage of citizens who are obese, compared to other states (Johnson, 2016). Desaturation in the obese is important to avoid because it leads to atelectasis and prolongs recovery. When an anesthetist is providing a general anesthetic to the obese patient population, it is …

Spirituality In Clinical Practice: Recognizing The Importance Of Personal Values And Beliefs In Medical Decision-Making, Katie Lutz

Doctor of Nursing Practice (DNP) Projects

This Doctor of Nursing Practice (DNP) project addresses the importance of values and beliefs in patient’s healthcare decisions. Relying on a holistic theoretical model that accounts for all aspects of the human experience, the focus shifts from standard healthcare delivery to exploration of spiritual values and beliefs. In the past two decades, researchers and healthcare professionals have juxtaposed healthcare and spirituality to broaden the domain of care and enrich the provider and patient experience. Evidence has shown the alliance of spirituality and clinical practice has the potential to improve wellbeing and healthcare outcomes.

Interventions: In a public health setting, a …