Nursing Commons^™

Timing Is Everything: Discharge Teaching To Parents In Pediatric Outpatient Surgery, Kate Boulder Dnp Candidate, Ccrn, Joseph Burkard Dnsc, Crna

Doctor of Nursing Practice Final Manuscripts

Background: Over 50 years of literature support the nursing “golden rule” that discharge teaching begins upon admission. Parents’ poor understanding of pediatric post-operative instructions following outpatient day surgery can put their child at risk for some preventable complications after arriving home.

Purpose: To improve parents’ understanding of discharge education using earlier initiation of post-operative teaching to best meet the needs of adult learners caring for a child under age 18 after surgery.

Process Used: Parents were educated using four cardinal strategies: early initiation of instructions, reinforcement of key points throughout the length of stay, optimal timing in a distraction-free environment, …

Activity Trackers: Are They The Answer, Connor Ogden, Neil Peterson

Journal of Undergraduate Research

Physical inactivity in young adults leads to a 40% greater chance of cancer mortality, 50% greater risk of dementia, 60% greater risk of stroke, type 2 diabetes, obesity, and a number of other health related issues1. In our country in which sedentary jobs have increased by 83% since 1950, and 69%2 of all adults are obese or overweight, these health related factors due to inactivity become a real concern. Many companies have created these activity trackers as a solution to solving physical inactivity. The purpose of this project was to evaluate what aspects of the Microsoft Band that young adults …

Racial Differences In Patient-Reported Post-Stroke Disability In Older Adults, Charles Ellis, Gayenell Magwood Phd, Rn, Faha, Faan, Brandi M. White

Publications

Longstanding disparities have been reported in stroke-related outcomes with blacks experiencing more post-stroke disabilities. Little is known about long-term disability outcomes among older stroke survivors. This study was a retrospective analysis of data from the 2015 National Health Interview Survey (NHIS). A group of 655 stroke survivors (541 white and 114 black) age 65 and older were asked to rate their ability to complete 10 functional tasks without special equipment. Univariate comparisons were completed using t-tests and chi-square statistics for racial comparisons of disability reports. Multinomial logistic regression was used to determine odds of reporting disability after controlling for relevant …

School Of Nursing News, Georgia Southern University

Nursing: News & Publications (2013-2023)

• School of Nursing Named No. 10 Most Affordable Online Colleges for Nurse Practitioner Degree

Copd Management And Role Of The Nurse Coach: Increasing Referrals And Participation In Pulmonary Rehabilitation, Carol Upcraft, C. Hoover, Joy Plamann, Jessica Oman

Articles

Chronic obstructive pulmonary disease (COPD) remains a significant cause for hospitalization and with complex management issues upon discharge a significant portion are being re-admitted within 30-days of first hospitalization. The beneficial effects of pulmonary rehabilitation (PR) in the management of COPD is well documented but continues to be underutilized as an important management strategy to reduce hospital readmissions. Transitional care programs which include nurse coaches, have immerged to empower patients to manage their disease and facilitate transitions through multiple care environments. Little is known about the efficacy of such programs on referral and participation in PR and subsequent reductions in …

Emergency Room Nurses Knowledge Of And Experience With Health Literacy And Their Patient Teaching Methods, Deborah Kennard

Seton Hall University Dissertations and Theses (ETDs)

Health literacy (HL) is the ability one has to understand health information and navigate within the health system. Health literacy is linked to health knowledge and acute and chronic health outcomes. The conceptual model of health literacy outlines the contextual factors related to individual health literacy throughout the health system and the mitigating influence on outcomes. Education is a key factor to health knowledge and behavior changes. Nurses are the primary educators for providing patient teaching and yet research indicates nurses are lacking in knowledge regarding this. One area in the health system where health literacy has a strong effect …

The Lived Experience Of Chemo Brain In Early Stage Breast Cancer In Women 50 And Under, Patricia A. Gibbons

Seton Hall University Dissertations and Theses (ETDs)

Cognitive deficits have been shown to affect those who have undergone treatment with chemotherapy. This is often referred to as chemo-brain. The purpose of this descriptive phenomenological study was to explore the lived experience of the chemo brain after undergoing chemotherapy for breast cancer. The study sample consisted of six women between the ages of 29 and 50 with early stage breast cancer. van Manen’s (1997) descriptive phenomenological method guided data analysis. The recurrent themes identified in this study were (1) Struggles with day to day life (2) Emotions related to diagnosis and treatment, (3) Fatigue (4) Coping and support, …

Evidence-Based Verbal De-Escalation Techniques For The Family Nurse Practitioner: Education And Simulation, Rachael K. Misitano

Doctor of Nursing Practice (DNP) Projects

Background: Healthcare workers are 4 times more likely to be exposed to workplace violence than workers employed in private industry, with assault rates as high as 7.8 per 10,000 workers. The National Institute for Occupational Safety and Health defines workplace violence as “violent acts, including physical assaults, and or threats of assault, directed toward persons at work or on duty” (OSHA, 2015, p. 2). Verbal de-escalation techniques that assist with care of the agitated patient are not routinely taught to Family Nurse Practitioners (FNPs) throughout their years of advanced coursework, yet it is something they are likely to encounter …

Promotion Of Advance Care Planning For Individuals Experiencing Homelessness, Sarah A. Hubbell

Doctor of Nursing Practice (DNP) Projects

Vulnerable populations in the United States experience disparities in access to advance care planning and may have significant unmet healthcare needs at the end of life, including unrelieved suffering. People who are homeless have increased morbidity and mortality risks, yet lack opportunities to discuss end-of-life preferences. A Doctor of Nursing Practice project consisted of designing, implementing, and evaluating an educational intervention in two settings for nurse practitioners and other clinicians on advance care planning with individuals experiencing homelessness. The intervention was associated with increased knowledge and confidence in advance care planning ability. Participants expressed positive intention to change individual practice …

Gavage Program For The Preterm Infant, Amanda K. Guina

Master's Projects and Capstones

Preterm infants in the Neonatal Intensive Care unit, are susceptible to hospital acquired infections due to their immature immune systems. To mitigate this occurrence a change project will be implemented to decrease the incidence of nosocomial infection in this population. The project will be focusing on preterm infants working on full nipple feeds. Our project is aiming to discharge this population home with a nasogastric tube to work on feedings, rather than remaining in the hospital. Chart Audits were conducted pre-program and found approximately 18 patients acquired blood stream infections and 2 acquired MRSA. The method used to assist in …

Inpatient & Outpatient Venous Thromboembolism: A Multifactorial Approach To Increase Mechanical And Pharmacological Prophylaxis Compliance, Suzanne E. Scheierling

Master's Projects and Capstones

Venous thromboemboli (VTEs) are a clinical and public health problem as they are commonly linked to inpatient experiences, yet frequently occur in the outpatient setting. VTEs place a significant burden on health care organizations and patients alike, as VTEs are costly, require long-term medications, and frequently reoccur. Research has identified risk factors and determined best practices for VTE prevention and prophylaxis, however little consensus exists among health care organizations and the implementation of best practices is varied. This project studied the challenges and opportunities in VTE prevention and prophylaxis at a large metropolitan hospital in California. Environmental changes were made …

Infection Control: Reducing Hospital Acquired Central Line Bloodstream Infections, Bobbie Joy Hollins

Master's Projects and Capstones

Hospital-acquired infections are a leading cause of morbidity and mortality in neonatal intensive care units (Ceballos, Waterman, Hulett, & Makic, 2013). It’s estimated that each neonatal bloodstream infection costs about $35,000 and adds about two weeks to a baby’s hospital stay (Akron's Children Hospital, 2015). This project was formulated to reduce the incidence of central line blood stream infections in the neonatal population. The setting used for this project was a 40 bed Level III Neonatal ICU. The methods executed include: conducting a root-cause analysis and formulating a unit survey. Kurt Lewin’s Three-Step Change Model was also used to complete …

Hospital Acquired Clostridium Difficile Infection Prevention, Sandy Maalouf

Master's Projects and Capstones

Abstract

The aim of my CNL Internship Project is to decrease the incidence of healthcare acquired C diff infections at the acute care unit 1800 to zero for the next quarter. This will be accomplished by developing an action plan to address the issue by collecting data from audits and developing evidence based practice interventions. The process begins with patient’s admission to the medical surgical unit and ends with patient’s discharge from the medical surgical unit.

By working on the process, the Hospital Acquired Infection (HAI) team expects to improve infection control among all units, increase patient safety, reduce unnecessary …

Breast Cancer Patient Preparedness For Transition To Survivorship: Individualized Survivorship Care Plans, Kimberly Beringer

Master's Projects and Capstones

Purpose. For breast cancer survivors, after-effects of surgery, radiation and chemotherapy can be substantial, and recurrence is a concern requiring constant surveillance. National healthcare organizations have promulgated guidelines that include providing individualized survivorship care plans (SCP’s). At a northern California oncology department, SCP’s will be prepared for breast cancer patients and delivered in-person by the oncology nurse navigator (ONN).

Method. The author worked with the ONN to develop the format and content requirements for the SCP’s. The ONN prepared individualized plans for patients and scheduled in-person appointments to deliver the SCP’s. A feedback survey to assess preliminary impact was then …

Improving Communication And Satisfaction Through Hourly Rounds, Karen E. Sondeno

Master's Projects and Capstones

The focus of this CNL project is quality improvement using high quality hourly rounds to achieve improved patient satisfaction and communication with nurses. It was determined by reviewing survey results that patient satisfaction and nurse communication is below National levels. Data shows that rounds are not being done well on a medical unit before the improvement project. It is proven that patients receive and perceive higher quality care and communication with increased nurse presence at the bedside. The population of the medical unit has high numbers of confused/dementia, and dual-diagnosis patients. It was determined that the unit would benefit from …

Perception And Behavior For Underreporting Workplace Violence, Marissa L. Payne

Master's Projects and Capstones

The project is focused in a medical centers’ emergency department that serves a diverse population, varying in age, health, socio-economic status, and mentation; and at a given 24-hour period, the department will care for about 150 to 200 patients. The focus is on the Clinical Nurse Leader (CNL) essential to advocate a change in the culture of acceptance of workplace violence and the perception of the value of reporting violent behavior. To identify the factors that hindered reporting of workplace violence, a root and cause analysis was performed. The analysis revealed that the most common reason behind underreporting is the …

Reducing Alarm Fatigue In Critical Care, Janice A. Winfrey

Master's Projects and Capstones

Reducing Alarm Fatigue in Critical Care

Abstract

This improvement project took place on the Critical Care Unit (CCU) of a non-profit hospital in Northern California. The unit houses 54 beds, employs over 210 employees, and houses the facility’s central cardiac monitoring station which utilizes unit staff. The objective was to improve patient safety through reducing the risk of alarm fatigue by decreasing the total number of clinical alarms on the unit. Specified goals included a 20% reduction in the number of alarms sounding on the unit with a 20% reduction in telemetry utilization. Goals were chosen based on unit assessment …

Optimizing Electronic Healthcare Records And Improving Process In The Healthcare Clinic, Joana Salazar

Master's Projects and Capstones

Abstract

The purpose of this project is to examine the reasons for low compliance in entering data into the electronic healthcare record (EHR) and implement a change to improve the process. The project consists of generating data and reviewing charts to determine the reasons data on homelessness and income status are not entered in the EHR. If data is not entered, this may lead to a threat to the quality of care provided by the clinic and a potential loss of status as a Federally Qualified Healthcare Center and recognition as a Patient-Centered Medical Home. The baseline data shows that …

Reducing Patient Supply Waste Through Nurse Education To Improve Quality Of Patient Care In The Clinical Microsystem, Lale Johnston

Master's Projects and Capstones

CNL Final Project Abstract

With my CNL project, I sought to reduce patient supply waste in the clinical microsystem by 50% by the end of the second quarter of 2017. The project was conducted in a 19-single-room adult surgical/orthopedic unit in a community hospital. I completed a through microsystem analysis with 5 P’s, SWOT analysis, and hospital HCAHPS scores as well as staff interviews. I then continued doing observational audits for supply use, barcode scanning, supplies in patient rooms, staff efficiency, and challenges facing nurses and their time constraints (Godfrey, Nelson, & Batalden, 2004).

During this process, I also completed …

Improving Breastfeeding Rates By Using Glucose Gel To Treat Newborn Hypoglycemia, Madena Barak

Master's Projects and Capstones

Newborn hypoglycemia occurs in 5-15% of newborns during the postnatal period (Weston et al., 2016). Typical treatment for hypoglycemia includes supplementing with formula, which causes a decrease in breastfeeding rates, decreasing patient satisfaction, and interfering with maternal-infant bonding. To combat this issue, a large community hospital in Southern California used Lewin’s Theory of Planned Change to implement an alternative intervention for the treatment of newborn hypoglycemia. Evidence based articles as well as collaboration with surrounding hospitals was used to support the use of oral dextrose gel instead of supplemental formula to treat newborn hypoglycemia. The hospital’s revised treatment protocol on …

Performance Gap Among Nurses In Splint Application And Crutch Training, Aidalyn P. Carino

Master's Projects and Capstones

Abstract

The aim of this CNL internship project is to improve the current nursing practices by closing the performance gap among nurses on splint applications and crutch training within the 3-month course of this project. This project was implemented in a urgent care setting where Minor injuries such as sprains, strains or fractures are commonly seen by immobilization by application of splints which is given by the nursing staff. Micro assessment of the work flow of unit showed that only a few members of the staff routinely do these procedures and results from a self- assessment survey showed that 50% …

I’M A Big Kid Now: Enhancing Transition Rn Residents’ Confidence During Pediatric Patient Care, Emily W. Lam

Master's Projects and Capstones

The title of the clinical nurse leader project is “I’m a Big Kid Now: Enhancing Transition RN Residents’ Confidence During Pediatric Patient Care”. The project aims to improve the support components for Transition RN residents during their Transition RN Residency at Children’s Hospital Los Angeles. The clinical leadership theme that correlates to this project is communication. The clinical nurse leader’s role is to act as an educator and a facilitator throughout this project. In examining the clinical nurse leader competencies, competencies “use performance measures to assess and improve the delivery of evidence-based practices and promote outcomes that demonstrate delivery of …

Standardization Of Shift Report By Implementing A Nursing Report Sheet And Addressing Patient Values To Meet Patient Needs, Roman A. Salas

Master's Projects and Capstones

Bedside shift report is a complex process, which involves the transition of care from one clinician to another. The Agency for Healthcare Research and Quality (AHRQ) (2013) reported that approximately 70% of patient adverse events are attributed to communication failures between healthcare providers. Nurses remain inconsistent with information sharing during bedside shift report leading to communication gaps. The object of the clinical nurse leader (CNL) internship project is to provide true patient-centered by standardizing bedside shift report by implementing a nursing report sheet and addressing patient needs. The project was conducted in a level-one trauma center in San Diego, CA …

Process Improvement Manual: Front And Back Office, Hafsah Badar

Master's Projects and Capstones

The global aim of this project is to decrease variations and improve efficiency in the tasks assigned to the support staff at an outpatient breast clinic. The breast center has a five-person administrative team who rotate through four positions monthly. The specific aim is by May 1, 2017, 100% of the five employees will have a comprehensive knowledge of their role, and adhere to a standardized way of completing tasks. The CNL Leadership themes used were Educator, Team Leader Manager, and Outcomes Manager. Informative interviews were conducted with the staff to gauge the unique needs of the team. 100% of …

Improving Stroke Documentation On A Stroke Unit, Yvette Melgoza

Master's Projects and Capstones

The aim of this project is to improve adherence of stroke documentation per stroke protocols on a stroke unit at an acute hospital setting through nursing education and EPIC modifications. A comprehensive retrospective data collection was done to determine the inconsistencies of nursing documentation per organizational protocols. Firstly, a randomized sample of 163 stroke patients (Site 1 = 98; Site 2 = 65) was generated for retrospective data collection. For this project, the main focus was Site 1 (n = 98). The sample from Site 1 consisted of 4 types of stroke patients, which were patients who either received alteplase …

An Eicu/Icu Collaborative To Reduce Sepsis Mortality, Laura S. Maples Ms.

Master's Projects and Capstones

Sepsis costs over 20 billion dollars annually to treat making it the most expensive diagnosis for hospitals (Afrefian, et al., 2017) and carries with it an average mortality rate of 45% (SCCM, 2016). The eICU/ICU collaborative project was developed to improve sepsis mortality at Sutter Health’s Solano hospital affiliate from 41.2% to the system-wide goal of 18.8% over the course of a year by implementing two technologies. The first was the onboarding of the non-invasive cardiac output monitoring (NICOM) technology by Sutter Solano to fulfill the 6-hour bundle compliance for septic shock resuscitation. The other technology was the activation and …

Delirium: A Cnl-Led Protocol To Clear Up The Confusion, Shanda N. Whittle

Master's Projects and Capstones

Project objectives: Delirium is a form of organ failure defined as an acute change in cognition, evidenced by altered consciousness and impaired attention that fluctuates over time, and is associated with increased morbidity, mortality, and healthcare services utilization. In the hospital where this evidence-based practice project took place, there was no formal protocol or guideline for assessing or managing delirium. Therefore, this project focused on improving the practice of identifying patients at risk for developing delirium with the AWOL tool and treating patients with signs and symptoms of delirium found using the Short-CAM assessment. Population and setting: This project took …

Pediatric Intensive Care Unit Skin-Care Team, Anna Therianos Konstantin

Master's Projects and Capstones

In the United States, pressure injuries (PIs) cost $9.1–$11.6 billion per year and claim more than 60,000 patient lives. The large Northern California hospital where this CNL project was conducted has had an 8.33% incidence of hospital-acquired PIs at or greater than stage two in the pediatric intensive care unit (PICU). Pressure injury prevention was not a high priority for the nursing staff; nurses were unaware of current PI prevention protocols or the PI prevalence in the PICU. The goals are to reduce PIs by 20% in 3 months, increase PI nursing education, and improve patient outcomes. Nursing skin-care rounds …

Fall Prevention: Responder 5 Bed Connectors, Ani Tatevossian

Master's Projects and Capstones

This paper explores falls, a sentinel event plaguing hospitals in the United States and internationally. Falls are a major contributor to negative patient outcomes and a source of financial strain for hospitals. One particular fall prevention intervention, Responder 5 bed alarms, was explored. A literature review on falls was conducted to study the effectiveness of bed alarms. Capezuti et al. (2009) found bed alarms to be error prone and stress the importance of patient risk factor assessment and using bed alarms as a multifactorial approach to fall prevention. Shorr et al. (2012) came to a similar conclusion after conducting a …

Reducing Operating Room Turnover Times, Marivic Z. Paraz-Lee

Master's Projects and Capstones

Background

The operating room (OR) in an ambulatory surgery center (ASC) is what generates income for an organization, but it can also be costly if it’s improperly managed. The purpose of this project is to decrease OR turnover time (TOT) in order to increase OR efficiency, patient and staff satisfaction, as well as be cost effective. As defined by Gottschalk et al. (2016), OR turnover time is “the duration of time from a patient exiting the OR to the time the succeeding patient enters the OR” (p. 489).

Methods

The method utilized for this project is gathering weekly average TOT …