Nursing Commons^™

Can The Implementation Of Interprofessional Rounds Improve Hospital Throughput Efficiency?, Rebecca Howdyshell

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Abstract

Efficient throughput processes are a vital part of providing cost effective, safe, quality patient care. Research has shown interprofessional rounds can have success at improving throughput processes. A rural, not-for-profit, 255 bed hospital in a Mid-Atlantic State was experiencing issues with throughput/patient flow. The aims of this quality improvement project were 1). to implement Interprofessional Rounds on the Progressive Care Unit (PCU); 2). To design and build a working Interprofessional Rounds template into meditech to guide Interprofessional Rounds and streamline discharge documentation; 3). to increase the amount of discharge orders entered between 0700 and 1300 by ten percent; and …

Effects Of A Crisis Intervention Team Assessment Center On Emergency Department Length Of Stay, Carlissa Lam

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Introduction: Emergency departments are overburdened with mental health patients who lack adequate access to behavioral health resources. The influx of patients has led to an increased length of stay in the emergency department for patients who are being evaluated for mental health concerns. Overcrowding can lead to delays in treatment, undesirable medical events, and patient mortality. Crisis Intervention Team (CIT) models bring law enforcement, mental health providers, emergency departments, and individuals with mental illness together to improve care for patients in crisis. They have been instrumental in identifying patients in crisis and transporting them to a Crisis Intervention Team Assessment …

Outcomes Of Implementing The Chronic Disease Self-Management Program (Cdsmp) In The Kurdish Community, Chinor Fattahi

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Background: The incidence of chronic diseases signifies a need to redesign the U.S. healthcare system to better support minority individuals. This project examined the impact of the chronic disease self-management program (CDSMP) workshop in the Kurdish community. The literature shows many positive outcomes of CDSMP workshops, including improvements in physical health, self-efficacy, depression, communication with providers, as well as reduced emergency department visits and hospitalizations. This results in healthcare cost savings for our local communities and our nation. The literature is limited on managing chronic diseases in the Kurdish population, a growing refugee population in the United States and central …

Video-Based Diabetes Education For A Culturally Diverse Population, Heather Harris

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

Immigrants and refugees represent an underserved population in need of quality, accessible, and culturally appropriate healthcare and education. Diabetes is a chronic condition frequently seen in this population. The author utilized the Wagner Chronic Care Model (CCM) as a theoretical framework for planning diabetes education delivery in this diverse population. Studies report significant health disparities in diabetes care and subsequent poor diabetes quality indicators in refugees and immigrants. Research has found that culturally sensitive diabetes education can improve diabetes outcomes in ethnically diverse populations. The author implemented a translational project to develop and evaluate a video-based diabetes health education intervention …

Improving Infection Management Of The Institutionalized Elderly, Jovel Angela Viloria Broqueza

Doctor of Nursing Practice Projects

Abstract

As the elderly population rapidly grows in the United States, the burden of managing infection in long-term care facilities (LTCF) escalates. The use of evidence-based infection identification algorithms for early recognition and treatment of pneumonia, urinary tract infections (UTI) and skin and soft tissue infections (SSTI) was evaluated at a Midwest suburban 110-bed long-term care facility. Focus group sessions were conducted at the facility with four nurse practitioners, the medical director, eight nurses and certified nursing assistants (CNAs) prior to an educational in-service which was provided to all staff at the facility. As criteria of infection were reported, nurses …

Transitions Of Care: Implementing Early Follow-Up Appointment To Help Decrease Readmission Rate, Lualhati Espina Dursun

Master's Projects and Capstones

Abstract

Problem – The rate of readmission in the country is at a severe level. According to CMS, in 2017 the average national readmission rate was 18.4%(CMS, 2018). Hospitals are penalized for unnecessary readmissions (HRRP, 2018). In addition to the financial burden of readmissions, quality of life is decreased with readmission.

Context – Early or timely outpatient follow-up after hospitalization has been projected as a means of decreasing readmission rates.

Interventions – Integrating follow-up appointment to the current care transition - HUB process as a means in reducing readmission rates.

Measures & Results – Identified high-risk patients that need timely …

Healing Wounds Through Nutrition, Deanna Garza

Master's Projects and Capstones

Abstract

The role of nutrition in wound care is often overlooked. The main reasons why wounds fail to heal are malnutrition, infection, impaired organ function due to co-existing diseases such as diabetes, hypertension, renal disease, and peripheral vascular disease to name a few. These factors have contributed to poor patient outcomes and patient satisfaction, as well as an increase in hospital length of stay. To promote wound healing, fuel from macro and micronutrients are necessary to deliver oxygen and energy for cell regeneration. However, nurses must possess knowledge and understanding of these requirements and the effects of nutrition on wound …

Nursing Engagement In Policy Development And Advocacy, Marketa Houskova

DNP Qualifying Manuscripts

At present, professional nursing does not benefit from strong policy development and advocacy influence in the United States. There are 425,000 licensed registered nurses in California, which is nearly twelve percent of the national nursing workforce. Yet only five percent of nurses serve on hospital boards, and legislative efforts to advance full practice authority for advanced practice RNs fail year after year in California and other states. Although nursing ranked most trusted and ethical profession for the past 16 years (Gallup 2017) and enjoys much respect in society, its collective voice is not being heard by decision-makers and legislators. This …

Growth Development And Health Promotion Across The Lifespan Nur 208, Joanna Burkhardt

Library Impact Statements

No abstract provided.

Root Cause Analysis To Improve Incident Reporting In An Ambulatory Care Setting, Lisa Ann Duncan

Doctor of Nursing Practice (DNP) Projects

Problem: The subject organization (SO) is a Federally Qualified Health Center (FQHC) with an internally developed incident reporting system. The SO wanted to improve patient and employee safety using data from incident reports, but the incident reporting system did not give enough information to recognize patterns and develop countermeasures.

Context: Supervisors welcomed the opportunity to learn more about incident report follow-up and conducting root cause analysis (RCA). Members of the Safety Committee were eager for data to use to develop countermeasures to improve patient and employee safety. Decreases in employee injuries can save the SO from increases in the …

Health Care Economics: Policy And Ethics Nur 412, Joanna Burkhardt

Library Impact Statements

No abstract provided.

Implementing Ihi Joy In Work Framework To Decrease Turnover Among Unit Leaders, Allison Reid

Doctor of Nursing Practice (DNP) Projects

Problem: A medical center in an integrated health care system in Northern California has experienced high turnover for unit level leaders employed in an acute care setting. The role of unit level leaders (managers, assistant managers, and supervisors) in this organization is complex, often stressful, and includes 24/7 accountability. These leaders must simultaneously deliver on organizational goals, patient safety, quality, budgets, and staff satisfaction (Loveridge, 2017). Increasing resilience can help these leaders cope with stress and find joy in their work, making them less likely to leave their leadership positions (Hudgins, 2016).

Context: According to Loveridge, the turnover rates of …

Transforming Nursing Preceptors By Developing Emotional Intelligence, Michael Francis

Doctor of Nursing Practice (DNP) Projects

Changing the process of professionally developing nursing preceptors to meet the growing and changing needs of the nursing profession is critical. This evidence-based project leveraged an advanced preceptor education program for inclusion of basic emotional intelligence tenets and transitioning them into preceptor self-awareness, leadership recognition, and return on human capital investment. A large integrated healthcare system in Northern California identified a strategic need for preceptor development and within the system two acute care hospitals and one home health/hospice agency were selected to participate. The intervention included the development of a six-hour curriculum delivered through an interactive and innovative in-person learning …

Frontline Focus: A Nurse Manager's Employee Engagement Toolkit, Christen Straw

Doctor of Nursing Practice (DNP) Projects

Abstract

Average hospital turnover rates in the US reached 18.2% in 2017. Turnover rates for registered nurses (RNs) were also at an all-time high of 16.8%. RN turnover can cost up to $61,100 per nurse resulting in the average hospital loss of $5.7 million per year (NSI, 2018). Employee engagement and job satisfaction levels are predictors of nursing turnover and patient outcomes and should be a top priority for nurse leaders. A disengaged workforce not only affects team morale and organizational spending, but it also impacts the quality of patient care. Multiple studies suggest that employee engagement is the number …

Implementation And Evaluation Of A Nurse-Driven Protocol For Urinary Catheter Management, Analynn Cisneros

Doctor of Nursing Practice (DNP) Projects

Problem Description: Hospitals compromise quality care and the health of its patients by subjecting the patients to risks that are preventable, such as nosocomial infections (IOM, 1999). The most preventable infection is a catheter-associated urinary tract infection (CAUTI) (Tenke, Meizei, Bode, and Koves, 2016). CAUTIs remain prevalent in the acute care setting (CDC, 2016).

Context: Prior to the implementation of this DNP project, the organization of focus did not have a nurse-driven protocol in place to guide urinary catheter management. Joint Commission mock surveyors recommended a protocol be implemented. A nurse-based protocol would benefit this Magnet hospital. Implementing …

School-Based Suicide Prevention Program Implementation: Improving Awareness Among Parents And Faculty, Nicole Neuman

Doctor of Nursing Practice (DNP) Projects

The health development and critical transition period of preteen to adolescence are subject to adverse experiences and prevalent risk behaviors that may negatively influence mental health. Emerging issues of depression and suicide among school-aged youths present a global epidemic. Well-designed interventions, such as school-based programs, align with national strategies and health initiatives to reduce suicide rates and facilitate treatment of concerning symptoms. Database searches for school-based, suicide, depression, prevention, and screening literature from 2012-2017 identified 12 relevant studies selected for review. Mental wellness and suicide prevention curricula must successfully improve wisdom, enhance coping skills/resilience, and foster relationships which support help-seeking …

Nursing Partnership With Patients, Parents And Families For Safety Through Simulation, Courtnay Caufield

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: The importance of communication between nurses, patients, and their family members with respect to treating each other as partners in safety cannot be overstated. It is imperative that families and patients feel empowered to speak up and report clinical errors at any time and be able to communicate effectively to prevent harm and encourage communication.

Context: This is especially important in the acute care setting, where patients may be in contact with multiple people and processes daily. Attention to this safety partnership can be established through improvements in patient satisfaction scores, which are usually collected from patients and …

Caritas Intervention To Reduce Stress And Increase Resilience Among Caregivers, Randy L. Williams Ii

Doctor of Nursing Practice (DNP) Projects

Problem

Workplace stress and burnout consistently rank among the highest concerns in surveys of caregivers. A gap analysis was conducted among a group of patient care coordinators and medical social workers. The gap analysis identified a need for tools to address stress, feelings of being overworked, and irritability.

Context

The setting is an acute care trauma facility providing care to general medical–surgical adult patients, cardiac care, pediatrics, and maternal child care. This facility exists within a larger integrated health care system, consisting of more than 20 acute care facilities in Northern California. The participants were patient care coordinators and medical …

Implementing A Surgical Infection Prevention Practice In An Integrated Healthcare System, Tammy Peacock

Doctor of Nursing Practice (DNP) Projects

Problem: One of the most preventable health care associated infections (HAI) is surgical site infection (SSI). Approximately sixty percent of SSI’s could be prevented. The devastation of an SSI to the patient can be catastrophic. The cost to the health care system for treating SSI’s can be substantial (Ban et al., 2017).

Context: The rate of surgical site infections has been on the increase over the past three years. The concern for the amount of harm affecting our patients was worrisome. The cost of reputation and the bottom line to the organization was recognized by senior leadership. The support from …

Teamstepps: A Foundation For Shared Governance In A High-Risk Obstetrical/Neonatal Service Line, Genevieve Wright

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: Declining registered nurse (RN) engagement in the maternal child health (MCH) department, despite improvements in RN staffing, some reductions in nurse-patient ratios, the addition of support staff resources, and a focus on quality and safety.

Context: The project setting is an MCH department of a 184-bed community hospital, part of a large national organization, serving a diverse population in Northern California. The initial stakeholders included RNs, managers, and assistant managers; the team was later expanded as the project developed (see Appendix A).

Intervention: The original aim of this project was to improve nurse engagement among frontline nurses through …

Improving Management Of Obstetrical Emergencies: Using Simulation-Based Training, Amira Amatullah

Doctor of Nursing Practice (DNP) Projects

The aim of this Executive Leadership Doctorate in Nursing Practice project was to assess the effectiveness of simulation-based training as a strategy to ensure patient safety and quality care by improving the knowledge and confidence of obstetric nursing staff. Collateral goals included the development of a simulation-based interactive training program to improve staff response to obstetric emergencies and the establishment of an Interprofessional Simulation Training Center.

The use of simulation-based training is widely accepted ans used in healthcare education. Several benefits of simulation-based training include a learner-centered approach, safe acquisition of technical skills training and development of effective communication skills. …

Student Perspectives On Working In Interdisciplinary Teams To Implement Mhealth, Elina Chun

Undergraduate Honors Theses

Interprofessional education of students in healthcare professions can lead to positive outcomes for students that are unique in a university setting. The purpose of this thesis is to describe benefits and challenges students encounter when working with students of other majors. This study used a convenience sample of students working on a university project to implement mHealth. Participants responded to two surveys with quantitative and qualitative questions. Students reported greater appreciation for diversity, the necessity of communication skills, and self-awareness of their own responsibilities in a team.

Health-Related Perception And Responsibility Behavior Among Individuals With And Without Chronic Illness, Danielle Dohrmann

Theses & Dissertations

Few studies have examined perceptions of responsibility attribution and well-being, and health responsibility behaviors in individuals with none, one, and multiple chronic illnesses. Adults (N = 421) in medical clinics completed questionnaires for this cross-sectional descriptive study. The Revised Causal Dimensional Scale measured responsibility attribution whereas sub-sections of the Chronic Disease Self-Management Program evaluation measured well-being perception and the health responsibility behavior of communication associated with a clinic visit. Chi-square, Wilcoxon-Mann-Whitney U, and Kruskal-Wallace tests were used to examine demographic characteristics and group differences. Individuals with multiple morbidities and of advanced age perceived their illnesses as more stable and rated …

Defying The Gravity Of Falls On Msu, Alvin Joseph Abad

Master's Projects and Capstones

Falls are a leading cause of injury and death for adult males in the United States and have been an ongoing problem on the Medical Surgical Unit (MSU). Therefore, the aim of this project is to increase fall prevention education and communication on MSU in order to ultimately improve fall rates. Although there are currently fall prevention processes already in place, these may not be sufficient as demonstrated by recent fall metrics. Many RNs on MSU are fairly new nurses; and their enthusiasm and adaptability may be an advantage for this evidence-based project. Furthermore, the management team seems to be …

Improving Nursing Communication Outcomes Through The Tell-Us Card, Nina Park, Laura Le, Brittney Pilker, Jillian Cule, Maricarmen Reyes, Jeffrey Salao

Master's Projects and Capstones

Nursing communication plays a pivotal role in patient-centered care. However, statistics have shown that failures in communication exist in more than 20% of all hospital settings (Sethi & Rani, 2017). Within the explored microsystem, a gap in patient communication was identified through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Reports revealed that the microsystem was performing at 69%, which is 11% below the national average for nursing communication (Centers for Medicare and Medicaid Services [CMS], 2018). After performing a microsystem assessment, there was a measurable communication opportunity between the patients and nurses. It was determined that …

Acquiring Knowledge About The Use Of A Newly Developed Electronic Fetal Heart Rate Monitor: A Qualitative Study Among Birth Attendants In Tanzania, Sara Rivenes Lafontan, Johanne Sundby, Hussein Kidanto, Columba Mbekenga, Hege L. Ersdal

School of Nursing & Midwifery, East Africa

In an effort to reduce newborn mortality, a newly developed strap-on electronic fetal heart rate monitor was introduced at several health facilities in Tanzania in 2015. Training sessions were organized to teach staff how to use the device in clinical settings. This study explores skilled birth attendants’ perceptions and experiences acquiring and transferring knowledge about the use of the monitor, also called Moyo. Knowledge about this learning process is crucial to further improve training programs and ensure correct, long-term use. Five Focus group discussions (FGDs) were carried out with doctors and nurse-midwives, who were using the monitor in the labor …

A Literature Review Of Pharmacotherapy Treatment Outcomes For Comorbid Post-Traumatic Stress Disorder And Stimulant Use Disorder: Methamphetamine Type, Abigail L. Christensen

Nursing Capstones

No abstract provided.

Use Of Antipsychotic And Mood Stabilizing Medication In Pregnancy, Elizabeth Ann Murphy

Nursing Capstones

No abstract provided.

Creating A Culture Of Learning: Improving Patient Mobility In A Medical-Surgical Unit, Camille Cabalsa

Master's Projects and Capstones

Abstract

PROBLEM: Hospitalization, especially among older adults aged 65 or over, can result in decreased mobility and functional decline. This decreased mobility can lead to accelerated bone loss, falls, increased length of stay, and delirium. In this medical-surgical unit, a pattern reflecting lack of adequate patient mobility has persisted over one year.

CONTEXT: Northwest (NW), a 42-bed community hospital medical-surgical unit- part of an integrated regional health care delivery system, has not been maximizing the mobilization of their patients for the past year based on internal data.The improvement project described in this paper focused on creating a culture of continuous …

Medication Error Prevention: Improving Patient Health Outcome, Brigitta Van Ewijk

Master's Theses

Medication administration errors were reported to have an error rate of 60% in early research mainly in the form of the wrong dose, time, or rate. Working conditions were found to be one of the main contributors to these errors. Recognizing and reporting medication errors are key to the implementation of the reduction of this critical health problem (Hughes & Blegen, 2008). DataRay Inc. (n.d.), states that almost one in five medication doses administered in hospitals is given in error. The two most common errors were (1) dispensing medicine at the wrong time (43% of incidents) and (2) omitting a …