Nursing Commons^™

Knowledge And Attitude Of Nurses In A New Rn Graduate Residency Program Regarding Pain Management, Kathryn Lee Wampole

Doctoral Dissertations and Projects

Most people have encountered pain at some point in their lives. It is a very common complaint nurses hear from patients. When assessing patients, nurses are taught to take what the patient says as his or her pain level as fact. Pain is not a vital sign that can be measured with medical equipment like temperature or blood pressure. Therefore, many nurses find assessing pain challenging. Adding to the complexity of pain management is the current opioid crisis. To help combat some of these issues, the project leader worked with healthcare administrators at a regional teaching hospital in the southeastern …

Cognitive Load Measurement, Worked-Out Modeling, And Simulation, Jayne Josephsen

Nursing Faculty Publications and Presentations

Using a cognitive load theory framework, this study investigated implementation of a worked-out modeling (WOM) prebriefing intervention on postsimulation knowledge acquisition and cognitive load experienced. A quasi-experimental quantitative design was used with a convenience sample of 61 senior-level nursing students who had previously participated in a simulation. The treatment group received the WOM intervention before simulation participation, and the control group received the usual presimulation interventions. A presimulation and postsimulation knowledge survey and a cognitive load measurement tool were administered after the simulation. Data indicated increased knowledge related to falls and situation, background, assessment, and recommendation in the treatment group …

Screening, Brief Intervention, Referral To Treatment (Sbirt) As A Harm Reduction Public Health Approach For At-Risk College Students, Karen V. Duhamel

Health Sciences Faculty Publications

SBIRT is a “comprehensive, integrated, and public health approach to the delivery of early intervention and treatment services for persons with substance use disorders or at-risk of developing these disorders” (MA SBIRT, 2019).

Can college counselors at a private university in CT who triage college students at-risk for problematic substance use, by using the Screening, Brief Intervention, Referral to Treatment (SBIRT) approach, as opposed to non-SBIRT, identify and refer more at-risk students to substance treatment within an 8-10-week timeframe?

Strategies To Improve Resource Availability For New Graduate Nurses In A Critical Care Setting, Natasha Stankiewicz, Jonathan Archibald, Shawn Taylor, Deborah Jackson, Bonnie Boivin, Mark Parker, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Amy Sparks

Operations Transformation

STRATEGIES TO IMPROVE RESOURCE AVAILABILITY FOR NEW GRADUATE NURSES

Due to changes in the employment arena, health care organizations are hiring new graduate RNs into acute care. At an academic tertiary medical center, new hires typically are assigned into a night shift, which traditionally has less resource availability.

The results of a recent AHRQ hospital survey on patient culture safety demonstrated that new graduates were feeling unsupported and that patient safety could be potentially compromised. A team of caregivers developed several goals to provide increased support, encouragement and education to night shift new hires. Improvement in overall patient care and …

Consistently Using A Transportation Department For Patient Discharge To Sustain Nursing Staffing Levels, Victoria Boutin, Joseph East, Stephen Tyzik, Joy Moody, Mark Parker, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

IMPROVING PATIENT FLOW BY UTILIZING A HOSPITAL TRANSPORTATION DEPARTMENT FOR DISCHARGES

Using a transportation department for transporting patients for discharge is the industry standard. At a large urban hospital, inconsistent use of this department has resulted in frontline caregivers (RNs) having to pick up this function, resulting in potentially unsafe staffing levels on the floor.

The goal of this quality improvement project was to improve the percent of discharges with the transport department from ≤10% to 70% by the end is fiscal year 2018 in an academic tertiary medical center.

Baseline metrics demonstrated the current state and a root cause …

Implementing Strategies To Reduce Central Line-Associated Blood Stream Infections On An Inpatient Pediatric Unit, Sherryann St. Pierre, Nicole Manchester, Jessica Howe, Melanie Lord, Mark Parker, Suneela Nayak, Ruth Hanselman, Stephen Tyzik, Amy Sparks, Barbara Bush Children's Hospital

Operations Transformation

STRATEGIES TO REDUCE CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS

Every central line associated bloodstream infection (CLABSI) leads to poor outcomes, increased mortality and increased healthcare costs. A pediatric care team in an academic tertiary medical center set a goal to reduce the number of these infections on their unit.

The team’s research showed that daily bathing greatly decreases CLABSI. Their baseline metrics demonstrated an unacceptable level of those with central lines being bathed. A root cause analysis revealed that patient and family refusal was the leading cause for those who did not bathe.

A performance improvement plan was initiated that consisted …

Increasing Bedside Medication Safety In An Intensive Care Setting, Natasha Stankiewicz, Jonathan Archibald, Scu 2, Mark Parker, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

A PERFORMANCE IMPROVEMENT PROJECT FOR INCREASED BEDSIDE MEDICATION SAFETY

The convenience of having certain medications directly available at bedside has long been a priority for a medical intensive care nursing team in an academic tertiary medical center.

However, it was apparent to new staff and leadership that there was a lack of awareness and interest in securing medications within the department. This posed a risk to patients, families, visitors and colleagues.

Baseline metrics on patient safety were collected and a root cause analysis was conducted. Countermeasures included increased education of medication safety as well as a instituting a KPI which …

Improving Revenue Capture And Patient Safety In An Icu Setting, Natasha Stankiewicz, Laura Lewis, Jonathan Archibald, Mark Parker, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Amy Sparks

Operations Transformation

IMPROVING REVENUE CAPTURE AND PATIENT SAEFTY IN AN INTENSIVE CARE SETTING

Materials management department is responsible for restocking chargeable supplies in an intensive care unit (ICU) at an academic tertiary medical center. Staff confusion as to what items were considered chargeable often led to low supply par levels resulting in delays of critical patient care.

Using baseline metrics, a team of caregivers created several performance improvement goals to increase nursing compliance with appropriate supply charging. The results of a root cause analysis spearheaded the development of a KPI that encompassed staff education, lost charge tracking and charge supply labeling.

Post …

Sustaining Daily Management With Gemba Walks: A Scheduling Model, Suneela Nayak, Ruth Hanselman, Stephen Tyzik, Amy Sparks

Operations Transformation

SUSTAINING DAILY MANAGEMENT WITH GEMBA WALKS: A SCHEDULING MODEL

At an academic tertiary care medical center, there are 110 Operational Excellence teams across 4 campuses. Every weekday, 10 GEMBA walks occur with the 11^th on Wednesdays. The expanding program has made daily leadership visits to all KPIs challenging. As a result, consideration of reduced gemba walks to departments who have met specific maturity/performance criteria.

The scope of the eight-week pilot consisted of 13 pre-identified teams that have weekly workflows. The teams must have met a baseline level of performance. Performance was scored for 9 variables measuring engagement, PDSA, use …

Improving Communication Between Child Life Services And Nursing On An Inpatient Pediatric Unit, Sherryann St. Pierre, Elizabeth Shaughnessy, Bethany Kay, Barbara Bush Children's Hospital, Mark Parker, Suneela Nayak, Ruth Hanselman, Stephen Tyzik, Amy Sparks

Operations Transformation

IMPROVING COMMUNICATION BETWEEN CHILD LIFE SERVICES AND NURSING ON AN INPATIENT HOSPITAL UNIT

Effective communication between patient caregivers has been shown to reduce stress and trauma related to hospitalization and subsequent improved outcomes. An HCAHP score for a 30 bed acute inpatient pediatric unit illustrated the confusion faced by children as a result of nursing and care life specialists not working together as a team.

A root cause analysis identified a number of issues as to why patients were not benefitting fully from child life services. Several counter measures were instituted with the goals of improving the HCAHP score and …

Strategies To Improve Timeliness For Cleaning Inpatient Rooms Following Patient Discharge, Lora Dixon, Mark Parker, Ruth Hanselman, Suneela Nayak, Amy Sparks

Operations Transformation

STRATEGIES TO IMPROVE THE TIME FRAME FOR CLEANING INPATIENT ROOMS BY ENVIRONMENTAL SERVICES

In an inpatient rehab hospital, it was noted that Environmental Services (EVS) was delayed in cleaning rooms between patient discharges and admissions. This resulted in the frequent use of a “stat clean” order that allows only 50% of the normal cleaning time , forcing patients to wait and impacting patient flow.

A root cause analysis demonstrated lack of communication between the rehab hospital and the contracted cleaning services. A number of counter measures were initiated with the goal that cleaning would be started within 20 minutes of …

Improving Safe Handoffs & Transitions From The Ed To Adult Inpatient: A Response To The Ahrq Hospital Patient Safety Culture Survey, Natalie Talbot, Joanne Chapman, Rhonda Diphilippo, Gail Savage, Michele Higgins, Nancijean Goudey, Lori Sweatt, Erin Graydon Baker, Joseph East, Stephen Tyzik, Suneela Nayak, Mark Parker, Ruth Hanselman, Amy Sparks

Operations Transformation

SAFE TRANSITIONS AND PATIENT HANDOFFS IN A LARGE ACUTE CARE HOSPITAL

It is well documented in the literature that ineffective patient handoffs and transitions continues to be an area that can lead to adverse patient safety events so it is an urgent opportunity for a performance improvement plan. At an academic tertiary care medical center, the lowest scoring domain from the FY2017 AHRQ Patient Safety Culture Survey was patient handoffs and transitions.

A team was established consisting of staff from the Emergency Department and a medical/surgical unit to develop a plan for implementing improvement interventions. Their goal was to attain …

Generalist Versus Specialist Nurses' Knowledge, Attitudes, And Behavioral Intentions Toward Promoting Pulmonary Rehabilitation For Patients With Chronic Obstructive Pulmonary Disease: A Cross-Sectional Correlational Study, Su-Er Guo, Hsueh-Chen Shen, Chizimuzo T. C. Okoli, Yen-Chi Liao, Kuen-Daw Tsai, Ming-Shian Lin, Hsin-Tien Hsu

Nursing Faculty Publications

Pulmonary rehabilitation (PR) is an effective strategy to manage chronic obstructive pulmonary disease (COPD), though its utilization rate is low. One reason for this low utilization rate is that nurses do not provide COPD patients with enough health education to increase the patient's motivation for PR participation. This study examined knowledge, attitudes, and behavioral intention toward PR promotion. The study also investigated the correlates of behavioral intentions to promote PR among pulmonary nurses.

A cross-sectional correlational design was used. Overall, 284 nurses (all women) from chest medicine and general internal medicine wards in 3 hospitals within Midwest Taiwan were recruited. …

Loma Linda Nurse - Vol. 26, Loma Linda University School Of Nursing

Loma Linda Nurse

Contents

FEATURES

4 | Where Legacies Begin — Alyssa Vega

8 | A Promise to Go Where the Lord Calls

10 | What I Wish I Had Known Before I Started Nursing School

14 | Constructing New Opportunities for Nursing Graduates

LLUSN HIGHLIGHTS

16-21 | ALUMNI NEWS

22-25 | HOMECOMING

26-27 |COMMENCEMENT

28-37 | ACADEMICS

38-39 | FACULTY UPDATES

Evaluation Of Clinical Growth And Nursing Student Motivation In The Traditional Clinical Learning Environment, Jessica Barkimer

Dissertations (1934 -)

Evaluation of students in the traditional clinical learning environment is difficult. There remains a lack of standard guidelines to evaluate students using valid and reliable instruments as well as inconsistent processes with lack of interrater reliability standards between educators. A need exists for fair and consistent evaluation of nursing students. When the clinical educator uses a standard evaluation process and understands students’ motivation for learning, adaptations in teaching strategies and education on self-regulatory strategies can be implemented to enhance learning and measure clinical growth. This research study used a prospective, correlational, pre-test/post-test design to examine the relationship between student motivation …

Home Health Care Effect In Post-Discharge Return To Hospital, Danielle M. Siclovan

Dissertations (1934 -)

Background: Home Health Care (HHC), the most commonly used bridge strategy for transitioning from hospital to home-based care, is expected to contribute to ongoing readmission avoidance efforts. However, evidence suggests HHC patients are readmitted more frequently than patients without HHC. Determining the effectiveness of HHC as a readmission reduction strategy requires a comparison sample of patients with similar characteristics referred and not referred to HHC. Methods: For this matched-sample comparative study, the available sample (n=18,774) included 3,629 patients referred to HHC and 15,145 non-HHC patients, from which 2,718 pairs matched 1:1 were obtained using exact and Mahalanobis distance matching. Unadjusted …

Qualitative Exploration Of The Perceptions Of Nursing Undergraduates Regarding Family Care At End-Of-Life, Penny A. Alt-Gehrman

Dissertations (1934 -)

Background/Purpose: Family care at end-of-life is delivered by nurses and includes communication and explanations, providing emotional support for the family, creating an environment in which death occurs with dignity, providing privacy, facilitating visitation, and honoring and meeting cultural and personal family values (Beckstrand et al., 2011; Bloomer et al., 2013; Cronin et al., 2015; Heidari & Norouzadeh, 2014). There appears to be a gap in the empirical evidence and literature on this topic. Regarding the knowledge and comfort of student nurses, and subsequently nurses, in family care at the end-of-life, there is disparity. To determine what must be taught to …

An Emancipatory Approach To Cultural Competency: The Application Of Critical Race, Postcolonial, And Intersectionality Theories, Linda M. Wesp, Victoria Scheer, Ashley Ruiz, Kimberly Walker, Jennifer Weitzel, Leslie Shaw, Peninnah M. Kako, Lucy Mkandawire-Valhmu

College of Nursing Faculty Research and Publications

Nurses teach, work, and conduct research in an increasingly hostile sociopolitical climate where health inequities persist among marginalized communities. Current approaches to cultural competency do not adequately equip nurses to address these complex factors and risk perpetuating stereotypes and discrimination. A theory-driven emancipatory approach to cultural competency will instead lead to lasting change and uphold the core nursing value of commitment to social justice. This article explicates key tenets of critical race, postcolonial feminist, and intersectionality theories and then applies them, using an emancipatory approach to cultural competency that can reshape nursing education, research, and practice.

Millennial Male Associate Degree Of Nursing Students: Perceived Motivators, Benefits And Barriers, Daniela Brink

All Theses And Dissertations

There is a severe nursing shortage in the United States which affects the delivery of healthcare. The reasons for the nursing shortage are many and complex including the national movement toward healthcare reform, an aging population making greater demands on an already stressed healthcare system, and stereotypical attitudes about the work of nursing in general. While men comprise approximately half of the population, men represent only 9.6% of the nursing profession. As millennials are the current emerging workforce, this problem of a nursing shortage could be addressed by increasing the diversity of the nursing workforce to include more men from …

Clinical Framework For Quality Improvement Of Cancer Cachexia., Clara Granda-Cameron, Mary Pat Lynch

College of Nursing Faculty Papers & Presentations

The objective of this article is to introduce the Clinical Framework for Quality Improvement of Cancer Cachexia (Cachexia Care Framework) as a tool to demonstrate the relevance of integrating the clinical components of cancer cachexia and the organizational strategies of a cancer institution on the quality of patient care and delivery of services throughout the cancer cachexia continuum. The data sources included peer-reviewed literature relevant to cancer cachexia and quality cancer care, and the authors' expertise. The Cachexia Care Framework results from a combination of the international consensus definition of cancer cachexia, the Institute of Medicine report Ensuring Quality Cancer …

Treatment-Related Decisional Conflict, Quality Of Life, And Comorbidity In Older Adults With Cancer., Jeannette M. Kates

College of Nursing Faculty Papers & Presentations

Objective: The present study aims to examine the relationships between and among cancer treatment-related decisional conflict, quality of life, and comorbidity in older adults with cancer.

Methods: A convenience sample of 200 older adults was recruited from outpatient medical oncology and radiation oncology practices in the northeastern United States. A cross-sectional, descriptive, correlational study design was used employing a survey method. Survey instruments included the Decisional Conflict scale (DCS) (with five subscales, including informed, values clarity, support, uncertainty, and effective decision); Self-administered comorbidity questionnaire (SCQ); European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (including five function …

Increasing Hcahps Scores By Scripting Of Hourly Rounding, Katherine Rivera

Doctoral Dissertations and Projects

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a standardized national report on patient perceptions of care and is now linked to hospital reimbursement by both government and now some independent insurance companies. Healthcare systems are therefore very interested in ways to increase patient satisfaction within their facilities. This evidence-based practice pilot project was based on the Iowa Model of Evidence and used a quasi-experimental process to ascertain if adding scripting to the hourly rounding process was able to increase patient satisfaction scores on the HCAHPS. The increase in patient satisfaction, in the area of perceived responsiveness …

“I Should Have Started Earlier, But I Was Not Feeling Ill!” Perceptions Of Kalenjin Women On Antenatal Care And Its Implications On Initial Access And Differentials In Patterns Of Antenatal Care Utilization In Rural Uasin Gishu County Kenya, Roselyter Riang’A, Anne Nangulu, Jacqueline Broerse

Population Health, East Africa

Aim: The aim of this study was to explore how Kalenjin women in rural Uasing Gishu County in Kenya perceive antenatal care and how their perceptions impede or motivate earlier access and continuous use of antenatal care services.

Methods: A study was conducted among 188 pregnant and post-natal mothers seeking care in 23 rural public health facilities. Gestational age at the initial antenatal care booking was established from their medical cards. Further researcher-administered questionnaire with closed and open-ended questions was used. Key informant interviews with traditional birth attendants (n = 6) and maternal and child health nursing officers (n = …

Improving The Interprofessional Relationship Between Nurses And Speech-Language Pathologists: A Pilot Study, Christina Hamling, Kristy Weissling

Honors Program: Senior Projects (Public)

The research presented in this thesis explores the impact of interprofessional education on undergraduate nursing and speech-language pathology students with an overall goal of improving the interprofessional relationship between the two fields. Utilizing quantitative and qualitative methods in the form of a pre-test, educational materials, live guided observation, and post-tests, the researchers found an increase in the nursing students ’ ability to identify the role of the speech-language pathologist in a medical setting (knowledge). There was also an increase in the speech-language pathology students’ ability to understand how and when to communicate with nurses in a medical setting (knowledge).

Translational Evaluation Of Acid/Base And Electrolyte Alterations In Rodent Model Of Focal Ischemia, Sarah R. Martha, Lisa A. Collier, Stephanie M. Davis, Hilary A. Seifert, Christopher C. Leonardo, Craig T. Ajmo, Elspeth A. Foran, Justin F. Fraser, Keith R. Pennypacker

Neurology Faculty Publications

BACKGROUND AND PURPOSE: Acid/base and electrolytes could provide clinically valuable information about cerebral infarct core and penumbra. We evaluated associations between acid/base and electrolyte changes and outcomes in 2 rat models of stroke, permanent, and transient middle cerebral artery occlusion.

METHODS: Three-month old Sprague-Dawley rats underwent permanent or transient middle cerebral artery occlusion. Pre- and post-middle cerebral artery occlusion venous samples for permanent and transient models provided pH, carbon dioxide, oxygen, glucose, and electrolyte values of ionized calcium, potassium, and sodium. Multiple regression determined predictors of infarct volume from these values, and Kaplan-Meier curve analyzed morality between permanent and transient …

Factors Contributing To 30-Day Readmission In Postsurgical Patients: A Reevaluation Of Hospital Policies And Proposal For Change, Miriam Morgan-Skinner

Doctor of Nursing Practice Projects

Background

Readmission can cause much frustration for patients and families. The Center for Medicare and Medicaid Services (CMS) has emphasized the importance of finding ways to decrease readmissions within 30 days of discharge. In the southwest healthcare organization studied, the 30-day readmission rate for abdominal surgeries was 10%. The goal of the study was to identify the causative factors for the readmissions and make appropriate suggestive changes. This project identified the factors contributing to the 30-day readmission rate in selected abdominal surgeries between January 2016-July 2017 and developed a policy to address the predominant factor.

Method

After receiving institutional review …

A Partnership Between Nursing Faculty, Students, And Urban Community Centers To Provide Vision Screenings For Low-Income Immigrant Women: An Experiential Case Study, Rose C. O'Halloran, Kerry A. Milner, Kim Foito

Sacred Heart University Scholar

Given the current health care climate, it is critical for nurse educators to provide learning opportunities for students to collaborate with leaders in the community to provide much-needed services to vulnerable populations. We developed, implemented, and evaluated a process for vision screenings and referrals to a local eye center for low-income, immigrant women over three years in an urban setting in the United States. This is a report on the program, including the challenges faced by the faculty and lessons learned by the nursing students.

Implementation And Evaluation Of A Physical Activity And Dietary Program In Federal Incarcerated Females, Rosemary A. Johnson, Kerry A. Milner, Christine Heng, Anna E. Greer, Susan M. Denisco

Nursing Faculty Publications

The purpose of this 3-month quasi-experimental pilot study was to examine the effect of a physical activity and dietary education program on body mass index (BMI) and resilience. Participants were given data-storing pedometers to record their physical activity, attended classes on healthy eating, and used portion control tools from http://ChooseMyPlate.gov . MyPlate usage and commissary purchases were collected weekly. BMI and resilience scores were measured at baseline, 6 weeks, and 12 weeks. Twenty-nine female prisoners completed the study. There was a statistically significant reduction in BMI after 12 weeks (χ2 = 7.56, p = .023) and resilience levels increased but …

Pain Management: A Flowsheet For Providers, Lisa Swezey

Doctoral Dissertations and Projects

Many different factors led to the trend of providers prescribing opioids for chronic pain. However, the misuse of and many deaths related to opioid prescriptions have caused the trend to reverse its direction. National organizations call for providers to stay clear of opioid medication and increase the use of nonpharmacological pain management, but also to treat pain adequately. There are still many barriers to decreasing the use of opioids and increasing the use of nonpharmacological methods. This scholarly project hoped to use an educational flowsheet to assist providers in meeting the demands from national organizations to decrease the use of …

An Enhanced Actualized Dnp Model To Improve Dnp Project Placements, Rigor, And Completion: A Research Brief, Marie Vanderkooi, Dianne Conrad, Sandra Spoelstra

Open Access Publishing Support Funded Articles

Doctor of nursing practice (DNP) projects are summative evaluations of enactment of the DNP Essentials. However, information about structure, process, and outcomes of DNP projects is scarce. Guided by an enhanced actualized DNP model, this study tested the effect of a PhD-DNP-site mentor model to guide DNP projects. Time-to-complete assignments, defense, and graduation improved; high satisfaction for students, mentors, and faculty were found; and a strengthened academic-practice partnership occurred, leading to additional student placements. Broader testing of the enhanced model in various size and types of academic-practice settings is needed prior to use.