Nursing Commons^™

Investigating The Relationship Between Unavoidable, Hospital Acquired Pressure Injury And Mortality: Is Unavoidable, Hospital Acquired Pressure Injury A Signal Of Increased One-Year Mortality Risk?, Eileen Jimenez

Theses & Dissertations

The purpose of this dissertation was to explore the strength of the relationship between unavoidable Hospital Acquired Pressure Injury (HAPI) and increased risk of one-year mortality for patients age 55 and older who were admitted to a hospital from 2015 to 2018. A quantitative, retrospective case-control study was designed to compare demographics, comorbid conditions, pressure injury risk, and living situation of those patients that developed unavoidable HAPI and hospitalized adults with similar physiological burdens that remained injury-free. The one-year mortality for the HAPI group was 27 of 48 (56%), and 26 of 47 patients (55%) for the Control group. The …

Glycemic Variability In Patients With Stage Ii-Iii Colon Cancer, Natalie Mandolfo

Theses & Dissertations

Patients with cancer experience metabolic changes such as hypoglycemia, hyperglycemia, and glycemic variability; collectively termed malglycemia. Glycemic variability, defined as fluctuations in glucose, is a marker of metabolic instability. Higher glycemic variability is associated with adverse health outcomes in the general population and in those with diabetes. Little is known about glycemic variability in patients with cancer, especially those with solid tumor malignancies. Glycemic variability is associated with increased infection, shorter periods of remission, and higher mortality in patients with hematological cancer. This body of work describes the concept and measurement of glycemic variability to assess glycemic control in patients …

A Program Evaluation Of Violence Prevention Task Force To Address Type Ii Workplace Violence Utilizing Precede/Proceed Model, Stephanie Autry

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Aim: The primary aim of this project was to complete a program evaluation of the institution’s Violence Prevention Task Force. Evaluation allowed for assessment of outcomes including 1). decrease in assaultive incidents; 2). decrease in assaults leading to injury; 3). increase in team member reporting of assaultive incidents; and 4). demonstrate the program’s adherence to published guidelines on workplace violence prevention.

Background: Violence against healthcare workers has been an increasing problem in our nation’s healthcare system. Type II workplace violence is defined as patient, family member, or visitor as the perpetrator directing violent/aggressive behavior towards healthcare worker and is described …

Postpartum Depression: Educating The Provider And Staff About The Importance Of Screening, Referrals, Follow-Up And Adherence To The Maternal Mental Health Safety Bundle Toolkit, Natalie Regis

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Background: Postpartum depression (PPD) affects approximately 10%-20% of women after childbirth. PPD is a disabling condition that can have serious health implications on mothers and their infants. Experts estimated that only 50% of women with PPD are diagnosed. Lack of education about screening practices can cause the disorder to go undiagnosed and untreated.

Purpose: The purposes of this quality improvement (QI) project were 1). To increase the provider and staff knowledge about the importance of screening with the implementation of a standardized screening tool 2). To increase PPD screening rates to 100% 3). To increase appropriate referrals to mental …

A Descriptive Study Of Male Victims Of Sexual Assault Seen For A Sexual Assault Forensic Medical Examination, Madeleine Prince

Undergraduate Honors Theses

Ten percent of all victims who report a sexual assault (SA) are male (Department of Justice, 2013), yet there has been little research on their experiences. Further study on the unique characteristics of male SA victims is warranted. The purpose of this study is to explore, identify, and analyze variables of male SA victims who received a SA forensic medical examination (SAFME), and identify implications and areas for future research. Data from the SAFME charts were entered into the Statistical Package for the Social Sciences (SPSS) version 25. Male victims were compared to female victims from the same data set. …

Assessing Healthcare Leader Competency Proficiency Levels In Evaluating Graduate Healthcare Leadership Student Competency Proficiency Levels And Curriculum, Brandi A. Sillerud, Heather C. Winkler

The Interactive Journal of Global Leadership and Learning

Healthcare leaders must possess specific competencies to perform their job requirements by identifying what competencies may need development and take steps to further their education, knowledge, and proficiency. This exploratory research aims to utilize industry data when evaluating student competency proficiency and how that data might impact curriculum development. The research question that is addressed: At what competency proficiency level do working healthcare leaders rate themselves utilizing Benner’s Novice to Expert Theory (1982)? Graduate programs should evaluate current industry data to evaluate how students’ progress in their programs and determine if curriculum changes are needed. Graduate programs should …

Oral Chemotherapy: Safe Handling In The Home, Cynthia Huff

DNP Qualifying Manuscripts

Background: According to the National Institute for Occupational Safety and Health (2016), oral anticancer agents (OAC) are hazardous drugs (HD) and require the same safe handling interventions in the home setting as in controlled health care environments. The use of a safe handling checklist for OAC administration is a way nurses can provide safe handling education to patients and caregivers and assess for understanding and competency for critical tasks. Effective home management strategies outlining caregiver protections, proper storage, administration of OACs, spill clean-up, and waste disposal could reduce exposure risks to toxic agents.

Objective: To present a safe-handling checklist …

A Compelling Case For Evidence-Based Practice Mentor Development Programs: An Integrative Review, Stacy Alves

DNP Qualifying Manuscripts

Background: In 2008, The Institute of Medicine (IOM) set a goal that by 2020, 90% of healthcare decisions would originate from the best evidence available. This goal remains intangible for many organizations. Despite reporting quality and safety as a top organizational priority, a survey of 276 Chief Nurse Executives (CNEs) found that only roughly 50% of the CNEs said that EBP was practiced in their hospitals only “somewhat” or “not at all” (Melnyk, Gallagher‐Ford, Thomas, Troseth, Wyngarden, Kzalacha, 2016). Many organizations struggle to systematically integrate EBP into practice (Melnyk et al., 2018; Warren et al., 2016a). The Advancing Research and …

Usp <800> Compliance: A Hazardous Drug Safe Handling Ppe Toolkit For Infusion Nurses, Cynthia Huff

Doctor of Nursing Practice (DNP) Projects

Problem: Safety concerns have existed for more than 40 years about how hazardous drug (HD) exposure contributes to long- and short-term adverse health outcomes for healthcare workers (HCWs). Careless handling may cause toxic residues to infiltrate hospital environments and patient care areas, and can even be traced to patients’ homes. New government regulations will require healthcare organizations to minimize exposure risks to HCWs by fully implementing the U.S. Pharmacopeia (USP) Convention Chapter 800: Hazardous Drugs: Handling in Healthcare Settings (USP, 2016) on December 1, 2019. According to Polovich and Olsen (2017), “The implementation of the USP <800> Standards will represent …

Safety Huddles: A Safety Net For Nurses Amid The Covid-19 Pandemic, Miranda Saint-Louis

DNP Qualifying Manuscripts

In March 2020, our 31-bed geriatric medical unit was designated the first COVID-19 unit in a teaching hospital located in a New York City COVID-19 hot zone. At the time, little was known about SARS-CoV-2 and the disease it caused. We needed to find a way to keep them calm, assure their safety, and provide competent and compassionate patient care in a situation where best practices had not yet been established. The concepts from this article can be applied to provide support staff in any crisis. Providing a safety net for staff enables a focus on life-saving patient care without …

Ensuring Racial Equity In Midwifery Education Programs: Beginning Steps For Midwifery Education., Ronnie Lichtman, Jennifer Woo, Pamela Reis, Carrie S. Klima, Dana Perlman

College of Health Professions Faculty Papers

No abstract provided.

Mexican Americans' Perspectives On "Borderline Diabetes" In Amarillo, Texas, Priscella Pena-Correa

Nursing ETDs

The purpose of this study was to explore the meaning of and experiences living with “borderline diabetes” among Mexican American adults residing in or around Amarillo, Texas. Sixteen Mexican Americans who self-identified as having “borderline diabetes” participated. Research questions focused on how participants understood the condition, self-care practices, and recommendations for improving prediabetes healthcare and education. An interpretive description approach was used to analyze data from phone interviews. Principal findings revolved around issues of disclosure vs. secrecy, information seeking, and challenges or “struggle” to change lifestyle, particularly diet. Self-care was managed in a relational way with support of family, friends, …

Improving Nurse Engagement Through Unit Practice Councils: A Literature Review, Pavna Sloan

Doctor of Nursing Practice (DNP) Projects

Problem: According to The Advisory Board Company, nurses are the least engaged group of healthcare employees (The Advisory Board Company, 2014). This finding concerns healthcare organizations because those with a high percentage of disengaged nurses have increased nurse turnover rates and decreased patient satisfaction and safety scores (Kutney-Lee et al., 2016). Shared governance, in the form of the Unit Practice Councils (UPC), is a model healthcare organizations implement to increase nurse engagement. A review of the current literature is needed to evaluate if the model is effective.

Purpose: The purpose of this article is to provide a comprehensive literature …

Improving Clinical Communication And Collaboration Through Technology, Michelle Machon

Doctor of Nursing Practice (DNP) Projects

Problem: Over the last 30 years, clinical communication methodologies in healthcare have evolved to become such disparate systems that they lead to confusion, wasted time, and clinician dissatisfaction. The Joint Commission (2016) reports up to 78% of sentinel events in hospitals are linked to communication failures, which have obvious implications for hospital systems in the quality and safety of their current communication systems.

Context: The purpose of this project was to determine the effectiveness of implementing a unified clinical communication technology platform in an acute care hospital setting and to make recommendations from that implementation to the organization’s larger health …

Implementing Simulation In Icu New Graduate Nursing Orientation: Introducing Two Practice Innovations, Aiza Quinday Msn

Master's Projects and Capstones

A change project involving the use of innovative wearable simulation technology was integrated into the 12-week new graduate nurse ICU training program at one community hospital in Northern California. Project implementation was interrupted by the Covid-19 pandemic, so only the first pilot training session was conducted. Initial results from this training session suggest that the simulation training had a positive impact on the nurses’ ability to assess patient breath sounds and to recognize and treat a rapidly deteriorating patient. This training session also allowed the project team to identify additional areas of skill assessment and opportunities for improvement for the …

Reducing Hospital Acquired Pressure Injuries Through A Standardized Prevention Bundle, Austin Lee Stoker

Master's Projects and Capstones

Abstract PROBLEM: Currently healthcare acquired pressure injuries (HAPIs) in the United States result in significant and unnecessary costs along with lost revenue for healthcare facilities. These costs are estimated to be between 9.1 and 11.6 billion dollars annually. Pressure Injuries (PIs) are directly associated with decreases in patient outcomes and are deemed preventable incidents. HAPI prevention can mitigate this clinical and financial problem for patients and organizations. CONTEXT: Unnecessary patient harm related to four HAPI occurrences in the last quarter on the 2B Medical Surgical Telemetry Unit in an integrated managed care delivery system continue to be of concern. Adherence …

Standardizing Patient Handoffs In The Icu – Implementing The “I Put Patients First” Tool., Wislande Joseph

Master's Projects and Capstones

Abstract

Background. Ineffective patient handoff can result in poor nurse communication, increasing the likelihood of adverse events including medication and documentation errors.

Context/Problem. In one 20-bed ICU unit in a northern California community hospital, 48 patient handoffs were observed over 2 weeks. Only 29% occurred at the patient’s bedside; 39.5% used a standardized handoff tool; and 54% included the patient and/or family. These findings indicate significant quality gaps in the unit’s ICU patient handoff processes.

Intervention. The educational intervention consisted of one introductory and two follow-up teaching sessions related to best practices for handoff processes followed by implementation …

Creation Of A Covid-19 Community Testing Team For Home Health And Hospice, Lilah Raja

Master's Projects and Capstones

The novel SARS-CoV-2 strain (COVID-19) was identified in Wuhan, China in December 2019 (Eddy et. al, 2020). The resulting US outbreak has affected the Kaiser Permanente (KP) Oakland health care system. With the threat of COVID-19 highest among immunosuppressed and elderly clients, KP Oakland home health and hospice (HH/HO) department is rapidly mobilizing to provide community and in-home testing for eligible clients. A project was created to build a COVID-19 testing team workflow to provide diagnostic and preventative testing. This project focuses on team-based interventions that will change the pre-existing practice of requiring HH/HO clients to travel to remote testing …

Development Of A Disaster Preparation Toolkit To Improve Community Resilience, Tiffany Wong

Doctor of Nursing Practice (DNP) Projects

Problem: Natural and man-made disasters happen in all communities and negatively impact the health and safety of populations. Vulnerable populations, such as older adults with comorbidities and disabilities or those aging in place, face greater challenges and have specific needs when faced with disasters. The physical, psychosocial, and cultural characteristics of older adults place them at greater risk during disasters. Emergency preparedness is necessary to build and improve community resilience, as well as to ensure older adults aging in place have the necessary supplies and support to respond to a disaster. Without a proper action plan, recovery efforts during disaster …

Transformational Leadership For Frontline Leaders, Marta L. Hudson

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem. Transformational leadership (TL) represents the gold standard of leadership styles in contemporary healthcare organizations. The transformational leader's ability to motivate, influence, stimulate, inspire, and attend to followers' individual needs is an antecedent to job satisfaction, quality, and patient safety. The project aimed to improve TL constructs among frontline leaders (managers and assistant nurse managers). Based on the results of a needs assessment, these frontline leaders were provided an opportunity to improve their TL style.

Context. Leadership development is a strategic priority for a medium-sized medical center in a healthcare system in Northern California. Frontline leaders within patient care …

An Evaluation Of Adolescent Concussion Management And Guidelines By Primary Care Providers In The Outpatient Setting: Dnp Scholarly Project, Mary Beth Newkirk

Doctor of Nursing Practice Scholarly Project

Understanding the pathology of a concussion has been a challenging task for many experts in healthcare. An agreed upon definition has yet to be developed and many health care providers are not properly educated to assess and care for those suffering from a concussion. Management of concussion in adolescents, a vulnerable population, requires even more consideration and training. The purpose of this study was to determine the knowledge current providers in the four-state region regarding sport-related concussion management in the adolescent population, to improve patient care and outcomes, and to improve knowledge learned through exposure to a clinical practice guideline-based, …

Evaluation Of A Fall Prevention Program For Older Adults In A Rural Community, Candice Morris

Doctor of Nursing Practice Scholarly Project

This project set out to evaluate fall prevention interventions for older adults in a rural community. A literature review was performed to identify evidence-based fall prevention programs that could be modified to meet the needs of the community. Stopping Elderly Accidents, Deaths, and Injuries (STEADI), the Otago Exercise Program, and Stepping On were selected as the most appropriate fit for the needs of this project. The researcher combined and modified the programs in order to bring the intervention to participants in the community. The modified fall prevention intervention successfully reduced key fall risk factors in the participants that completed the …

Implementation And Evaluation Of Whole Health Opioid Safety Shared Medical Appointments In A Veteran Population: A Quality Improvement Study, Sherry Cox

Doctor of Nursing Practice (DNP) Projects

Problem: The most recent data from the Centers for Disease Control and Prevention (CDC, 2018b) suggest that 130 Americans die from an opioid overdose each day, thus creating an unprecedented number of opioid-related deaths in the United States to date.

Context: Of particular interest to the author and this DNP project is that Veterans are twice as likely to die from an opioid overdose, compared to the average American, making this epidemic a priority for Veterans Health Administration (Wilkie, 2018).

Interventions: The author developed a 9-session Opioid Safety Shared Medical Appointment (SMA) program to reduce opioid reliance in …

Program Implementation For New Graduate Nurses To Go From Moral Distress To Moral Courage And Beyond, Melinda Furrer

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: Moral distress is a widespread issue across all nursing professions: from new graduate nurses to nurses with many years of experience. New graduate nurses are susceptible to moral distress and leaving the profession within the first year. Nationally, there has been a 27.7% turnover within the population of new graduate nurses with less than one year of experience (Nursing Solutions, Inc., 2019).

Context: This Doctor of Nursing Practice (DNP) quality improvement (QI) project consisted of implementing a program to help new graduate nurses build moral courage. The QI project encourages self-empowerment, moral courage, and resiliency among new resident …

An Online Self-Directed Learning Module For Regional Stroke Survey Success, Winchell Rodriguez Kuttner

Doctor of Nursing Practice (DNP) Projects

The lack of a standardized education for stroke coordinators focusing on The Joint Commission (TJC) standards and requirements in preparation for the stroke program disease-specific care (DSC) certification survey every two years has led to undue added stress prior to survey. The development of tools and resources has been identified to address the current educational gap in stroke coordinator orientation. This project addressed the gap by creating an online, self-directed learning module to assist the stroke coordinators in knowledge acquisition of the stroke standards and requirements.

A stroke coordinator plays a critical role in stroke care delivery. An educational module …

An Education Program For Novice Nurses To Increase Case Management Knowledge, Emily Trefethen

Doctor of Nursing Practice (DNP) Projects

Problem: Heart failure (HF) is a chronic disease where the heart cannot deliver an adequate amount of blood that the body requires. HF is one of the costliest cardiovascular diseases plaguing public health in the United States (Go et al., 2014). HF is the main reason for hospitalizations in adults and a leading contributor to the rise in healthcare costs. Approximately 25% of Medicare patients are readmitted within 30-days of discharge (Go et al., 2013). To address excessive hospital readmissions, the Centers for Medicare and Medicaid Services (2019) initiated the Hospital Readmissions Reduction Program in October 2012 to reduce Medicare …

A Performance Improvement Nursing Fellowship To Enhance Timely Access To Care, Cheryl Reinking

Doctor of Nursing Practice (DNP) Projects

This scholarly report describes a Doctorate of Nursing Practice (DNP) project that advanced the performance improvement (PI) knowledge of frontline nurses to improve timely access to acute care during a 6-month PI/Lean management nursing fellowship. Patient flow issues delay access to care and result in negative patient quality outcomes and safety failures. Patient experience, confidence, and satisfaction in healthcare organizations erode when timeliness and efficiency are deficient. The project site is a 443-bed, two-campus, not for profit community hospital in Northern California. This project included the implementation of a PI/Lean nursing fellowship program as an evidence-based intervention to address patient …

Identification Of Victims Of Human Trafficking: Leading Change Through A Global Pandemic, Connie Clemmons-Brown

Doctor of Nursing Practice (DNP) Projects

Human trafficking is a multi-billion-dollar global industry, generating $150 billion annually (International Labour Organization [ILO], 2014), and driven by the exploitation of victims of all ages, primarily for forced labor or commercial sex. Victims endure frequent and prolonged abuse, suffering illnesses, and injuries. When accessing the health care system, they often go unrecognized by health care providers and nurses. Recognition requires training to raise awareness and the right tools to capture the information necessary to identify victims and address opportunities to improve their safety, care, and support. The aim of this Doctor of Nursing Practice (DNP) evidence-based change project was …

Chief Nurse Executive Work Engagement: System Leadership Through A Natural Disaster, Strike, And Pandemic, Ryan Fuller

Doctor of Nursing Practice (DNP) Projects

Problem. In a 21-hospital region of a 39-hospital integrated health system, CNE turnover peaked at 63% (12 CNEs) in 2015. Interviews were conducted in 2019 with 12 CNEs across the region to understand potential issues related to CNE job satisfaction. Responses revealed concerns regarding empowerment, alignment, work-life balance, information transparency/sharing, and recognition. While identifying a solution to address CNE concerns, the organization experienced successive crisis events during a 12-month period that included a record-setting wildfire, multiple labor union strikes, and a novel pandemic. The regional leadership team (RLT) required new approaches to facilitate effective communication during a crisis between the …

Implementation Of Artificial Intelligence Initiated Rapid Responses To Reduce In-Hospital Cardiac Arrest, Alicia Potolsky

Doctor of Nursing Practice (DNP) Projects

Hospitals with strong and consistently activated rapid response teams (RRTs) have significantly fewer cardiac arrests. Early recognition of clinical deterioration supports the timely activation of RRTs, which increases earlier assessment and intervention. Current early warning tools are not sufficient and reliable for recognizing patient deterioration, and they are evolving, incorporating artificial intelligence (AI) to identify clinical decline much earlier. The project organization had previously implemented the medical early warning score tool into the RRT nurses’ practice to prioritize patient assessments, but this was not sustained due to its unreliability in identifying patients at risk.

Aiming to reduce the number of …