Nursing Commons^™

Teamwork That Affects Outcomes: A Method To Enhance Team Ownership, Brian Carlson, Richelle Graham, Brad Stinson, Jordan Larocca

Patient Experience Journal

Healthcare is the ultimate team sport, and this case study explores how to build teamwork across teams. The ability for nursing, environmental services and food and nutrition services to work collaboratively to benefit patients is paramount to a patients experience and outcomes. The case study describes how the work was done to build teams and then improved outcomes in both patient and employee experiences. The learnings are applicable to any team setting not just those described in this case study.

Experience Framework

This article is associated with the Staff & Provider Engagement lens of The Beryl Institute Experience Framework ( …

Global Child And Family-Centered Care Fellowship, Education And Mentorship For Pediatric Healthcare Professionals: A Literature Review, Ashley Zheng, Bobbijo Pansier

Patient Experience Journal

Child- and family-centered care (FCC) is increasingly accepted and implemented to optimize the healthcare experience for patients, their families, and healthcare professionals. Standish Foundation for Children, a 501(c)(3) non-profit, has designed and piloted a fellowship to educate pediatric healthcare professionals in FCC & psychosocial care via an inquiry and mentorship model in Tbilisis, Georgia. This review aimed to evaluate and synthesize existing literature on psychosocial and FCC mentorship for pediatric healthcare professionals in four parts: ongoing need, effects on healthcare professionals, effects on children and their families and/or caregivers, and in cross-country healthcare settings. Reviewers searched open-source databases for articles …

Patient And Provider Experiences With Virtual Care During The Covid-19 Pandemic: A Mixed Methods Study, Mars Zhao, Hisham Elshoni, Jennifer O'Brien, Erin Barbour-Tuck, Mary Ellen Walker, Heather Dyck, Andrea Vasquez, Eric Sy, Angela Baerwald, Clara Michaels, Rejina Kamrul, Olivia Reis, Brenda Schuster, Barb Beaurivage, Adam Clay, Mark Lees, Jonathan Gamble

Patient Experience Journal

The COVID-19 pandemic prompted the rapid uptake of Virtual Care (VC). Positive patient outcomes with VC are previously reported but little is known about the experiences of patients and providers using VC during the pandemic. We aimed to describe patient and primary care provider experiences, satisfaction, perceptions, and attitudes to VC during the COVID-19 pandemic that might explain adoption of VC across the continuum of care and inform sustained uptake. We conducted a sequential explanatory mixed methods study using online surveys and virtual interviews with a convenience sample of primary care providers and patients in a Canadian province (July – …

Understanding Modern Drivers Of The Employee Experience In Healthcare, Antonio Pangallo, Tim Atwell, Kristi Roe, Adrienne Boissy

Patient Experience Journal

Employee engagement has been considered the guiding metric to convey the health, loyalty, and performance of the healthcare workforce. However, the pandemic created new challenges and stimulated deeper conversations around remote work, systemic racism, inclusivity, trust, well-being, and mental illness, which calls into question whether engagement alone is enough. Using an employee experience model deployed in other industries, we identified key drivers of six employee experience (EX) outcomes. We conducted a panel study with close to 5,000 nurses and physicians to identify and prioritize current key drivers specific to the healthcare employee experience. Relative weights analyses suggest that being treated …

Pneumothorax, Jennifer Wenger

Nursing Student Class Projects (Formerly MSN)

Pneumothorax is the presence of air or gas in the pleural space caused by rupture in the visceral pleura of the parietal pleura and chest wall. A pneumothorax is the most common thoracic disease affecting adolescence and young adults. There are several types of pneumothoraxes including spontaneous pneumothorax caused by the rupture of a bleb, usually in relatively healthily individuals. Secondary pneumothoraxes are cause by trauma or diseases. Penetrating/ blunt trauma, surgical intervention, COPD/emphysema, and mechanical ventilation are all risk factors associated with secondary pneumothorax. Common symptoms are sharp chest pains on inspiration, shortness of breath and tachypnea. Is some …

Chronic Obstructive Pulmonary Disease (Copd), Joseph Earich

Nursing Student Class Projects (Formerly MSN)

Background: Chronic Obstructive Pulmonary Disease (COPD) is an irreversible, preventable respiratory disease characterized by airflow limitation and obstruction that is usually progressive. COPD affects millions of people globally and over $7 billion dollars is spent on COPD related hospitalizations in the U.S. annually. This poster includes information focused on COPD, the underlying pathophysiology, clinical manifestations, diagnosis, nursing care implications, and treatment.

Methods: Research articles within the last five years were obtained using keywords such as COPD, pathophysiology, treatment, prevention, emphysema, and chronic bronchitis from databases EBSCO and PubMed. The data and quality of these articles were assessed and information compiled …

Genomics-Informed Nursing Care: A Survey Of Nicu Nurses' Experience And Perspectives Related To Genomic Sequencing, Rachel I. Anderson

Theses and Dissertations

Background: Genomic sequencing is used in the Neonatal Intensive Care Unit (NICU) to diagnose babies with genetic disorders. Purpose: To explore the experiences and knowledge of nurses working in NICUs related to genomic sequencing. Methods: This was a mixed-methods, cross-sectional descriptive survey of NICU nurses attending a national conference. Quantitative data were analyzed using descriptive statistics. Qualitative data were coded into categories and themes. Results: Of 188 NICU nurses, nearly half reported experience with genomic sequencing. Among nurses with experience, 62.7% rated the amount of discussion they had with families about genomic sequencing as "0". Additionally, 72.7% of participants reported …

Absence Of Association Of Tinnitus With Pre-Existing Hypertension: A Population-Based Study, Po-Hsiu Huang, Sudha Xirasagar Mbbs., Ph.D., Jin-Hua Chen, Yen-Fu Cheng, Nai-Wen Kuo, Herng-Ching Lin

Publications

OBJECTIVES: Whether tinnitus is associated with pre-existing hypertension remains uncertain. This study explored the association between tinnitus and pre-existing hypertension. METHODS: We obtained data on a retrospective cohort of 542 884 cases ≥18 years old with a first-time tinnitus diagnosis from Taiwan's National Health Insurance Research Database. We used propensity-score matching to select 542 884 matched controls and performed multiple logistic regression analyses to estimate the adjusted odds of prior hypertension among patients with tinnitus versus controls. RESULTS: Bivariate analysis showed no significant difference in the prevalence of prior hypertension between the tinnitus and no-tinnitus groups (35.58% vs 35.5%, P …

Development And Modification Of A Culturally Tailored Education Program To Prevent Breast Cancer In Korean Immigrant Women In New York City, Jin Young Seo, So-Hyun Park, Sung-Eun Choi, Minkyung Lee, Shiela M. Strauss

Publications and Research

Breast cancer (BC) is the most common cancer in Korean American (KA) women. In view of its high prevalence in these women, their low screening rates, and the cultural influence of BC risk factors in their lifestyles, we developed a community-based culturally tailored BC prevention program, the Korean Breast Cancer Risk Reduction Program (KBCRRP). Guided by the PRECEDE-PROCEDE and health belief models, the KBCRRP was developed to achieve four goals: (1) healthy weight, (2) physically active lifestyle, (3) healthy diet, and (4) BC screening and adherence. KBCRRP combines effective multicomponent strategies for BC screening and a group-based lifestyle intervention incorporating …

Increasing Appointment Adherence In Patients With Diabetes Mellitus Via Appointment Reminders And Patient Education, Leslie Guy

Student Scholarly Projects

Practice Problem: Appointment no-shows and nonadherence have been an organization-wide concern within the project setting, resulting in increased healthcare costs and workload while disrupting the continuity of patient care.

PICOT: The PICOT question that guided this project was: In adult diabetic patients ages 19-99 (P), how do appointment reminders by nursing staff and patient education related to appointment adherence (I) compared to the current practice of appointment reminders by administrative assistants and no patient education related to appointment adherence (C) affect appointment adherence rates (O) within ten weeks (T)?

Evidence: Current evidence demonstrates that patient appointment reminders improve appointment …

Unmasking Beta Thalassemia, Shaunte Churchill

Nursing Student Class Projects (Formerly MSN)

Abstract for Beta Thalassemia Poster Project

Beta Thalassemia is a highly prevalent inherited disease that has the ability to cause symptoms where a patient can present asymptomatic to severe life-threatening conditions. The drive behind researching this topic was regarding my husband and the journey to getting a diagnosis for his unknown problems. Diagnosis can occur from birth into middle adulthood. The milder cases tend to be diagnosed in adulthood. There are new innovative ways to help combat symptoms of beta thalassemia, however, there has not been one successful solution for a cure except very specific bone marrow transplantation. This also …

Dnp Final Report: Implementation Of An Electronic Clinical Placement System For Improving Faculty Workflow And Accreditation Compliance, Janice R. Hawes

DNP Final Reports

Healthcare today is continually evolving and requires healthcare providers to coordinate and work together to provide quality care. Among healthcare changes is the increasing expansion of technological improvements assisting in mainstreaming processes. In the academic setting, these changes are currently needed to help improve faculty workflow and assist in regulatory compliance. The purpose of this paper is to discover if implementing technology in a clinical nursing setting through an evidence-based practice approach will improve nursing faculty workload and aid in accreditation compliance. The design and methodology for this project were developed using the Iowa model of evidence-based practice, the Donabedian …

Evidence-Based Best Practice Toolkit For Social Determinants Of Health: A Program Evaluation Review, Bryleigh Berry

Student Scholarly Projects

Despite an increase in healthcare expenditure, racial and ethnic disparities remain a substantial concern among adult primary care patients in the United States. This is largely due to the focus on medical intervention and disregard for the underlying factors that contribute significantly to health outcomes such as economic stability, educational access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. The PICOT question that guided this program evaluation review project is: In adult clients seeking care at a primary care clinic (P), how does a SDOH toolkit based on the CDC framework (I) compared …

Icu Liberation Bundle: A Multidisciplinary Approach, Julie Anne Snyder Amoroso

Student Scholarly Projects

Practice Problem: Patients with increased ventilator days see dramatic increases in their chances of developing healthcare-related conditions (HAC). Extended ICU stays increase the potential for problematic issues in patients' physical, mental and spiritual health with short-and-long-term consequences.

PICOT: The PICOT question that guided this project was looking at adult ventilated patients in a medical ICU (P) and what is the effect of initiating interdisciplinary ABCDEF-ICU liberation bundle rounding as (I) compared to no ICU liberation bundle rounding (C) has on the length of ventilator days (O) over eight weeks (T).

Evidence: Evidence from quality studies and backing from the …

Addressing Anxiety In Hospitalized Adults Using A Music Intervention, Raina M. Rochon

Student Scholarly Projects

Practice Problem: The practice problem is anxiety related to hospitalization among adults in an acute care setting. Increased anxiety can lead to other issues while hospitalized including disruptive behaviors.

PICOT: The PICOT question that guided this project was: In hospitalized medical-surgical adults (P), how does the implementation of a music intervention as an adjunct to standard distraction techniques (I) compared to standard care (C) affect symptoms of anxiety as observed by the rate of behavior de-escalation team calls (O) within eight weeks (T)?

Evidence: There were five systematic reviews, four systematic reviews with meta-analysis with high level of …

Feasibility Of An Emergency Department Fall Screening Tool And Intervention Bundle Checklist On Nursing Fall Prevention Documentation: A Quality Improvement Project., Bailee E. Pope

Doctor of Nursing Practice Papers

Background: The World Health Organization (2018) and The Joint Commission (2015) define falling as a sudden, unplanned involuntarily advancement toward the ground, that may or may not result in injury. Fall rates are directly related to a facility’s mortality and morbidity rates, delayed patient care, additional diagnostic testing, and increased length-of-stay. Evaluating the practices of a local emergency department (ED), it was noted that ED nurses are not documenting their acknowledgment of a patient’s risk for falls, and also failed to chart interventions aimed at preventing falls. Failing to implement these practices into regular patient care can lead to negative …

School Nurses’ Participation In Accommodations For Children With Epilepsy: A Quality Improvement Project., Paula A. Johnson

Doctor of Nursing Practice Papers

Abstract

Epilepsy is the most frequent, chronic, neurological condition in childhood, impacting 0.5 to 1% of the population. Documented learning problems associated with childhood epilepsy include memory problems, attention deficits, reading difficulties, and processing speed abnormalities. Epilepsy also impacts psychological health with poor self-esteem, a high incidence of bullying, and poor school performance. The Every Student Succeeds Act identifies the school nurse as a leader in chronic disease management; advocating for students to receive the resources and support they need to achieve academic success. The large Midwestern school system, studied in this capstone project, has 804 known students with epilepsy. …

Implementation And Evaluation Of Asthma Education Cell Phone Application: Asthmaxcel, Within An Allergy And Asthma Specialty Practice., Michael Stefan Swift

Doctor of Nursing Practice Papers

Abstract

Background: Asthma is the leading chronic illness among pediatric patients. One of the most significant obstacles facing asthma care is adherence to asthma management plans. In the pediatric population, adolescents (ages 12-17) traditionally have poor asthma management. Research shows that adolescents respond well to technology-based education and that improving adolescent healthcare literacy leads to better asthma control.

Environment: This project took place at an allergy and asthma specialists office. This private practice includes primary care allergy, asthma, and immunology services that follows roughly 120 adolescents with asthma.

Purpose: The purpose of this project was to provide the allergy and …

Multicomponent Approach To Delirium Prevention In The Acute Care Setting: An Evidence-Based Quality Improvement Project., Kelley James

Doctor of Nursing Practice Papers

Background: Acutely ill, hospitalized individuals are at an increased likelihood of developing delirium. Between 30-35% of those patients admitted to the hospital will develop delirium, and as a result, these individuals will face an increased risk of mortality, adverse medical events, restraint usage, and incur a more extended hospitalization. The literature supports early screening utilizing the Confusion Assessment Method (CAM) tool and nurse-driven, multicomponent interventions to aid in preventing its development.

Environment: This project was implemented in a long-term, acute care facility specializing in patients requiring long-term mechanical ventilation, advanced wound care, pulmonary and respiratory care, and the rehabilitation of …

Reducing Weekly Screen Time Use In College Students., Anna Louise Davidson

Doctor of Nursing Practice Papers

Background: Screen time overuse is a serious problem currently affecting college students. Studies have shown that too much screen time use can contribute to symptoms of depression and anxiety as well as stress, insomnia, and sedentary behavior contributing to obesity and cardiometabolic issues. Though much research has been devoted to assessing and reducing screen time use in children and adolescents, there are fewer published studies on interventions specific to college students. Therefore, the interventions for adolescents (ages 13 to 17) were reviewed and synthesized, as college students are close in age and brain development to late adolescent stage.

Setting: The …

Improving Trauma-Informed Education And Parenting For Resource Parents At A Foster Care Agency., Courtney Albers

Doctor of Nursing Practice Papers

675,000 children nationwide were involved with the foster care system in 2019, and nearly all children within the foster care system are actively suffering from the effects of trauma. Resource parent trauma-informed trainings, such as Resource Parenting Curriculum (RPC) developed by The National Child Traumatic Stress Network, are associated with improved parental perceptions towards trauma-informed care, improved child outcomes, and placement stability. Foster care agencies have trauma-informed state-based curriculum, but it does not meet the needs of resource parents, specifically those caring for children with developmental delays or disorders. The project was implemented at a therapeutic foster care agency for …

Quality Improvement For Timely Extubation In An Urban Community Icu., Connor Epperson

Doctor of Nursing Practice Papers

Background: Prolonged duration of mechanical ventilation (MV) is associated with higher morbidity, mortality, and increased resource utilization. Research has shown that the coordination of spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs) through standardized protocols increases frequency of readiness to extubate assessments, thus reducing time on MV.

Purpose: The purpose of this project was to improve weaning protocol adherence by re-educating RN staff about the current weaning protocol and the importance of interdepartmental communication to perform coordinated SATs/SBTs, thus reducing MV duration.

Intervention: Education was provided to nursing staff on the current weaning protocol and the …

Reducing Delirium In Medical Intensive Care Unit., Hope Kathryn Eppley

Doctor of Nursing Practice Papers

Background: Delirium in MICUs (medical intensive care units) is an acquired and detrimental condition patients often seen in MICU. This condition has a high prevalence and can result in increased risk of death, comorbidities and length of hospital stay. Prevention is critical to avoid an increased risk of mortality.

Aim: The purpose of quality improvement (QI) project was to implement a delirium bundle in a medical intensive care unit (MICU) to reduce delirium by 20% over an 8-week period.

Method: This QI project utilized the IHI rapid cycle quality improvement model, using two cycles of the Plan-Do-Study-Act (PDSA) model …

Implementation And Evaluation Of A Mental Health Referral Pathway For School Nurses., Jessica Rivera

Doctor of Nursing Practice Papers

Nearly one in six American children between the ages of six and 17 have a treatable mental disorder (American Academy of Family Physicians [AAFP], 2020). Still, less than half do not receive help from a mental health professional (Whitney & Peterson, 2019). School nurses have an opportunity to bridge the gap by improving youth access to mental health care. Purpose: The purpose of this quality improvement project was to implement and evaluate a mental health referral pathway for school nurses. The specific aims were to improve school nurses' preparedness to recognize and address mental health concerns and to increase the …

Implementing A Diabetes Risk Screening Protocol In The Primary Care Setting., Anna Marks

Doctor of Nursing Practice Papers

Abstract

Background: Over one-third of the United States population, approximately 86 million individuals, are estimated to have prediabetes (CDC, 2021a). If left untreated, prediabetes will progress to type II diabetes mellitus (T2DM) in approximately 25% of subjects within 3–5 years, and as many as 70% of individuals with prediabetes will develop T2DM within their lifetime (Hostalek, 2019).

Purpose:The purpose of this quality improvement project was to implement and evaluate the American Diabetes Association MyChart Diabetes Risk Assessment tool in a primary care clinic to optimize the early identification of prediabetes and T2DM in non-pregnant adults ages 18 to 70 …

Trauma-Informed Schools: A Quality Improvement Project For A Rural Public-School System., Channing Kay

Doctor of Nursing Practice Papers

Abstract

Background: Adverse Childhood Experiences (ACEs) are traumatic events that occur from birth to adulthood and have shown to be significant in increasing the risk for both physical and psychological anomalies (Felitti et al., 1998). ACEs are not siloed to poor communities but were observed in 67% of adults throughout 25 US states (Felitti et al., 1998). Despite the significance found in the literature, few preventative measures are being implemented to protect against these experiences.

Setting: The project seeks to address mental health disparities associated with rural-underserved populations. The school system participating in the project is a rural community school …

Neonatal Developmental Care Makes Sense: Implementation Of An Evidence-Based Guideline For Developmentally Appropriate Multi-Modal Positive Sensory Exposures., Nicole Moseley Jaeger

Doctor of Nursing Practice Papers

Background: There is increasing awareness of the contribution of the neonatal intensive care (NICU) environment and the importance of developmental care (DC) interventions to long-term outcomes in high-risk infants. Care at the project site reflected that given at many hospitals, where positive sensory experiences and negative sensory mitigation are done but inconsistently. There was not a guideline in place for DC interventions.

Setting: The project site housed a newly renovated single-family room (SFR) NICU with 12 licensed Level II beds and ability to flex to 19 beds. Neonates at gestational ages ≥28 weeks, requiring critical care for a …

Implementation Of Scripted Debriefings Following Neonatal Delivery Room Resuscitations., Kimberly M. Knott

Doctor of Nursing Practice Papers

Abstract

Background: The functioning of neonatal delivery teams can be affected by technical and non-technical skills of individual team members. The team in this project was challenged by varying knowledge and skill levels and did not have a standardized process for debriefing resuscitation events. The literature shows that debriefings can aid in improving knowledge, skills, teamwork, and communication of resuscitation teams.

Purpose: The purpose of this quality improvement project was to implement a scripted, post-resuscitation debriefing with the neonatal delivery team to improve non-technical skills of the resuscitation team and identify challenges to providing optimal care.

Method: Scripted, …

Quality Improvement: Piloting A Pediatric Obesity Prevention Screening Tool And Intervention In A Family Practice Setting., Erin Shaye Semeyn

Doctor of Nursing Practice Papers

Background: In the United States today, nearly one third of children fall into the category of overweight or obese. Because it is extremely difficult to treat childhood obesity once it occurs, prevention is the optimal approach to childhood overweight and obesity (Brown & Perrin, 2018; Cooper & Mandel, 2020). An ideal time to address obesity prevention health behaviors is during pediatric primary care visits. Since the COVID-19 pandemic began in the United States in 2019, visits to primary care offices, including visits to an urban university-based family practice clinic in Kentucky, dropped as some pediatric patients and their caregivers worried …

A Policy Project: Implementing Safe Firearm Storage Legislation In Kentucky., Maggie M. Wiser

Doctor of Nursing Practice Papers

Ensuring the safe storage of firearms in the home is a research-supported method of reducing the incidence of firearm injury and death, specifically unintentional injury and self-harm in the pediatric population. The American Academy of Pediatrics recommends keeping all firearms stored locked, unloaded, and separate from ammunition. While evidence shows that implementing laws regulating the storage of firearms can be effective to reduce morbidity and mortality, the state of Kentucky currently has no such regulations. For this DNP project, John Kingdon’s Multiple Streams Framework was used as a guideline for policy analysis with the intention of identifying opportunities to advocate …