Nursing Commons^™

Refining Triage Documentation Practices In A Metropolitan Emergency Department, Jack A. Moody

Master's Projects and Capstones

Problem California ranks ninth nationwide for its lengthy emergency department wait times, presenting a pressing challenge for healthcare facilities. Context This quality improvement project, set in the emergency department of a large urban hospital in the Bay Area, aimed to address this issue by targeting workflow efficiency through the reduction of triage times. Intervention The intervention centered on implementing changes to the triage documentation, informed by staff feedback obtained through an opinion survey. Proposed modifications included the elimination of redundant questions, consolidation of related categories, and a logical reorganization of triage topics. Measures Key measures utilized in the project included …

Transforming Peripartum Nurse Knowledge Exchange (Nke) Through A Standardized Handoff Guide, Lillian Quach

Master's Projects and Capstones

Problem: Medical errors and adverse events can result from inconsistent handoffs during patient transfers. As seen in Hospital A’s peripartum unit, there is no formal policy regarding the handoff process, also known as the Nurse Knowledge Exchange (NKE). This quality improvement project aims to introduce a standardized handoff guide to enhance communication and minimize harmful outcomes following patient transfers.

Context: The setting for this project is an urban hospital in Northern California with nine laboring beds and 21 postpartum beds.

Interventions: The project employed a systemic approach involving stakeholder involvement, literature review, and data analysis to identify areas for improvement …

Application Of Lymphedema Education Toolkit For Nurse Coordinators, Julian K. Miranda

Master's Projects and Capstones

Problem: There is approximately one in five breast cancer survivors affected by breast cancer-related lymphedema (BCRL), a potentially debilitating condition affecting the physical, emotional, social, and financial well-being of individuals. Context: This Quality Improvement (QI) project was conducted at an outpatient facility of Hospital X’s Women’s Cancer Center. Within this microsystem, there are 24 permanent clinical nurse coordinators and advanced practice providers, with 15 nurse coordinators dedicated to care for patients with breast cancer or gynecological conditions. Intervention: The intervention aims to evaluate if a standardized educational tool improves early interventions for patients with lymphedema and knowledge among healthcare providers …

Increasing Adherence To A Nurse-Driven Removal Protocol To Reduce Indwelling Urinary Catheter Days, Hannah K. Brosnan

Master's Projects and Capstones

Problem

Nurse-driven removal protocols (NRDPs) have been shown to reduce indwelling urinary catheter (IUC) days and prevent catheter-associated urinary tract infections (CAUTIs). Communication barriers prevent consistent implementation of the NDRP, leading to delayed IUC removal and increased risk of CAUTIs.

Context

The project was conducted in a 16-bed adult surgical intensive care unit (ICU) at a teaching hospital in a major metropolitan area.

Interventions

Urinary catheter reminder posters displaying IUC days were posted at each bedside to prompt discussion of IUC indication and removal. An email describing the project background was sent to all nurses and physicians by the unit …

Enhancing Pain Documentation In Medical Surgical Units: Integrating Supportive Tools With Pain Nursing Education, Mariana Arias

Master's Projects and Capstones

Problem: Pain management in in-patient care, particularly involving opioids, is critical due to the associated risks. Proper pain assessment is essential to ensure safe medication administration and mitigate adverse effects.

Context: This quality improvement (QI) project aimed to improve opioid assessment and documentation rate above 90% compliance in two medical-surgical units, focusing on bedside nurses who play a crucial role in patient safety and effective pain management.

Interventions: A baseline survey provided nurses' understanding on compliance criteria and assessment timing. Interventions included visual reminders, informational posters, and instructions on how to access individual compliance reports.

Measures: A post intervention survey …

Enhancing Peripartum Care Through Standardized Nurse Knowledge Exchange, Gabriela Ochoa

Master's Projects and Capstones

Problem Inconsistent handoff practices during patient transfers can cause mistakes and adverse outcomes. Hospital A's peripartum unit has no set policy for Nurse Knowledge Exchange (NKE) during transfers. This project will introduce a standard handoff guide to enhance communication and prevent harmful results after patient transfers.

Context The quality improvement project was conducted in a peripartum mesosystem within an urban hospital in Northern California. This specific area of the hospital comprised 21 postpartum rooms and nine laboring rooms.

Intervention The project involved a methodical strategy that encompassed engaging stakeholders, conducting a literature review, and analyzing data to pinpoint areas for …

Increasing Opioid Pain Pre-Assessment And Reassessment Documentation Rate In Medical-Surgical Units, Hae Rim (Helen) Hwang

Master's Projects and Capstones

Problem The fifth vital sign, pain, requires proper pain management in hospital settings, often involving opioids with significant risks of adverse reactions. Appropriate pain assessment and management is vital to ensure safe medication administration and mitigate potential adverse reactions.

Context This quality improvement (QI) project aimed to enhance opioid assessment and documentation rate above 90% compliance in two medical-surgical units, with a focus on bedside nurses. Nurses play a key role in administering and documenting pain assessments, a practice crucial to managing patient safety and effective pain management specific to opioid use.

Intervention A baseline survey provided nurses’ understanding on …

Raising The Bar: Optimizing Peripartum Handoff Through Standardized Nurse Knowledge Exchange (Nke), Kimberly Martinez Rn

Master's Projects and Capstones

Problem Hospital X’s peripartum microsystem has no policy guiding the Nurse Knowledge Exchange (NKE) process. Variability in handoffs during patient transfers could lead to medical errors and adverse events. This quality improvement (QI) project aims to pilot a standardized handoff guide to improve nurse communication and avoid adverse patient outcomes following patient transfers. Context The setting for this QI project was a peripartum mesosystem at an urban hospital located in Northern California with 21 postpartum rooms and nine labor rooms. Intervention The project employed a systematic approach that involved engaging stakeholders, analyzing microsystems, reviewing literature, and analyzing data to identify …

Improving Prolonged Antibiotics Education In A Pediatric Unit, Zerena S. Silva Villamonte

Master's Projects and Capstones

Problem Children’s Hospital A's incidence report tool, iCares, demonstrates that 50% of the issues related to prolonged intravenous (IV) antibiotics are categorized as administration issues. This leads to the medication being delivered at the wrong time or rate. Having these issues increases patient length of stay, increasing hospital costs. Context The microsystems for this quality improvement project include inpatient pediatric patient care units (PCU) 300, 360, and 400. Children’s Hospital A is a 361-bed San Francisco Bay Area hospital. Interventions The Clinical Nurse Leader students implemented a presentation defining prolonged IV antibiotics, their rationale, and a video demonstrating the correct …

Increasing Awareness And Communication To Decrease Catheter Days In The Surgical Intensive Care Unit, Kamila Fortney

Master's Projects and Capstones

Problem Nurse-driven removal protocols (NRDPs) have been shown to reduce indwelling urinary catheter (IUC) days and prevent catheter-associated urinary tract infections (CAUTIs). Communication barriers prevent consistent implementation of the NDRP, leading to delayed IUC removal and increased risk of CAUTIs. Context The project was conducted in a 16-bed adult surgical intensive care unit (ICU) at a teaching hospital in a major metropolitan area. Interventions Urinary catheter reminder posters displaying IUC days were posted at each bedside to prompt discussion of IUC indication and removal. An email describing the project background was sent to all nurses and physicians by the unit …

Enhancing Nurse Awareness Of A Stroke Patient Satisfaction Survey And Their Significance In Practice, Amanda Dao

Master's Projects and Capstones

Problem As a leading cause of death and disability in the US, strokes often require complex, multifaceted care. Often ignored, patient satisfaction is a crucial aspect of this care and is positively linked to key health indicators. Regulatory guidelines underscore the need for stroke-specific patient satisfaction survey (SSPS) utilization in post-stroke care. Context Hospital X is a large Comprehensive Stroke Center in the Bay Area, serving patients with various stroke etiologies and complexities. At present, its Neuro Observational Unit (NOU) does not administer a SSPS. InterventionTo address this gap in care, an educational presentation using literature evidence in support …

Improving Nurse Support Of Patient Satisfaction Surveys Through Team Huddle Education, Matthew Price

Master's Projects and Capstones

Problem As a leading cause of death and disability in the US, strokes often require complex, multifaceted care. Often ignored, patient satisfaction is a crucial aspect of this care and is positively linked to key health indicators. Regulatory guidelines underscore the need for stroke-specific patient satisfaction survey (SSPS) utilization in post-stroke care. Context Hospital X is a large Comprehensive Stroke Center in the Bay Area, serving patients with various stroke etiologies and complexities. At present, its Neuro Observational Unit (NOU) does not administer a SSPS. Intervention To address this gap in care, an educational presentation using literature evidence in support …

Reducing Barriers To Timely Indwelling Urinary Catheter Removal, Huyen T. Nguyen

Master's Projects and Capstones

Problem Nurse-driven removal protocols (NRDPs) have been shown to reduce indwelling urinary catheter (IUC) days and prevent catheter-associated urinary tract infections (CAUTIs). Communication barriers prevent consistent implementation of the NDRP, leading to delayed IUC removal and increased risk of CAUTIs. Context The project was conducted in a 16-bed adult surgical intensive care unit (ICU) at a teaching hospital in a major metropolitan area. Interventions Urinary catheter reminder posters displaying IUC days were posted at each bedside to prompt discussion of IUC indication and removal. An email describing the project background was sent to all nurses and physicians by the unit …

Determining The Impact Of Mindfulness Activities To Increase Joy In Work And Decrease Burnout: An Integrative Review, Kimberly Gleason Bogart

Doctoral Dissertations and Projects

This integrative review aims to evaluate whether mindfulness effectively increases joy in work and decreases nursing burnout. A lack of joy leads to feelings of burnout and negatively affects nurses and their desire to leave the profession. Nursing is often accompanied by intense emotional and physical demands that can lead to job dissatisfaction, anxiety, and stress. Burnout diminishes the quality of care and negatively impacts nurses’ well-being. This integrative review aims to explore mindfulness interventions to increase joy within nursing and potentially alleviate burnout. Drawing upon existing literature, this paper examines various mindfulness interventions and factors contributing to burnout among …

Development Of An Endometriosis Toolkit To Support Clinicians In Providing Quality Care For Women, Rachel Hasbun

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Endometriosis is the abnormal growth of endometrium-like tissue outside the uterine cavity, affecting approximately 11% of women in the United States during their reproductive years. Diagnostic challenges stem from its varied clinical presentations, reliance on laparoscopy for definitive diagnosis, and limited awareness among practitioners and patients, potentially leading to diagnostic delays of up to 13 years.

Problem: The complexities of diagnosing endometriosis in primary care and specialty settings, combined with limited provider awareness and a lack of comprehensive resources, hinder timely and accurate identification. This leads to suboptimal treatment and care for women affected by the condition.

Methods: …

Inservice Education: Management Of Fever And Neutropenia Among The Pediatric Oncology Population, Sarkis Makarovich

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: In pediatric cancer patients, comprehensive treatment and its side effects, such as fever and neutropenia (FN), significantly impact physical and emotional well-being. Prompt evaluation and treatment of FN are crucial to prevent complications. Proper training of parents in preventing, recognizing, and managing low-grade fever and administering antibiotics at home or outpatient settings is essential for positive outcomes.

Local Problem: A multidisciplinary pediatric cancer treatment center in Northern California.

Methods: A pre- and post-assessment evaluation was conducted to evaluate the knowledge acquisition of nurses after an educational intervention.

Intervention: This Doctor of Nursing Practice (DNP) project aimed to enhance …

Undergraduate Baccalaureate Nursing Student Knowledge And Attitudes Towards Neonatal And Pediatric Pain Management Practices, Jordan Lee Slowik

Doctoral Dissertations and Projects

Research has indicated that pain management practices amongst registered nurses is inadequate across all age groups; however, it is frequently noted that children receive less analgesia in comparable situations than adult clients leading to harmful and costly consequences. There is a distinct gap in nursing educational research understanding nursing student knowledge and attitudes towards neonatal and pediatric pain management practices. Using a convenience sample from a private, Christian-based university in the southeastern United States, this study used a quasi-experimental, one-group pretest/posttest design to understand the impact of elective nursing courses on undergraduate baccalaureate nursing student knowledge and attitudes towards neonatal …

The Experiences Of Alaska Native Students' Decision To Enter Nursing School: A Transcendental Phenomenological Study, Denise Michelle Gilliland

Doctoral Dissertations and Projects

The purpose of this transcendental phenomenology study was to examine the lived experiences of Alaska Native students’ decisions to enter nursing school, thus choosing nursing as a career. The increased recruitment of Alaska Natives into nursing is imperative. According to the research, a direct association exists between increasing the number of minority nurses and decreasing health inequities. Despite the demand, only a small number of Alaska Native students continue to enroll in nursing programs in Alaska. The theories guiding this study were Ryan and Deci’s self-determination theory and Lowe and Struthers’s theory of nursing in Native American culture. They provided …

Let's Talk About Sex & Prep: District 2 Does!, Chrissa M. Shaffer

Georgia Public Health Association Annual Meeting & Conference

Defining what a PrEP Service Program entails and how it could benefit your district or county health center. Discussing methods that have been used to set up PrEP Services within a district – including training, resources, and promotion. Identifying the challenges and working through them. Reviewing the results of the PrEP Services over the past year, and the ongoing goals to encourage and increase our PrEP Services.

Reducing Delirium In Post-Surgical Patients Through Pre-Operative Risk Assessment Screening: A Policy Option, Skye Porter Berg Msn, Fnp

Doctor of Nursing Practice Final Manuscripts

One of the major complications and reasons for prolonged stay amongst patients who undergo surgery is related to the occurrence of hospital associated delirium. Unfamiliar environment, previous comorbidities, age and anesthesia can alter and affect cognitive status in the general population. While there is substantial evidence previously listing high risk patients through demographics as well as prior medical history, this study collectively gathers information based upon prior evidence-based practice data to determine the benefit of prescreening patients through use of a predictive indicator tool. Based on the literature review and inclusion data gathered from fifty patients undergoing surgery, it was …

Implementing Animal-Assisted Therapy During Psychiatric Intakes, Rebecca Dorne

Doctor of Nursing Practice Final Manuscripts

Introduction: The purpose of this evidence-based project is to determine if Animal-Assisted Therapy (AAT) causes improvements in veterans’ feelings of anger, anxiety, depression, and suicidality in the acute psychiatric setting during psychiatric evaluations. The project aims to provide veterans with an additional way to experience short-term relief from symptoms while discussing their symptomology with mental health providers.

Background: The prevalence of depression is 20% higher in veterans than in that of the general population. Similarly, it has been shown that 23% of all veterans using VA care have had PTSD at some point in their lives. In the Psychiatric Emergency …

Improving Treatment Adherence Of Chronic Disease Management In Patients Presenting To The Interventional Pulmonary Perioperative Services With Telephone Follow-Ups, Victoria Dao, Desiree Camille Nanat

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose of Project: The purpose of this evidence-based practice (EBP) project was to review research-based evidence systematically and to implement evidence-based change in practice in the clinical setting. The goal is to improve treatment adherence in patients with obesity, hypertension (HTN), type 2 diabetes mellitus (T2DM), and obstructive sleep apnea (OSA) by providing telephone follow-ups within 30 days post-perioperative discharge.

Background: Obesity, HTN, T2DM, and OSA continue to pose significant challenges to the United States healthcare system. Nonadherence to prescribed management of these chronic diseases is prevalent among patients presenting to the perioperative department of a regional academic hospital …

Improving Healthcare Workers’ Biohazardous Spill Safe Handling Skills, Zeina Mhanna, Ahmad Tassi

BAU Journal - Health and Wellbeing

All healthcare workers (HCWs) are exposed to biohazardous material. Biohazardous material may come in the form of spills, posing a risk of infection to (HCWs) who are not trained on how to safely handle them. While international guidelines recommend training HCWs on how to safely handle biohazardous spills in order to improve their skills, there are no studies that tackled this recommendation. The aim of this study is to improve HCWs’ biohazardous spill safe handling skills through training, and to evaluate the association between the HCWs’ improvement level and demographical characteristics. The study was conducted in a Southern Lebanese hospital …

The Lived Experiences Of High-Performing Black Male Students With Advanced Placement Courses, Griselda Almonte-Delgado

Seton Hall University Dissertations and Theses (ETDs)

Black male students are underrepresented in Advanced Placement (AP) courses. Studies on the perspective and experiences of high performing Black male students with Advanced Placement (AP) is limited. Available research indicates that high performing Black students are enrolled at half the rate of White students both nationally and locally in Advanced Placement (AP) courses (Dept. Of Civil Rights, 2021). Research uncovers multifaceted factors influencing enrollment, ranging from personal motivation to systemic barriers. To qualitatively address this dissonance, this research used Attribution Theory as its framework to examine the lived experiences and perceptions of eight high performing Black male students from …

Influence Of Social Media On Mothers’ Decision-Making Regarding Vaccinations, Wendy Michele Patterson

Walden Dissertations and Doctoral Studies

This study involved determining why mothers hesitate to vaccinate their children and where they get their information about vaccinations. This descriptive qualitative study guided by the health belief model explored the influence social media has on mothers’ perceived barriers to vaccinating their children. A descriptive qualitative approach was used, and one-on-one audio interviews were conducted via Zoom or in person with 19 participants. Participants were mothers 19 or older, had children between zero and 18, made medical decisions for their children who resided in their household, and sought information about vaccinations via healthcare providers, social media platforms, friends, or family. …

The Perceptions Of A Nurse-Led Telehealth Discharge Program On Continuity Of Care For Pediatric Rheumatology Patients, Adrienne Ramirez

Doctoral Projects

When pediatric rheumatology patients are discharged from a hospital, they are given a complex discharge plan which involves responsibilities in self-managing their care at home. This creates an overwhelming time for patients and families who may have questions or concerns during this time. In order to address this care gap and provide continuity of care, this quality improvement project implemented a nurse-led telehealth discharge visit intervention to 15 pediatric rheumatology patients during the transition from hospital discharge to outpatient care. This quality improvement (QI) project also aims to describe the patients’ perceptions of the nurse-led telehealth discharge intervention on continuity …

The Impact Of Electronic Health Record Unintended Consequences On Quality Of Care Within A High Complexity Healthcare Organization, Joetta Powell

ATU Theses and Dissertations 2021 - Present

“Unintended consequences are unexpected, and unwanted outcomes that can limit the value of EHR implementation and adversely affect quality of care and patient safety” (Lee & Kang, 2021, p. 898). Few organizations have redesigned the EHR to improve usability to mitigate potential patient safety concerns. This study aims to identify unintended consequences in patient care workflows and determine educational needs related to EHR usability. A mixed method approach was used to investigate unintended consequences in deidentified patient safety reports submitted Jan 1, 2020, through December 31, 2023. The data was analyzed to identify error types and educational deficits. The Acute …

Utilizing Decision Tree Implementation And Provider Education To Improve Colorectal Cancer Screening Orders: A Quality Improvement Project, Alicia Kollar

Doctor of Nursing Practice (DNP) Manuscripts

Background and Significance: Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer-related deaths (Jain, et al., 2022). Healthy People 2030 objectives include reducing the CRC death rate and increasing the proportion of adults who get screened (Healthy People 2030, n.d.). According to 2021 data, only 58.7% of adults are screened with a Healthy People target of 68.3%. Healthy People states that there are effective screening tools to detect colorectal cancer early, and people are more likely to survive it (Healthy People 2030, n.d.). Purpose: This quality improvement (QI) project aims to implement an …

Strokes Of Excellence And Opportunity: A Program Evaluation Analyzing Emergency Department Stroke Care In A Newly Formed Five-Hospital Health System, Joshua Adams

Doctor of Nursing Practice (DNP) Manuscripts

Stroke is a significant public health problem in the United States and globally. For patients experiencing an acute ischemic stroke, also known as “infarct” or “brain attack,” the effectiveness of treatment is extremely time dependent. This DNP Project presents a program evaluation of stroke care delivered in five emergency departments (EDs) in community hospitals in a health system newly formed through the merger of two smaller organizations. This evaluation focused on assessing the five programs’ effectiveness in delivering timely and effective care to stroke patients with the standardized performance measure door-to-needle (DTN). The evaluation also included a review of factors …

Identify And Overcome The Barriers Of Care From A Patient And Provider Perspective In Adult Patients With Type 2 Diabetes Mellitus In A Federal Qualified Health Clinic: A Quality Improvement Project, Jill Miscovich

Doctor of Nursing Practice (DNP) Manuscripts

Diabetes is a significant healthcare issue that not only effects the United States but also has a global impact, it is costly for the workforce and to manage. Diabetes management is more complex in rural areas due to increased SDOH and barriers to care. The purpose of this quality improvement (QI) project is to identify and overcome the barriers to care from the patients and nurse practitioners’ (NPs) perspectives in adult patients with type 2 diabetes mellitus (T2DM) in a rural federal qualified health clinic (FQHC). A mixed method approach was used including qualitative and quantitative data project manager created …