Nursing Commons^™

Reducing Same-Day Case Cancellation By Implementing 72 Hours Preop Phone Calls, Debbie Sharon Centeno

Master's Projects and Capstones

Problem: The increased frequency of same-day surgical cancellations affects patient care quality, causes loss of expenses for patients and facilities, and causes non-compliance with block utilization against regional standards.

Context: A collaborative effort was undertaken to reduce same-day case cancellations in the Ambulatory Surgery Unit (ASU). Patients received preoperative instructions 24 hours before surgery through email or phone call. Data collection revealed that the common causes of same-day cancellations were avoidable reasons (not NPO, patient ill, request for another schedule, no ride), indicating the need for improvement in delivering preoperative phone calls.

Interventions: This included educating preoperative nurses, creating a …

Enhancing Teamwork With Cliftonstrengths, Lauren A. Lelaidier

Master's Projects and Capstones

Abstract

Problem: Poor teamwork has a negative impact on patient safety, patient outcomes, patient satisfaction, healthcare work environments, and staff satisfaction. Effective teamwork is therefore critical but can be challenging.

Context: At a large, non-profit, academic healthcare system in San Francisco, all staff members working in the clinical research services (CRS) department identified teamwork as an area of concern. Teamwork survey results also indicated that teamwork could be improved.

Interventions: A literature review provided evidence that many types of team training are effective in multiple settings. Team training for all CRS staff included three interventions: a CliftonStrengths assessment, a one-on-one …

An Initiative To Improve Ssi Bundle Metrics Adherence Specific To Post-Op Warming And Temperature Documentation Practices In The Post-Anesthesia Care Unit, Dorothy Vergel

Master's Projects and Capstones

Abstract

Problem: Over the past year, the department failed to meet SSI Bundle Metrics scores consistently due to process identification failures and documentation lapses.

Context: The post-op warming temperature documentation and practices project focused on addressing critical quality issues related to documentation and education gaps in the post-anesthesia care unit (PACU) microsystem. This project took place in a 249-bed hospital in Northern California, which includes 15 post-surgical bays. The PACU primarily serves patients needing acute care post-surgery, with surgical cases handled, including general surgery, plastic surgery, neurosurgery, orthopedic and spine surgery, vascular surgery, and urology.

Interventions: The design …

Pediatric Respiratory Assessment Measurement Tool And The Benefits Of Utilizing It: An Integrated Review, Amy Michelle Randolph

Doctoral Dissertations and Projects

Asthma is a leading cause of hospitalizations of pediatric patients. The absence of comprehensive screening in the emergency department setting can impact the care of the patient who presents in respiratory distress. This integrated review focused on the benefits of the utilization of the Pediatric Respiratory Assessment Measurement tool. The methods utilized to collect evidence included a web-based search that led to a review of multiple articles. The results were analyzed using MeInky’s Hierarchical Levels of Evidence and organized into a literature matrix. The review ultimately supported the hypothesis that the PRAM tool is an effective instrument compared to other …

Increasing Resiliency In Front-Line Nurse Managers, Adrianne N. Bunyard-Fallquist

Master's Projects and Capstones

Problem

According to Membrive-Jimenez et al. (2020), 29% of nursing managers experience emotional exhaustion due to work overload, conflict mediation, and a lack of support from senior leadership. In a central California hospital, front-line nurse managers struggle to meet organizational goals and support their teams, with 64% indicating dissatisfaction in their roles in fall 2023. This highlights the need to improve job satisfaction and retention.

Context

A large healthcare system in Northern California has implemented Caring Science (Foss et al., 2015) and HeartMath® (HeartMath, 2023) techniques in a rural hospital to improve nurse manager retention and job satisfaction. The project …

An Integrative Review: Improving Copd Patient Outcomes Using The Teach-Back Method, Bichundo Lambert

Doctoral Dissertations and Projects

Chronic obstructive pulmonary disease (COPD) is a common clinical health concern that causes airflow resistance to the lungs and persistent respiratory symptoms, which can impact quality of life for the COPD patient. The condition is common to adults over 40 years of age. It is estimated that 210 million people worldwide suffer from the disease, and its incidence is on the rise. In United States, COPD affects 16 million people and costs the government $24 billion annually. The researchers predicts that COPD will be the third-leading course of mortality by 2030 worldwide. The objective of this integrative review was to …

Rheumatoid Arthritis Disease Activity Is Associated With Frailty In Veterans, Courtney N. Loecker

Theses & Dissertations

Frailty, a physiologic vulnerability to everyday stressors, affects approximately 30% of the 1.3 million Americans with rheumatoid arthritis (RA) and is associated with increased risk for adverse health outcomes. Active RA manifests as inflammation, pain, and joint damage leading to functional impairments and morbidity which cumulatively influences frailty. However, the relationship between RA disease activity and frailty is incompletely understood.

This study evaluated the relationship of RA disease activity and frailty at baseline and over up to five years in Veterans. A cohort study was performed using data from the Veterans Affairs Rheumatoid Arthritis registry. RA disease activity was measured …

Exploring Prelicensure Bsn Students' Knowledge Of Mindfulness Meditation Using A Smartphone App To Manage Stress And Promote Resilience: A Qualitative Single Case Study, Beth A. Kelley

Doctoral Dissertations and Projects

The purpose of this qualitative single case study was to explore pre-licensure Bachelor of Science in Nursing (BSN) students' knowledge of mindfulness meditation (MM) using a smartphone app (SMA) to manage stress and promote resilience. Guiding this study was the transactional model of stress, adaptation, and coping by Lazarus and Folkman (1984) and the zone of proximal development (ZPD) educational theory by Vygotsky. The study asked the following questions: What was pre-licensure Bachelor of Science of Nursing (BSN) students’ knowledge of mindfulness meditation (MM) using a smartphone app (SMA) to manage stress and promote resilience? What had the prelicensure BSN …

Patient Experiences With An Mhealth App For Complex Chronic Disease Care: Connections Despite Lack Of Traditional Clinical Interactions, Jenney Lee, Melissa Cheyney, Michael A. May, Marit L. Bovbjerg

Patient Experience Journal

Chronic diseases are costly to treat and burdensome for patients. Mobile health (mHealth) technologies might reduce costs of care and increase patient self-efficacy in chronic disease management, but the patient experience of mHealth is poorly understood. Our objective, therefore, was to evaluate patient experiences with using an mHealth app for complex chronic disease management, within a U.S. population of low-income patients. We used nurse/patient text messages from an mHealth complex chronic disease management tool, and exit interviews from patients, to assess qualitatively Medicaid patients' experiences with a remote monitoring mHealth app. Salient themes about the patient experience included: (1) Visibility …

Educating Nursing Staff On Urinary Tract Infections, Eldarada Rosamay Searcy

Walden Dissertations and Doctoral Studies

The primary objective of this doctor of nursing practice (DNP) project was to educate staff on urinary tract infection (UTI) prevention. A gap in practice was identified among nursing staff at an assisted-living facility who lacked current, evidence-based knowledge. This project was conducted to determine whether educating staff on UTI prevention increased their knowledge. Knowles’s adult learning theory and the analysis, design, development, implementation, and evaluation model were used as the theoretical framework that guided this project. Eighty-eight healthcare workers at the project site voluntarily participated in this project. Before the education session, a 10-question, multiple-choice pretest was administered to …

Decreasing Incivility Through Improved Communication And Teamwork, Marvin Ernest Tamayo

Master's Projects and Capstones

Problem: Workplace incivility (WI), lateral violence (LV), and bullying in healthcare settings are pervasive issues negatively impacting staff morale, turnover rates, and patient care outcomes. High turnover and low employee satisfaction scores from a September 2023 culture of safety survey signaled a toxic work environment characterized by ineffective communication and unprofessional behavior. Context: A 24-bed telemetry-stroke unit at a 172-bed acute care facility in the North Bay area of San Francisco.

Interventions: The Transtheoretical Model (TTM) of behavior change and the Crucial Conversation frameworks were used to improve staff communication and reduce incivility.

Measures: September 2023 and March …

Preventing Hospitalization-Associated Disability, Elizabeth M. White

Master's Projects and Capstones

Problem: Hospital-associated disability (HAD) affects one-third of hospitalized adults, diminishing post-discharge independence and contributing to high mortality rates. Identifying at-risk patients through early assessment of nutritional and functional status upon admission is critical to personalizing care and improving discharge outcomes.

Context: A 24-bed adult medical-surgical unit in a 173-bed suburban hospital in Northern California is part of a large not-for-profit healthcare organization. Interventions: Nursing staff received education on the Enhanced Recovery Medicine (ERM) pathway designed to prevent HAD. A visual display board, maintained and updated by unit champions, gave staff performance feedback. Nursing leadership reviewed admission assessments and addressed barriers …

Clinical Trial Research Nurse New Employee Onboarding 30- 60 -90 Day Checklist, Arin Alesia Urban

Master's Projects and Capstones

Problem: The clinical trials research management team was plagued with high nurse turnover and poor clinical documentation due to a lack of seasoned clinical research nurses.

Context: A regional clinical trials team serving 22 hospitals within a Northern California not-for-profit health system.

Interventions: Mixed methods were used to inform the development of new employee onboarding for novice clinical trial nurses utilizing a structured 30-60-90-day checklist, improved communication channels, and continuous mentor support.

Measures: Monthly quality queries and quarterly staff turnover rates were tracked. Employee feedback was collected to assess the interventions' impact.

Results: The number of quality queries was reduced …

Improving The Diagnosis And Treatment Of Obstetric Sepsis, Edwije Joseph

Master's Projects and Capstones

Problem: Maternal mortality affects women during four phases of obstetrics, including triage, antepartum, labor & delivery, and postpartum. In the U.S., sepsis is the third leading cause of maternal death. Inconsistent screening practices and delays in recognizing symptoms can occur in any phase. These factors were identified as root causes in a northern California community hospital with 600 monthly deliveries.

Context: Two maternal sepsis cases cost $90,000 annually. A standardized pathway was initiated nationally in October 2023 through the California Maternal Quality Care Collaborative (CMQCC). One regional hospital system initiated a quality improvement project over 5 months within a community …

Improving Stroke Education Scores At A Primary Stroke Center, Jesse J. Young

Master's Projects and Capstones

Abstract

Problem: The COVID-19 pandemic precipitated a significant departure from the nursing profession, leaving healthcare organizations grappling with critical staffing shortages and compromising patient care standards. In 2023, an advanced Primary Stroke Center in a Northern California hospital’s STK-8 scores fluctuated between 80-100%, with an average annual score of 92.8%, putting the facility's primary stroke certification and long-term patient outcomes at risk.

Context: A 24-bed acute stroke and telemetry unit in a Northern California hospital and designated primary stroke center.

Interventions: The following measures were implemented to improve the quality of stroke care and enhance STK-8 compliance, including …

Implementing Maternal Fetal Triage Index (Mfti) In A High-Risk Obstetrical Setting, Erica Bordenkircher Luna

Master's Projects and Capstones

Problem: The Maternal Fetal Triage Index (MFTI) for obstetric triage provides a systematic method for assessing and assigning acuity. Data evaluated for February 2024 and March 2024 identified the need for improved response times for triage Priority Two, which averaged 28.75 minutes (goal 15 minutes) for a provider to present to the bedside. The average percentage of patients with documented MFTI scores was 70.65% ( goal >80%).

Context: A high-risk 24-bed obstetrical department in an acute care hospital in Northern California that triages over 600 patients monthly with over 400 deliveries in the same period.

Interventions: Real-time observations and staff …

Process Improvement To Reduce The Incidence Of Delirium In An Overflow Unit, Raquel G. Chong

Master's Projects and Capstones

Abstract

Problem: This quality improvement project aims to reduce the incidence of hospital-acquired delirium in an overflow unit, which serves a diverse patient population from medical-surgical and telemetry microsystems. The unit averages 96 delirium episodes annually, costing approximately $3,456,000. The goal is to reduce delirium incidence by 25%, decreasing monthly cases from 8 to 6 by October 31, 2024, and annual cases to 72 by April 2026.

Context: Delirium is a prevalent and severe neuropsychiatric syndrome that significantly affects older hospitalized patients, characterized by acute disturbances in attention, awareness, and cognition.

Interventions: The project introduced a bundle of four interventions …

Decreasing Incivility And Bullying Through The Development Of A Healthy, Respectful Work Culture, Bridgette Wilson

Master's Projects and Capstones

Abstract

Problem: Incidents of bullying and incivility, including verbal aggression and exclusionary practices within the Telemetry department.

Context: This quality improvement project addresses workplace incivility, bullying, and harassment. The project aims to develop and implement a Compact Agreement of Unit Norms to foster a healthier work environment.

Interventions: Interventions included leadership education on bullying and conflict resolution, team awareness was heightened through workshops defining bullying and incivility, and a collaborative Compact Agreement of Unit Norms was developed and implemented.

Measures: An analysis of reported incidents for the first quarter of 2024 through the Electronic Reposting System (ERRF) on the Telemetry …

Post Anesthesia Care Unit Comprehension Safety Program Quality Improvement Project On De-Escalation Of Patients, Mary M. Gaukler Giannavola, Basil George Verghese, Deborah Maier

Advances in Clinical Medical Research and Healthcare Delivery

Background:

Violence within the healthcare setting has risen significantly, and has crossed into areas where staff are less prepared to manage and deescalate challenging patient encounters. This lack of preparedness and confidence has led to increased staff stress, burn out, and can potentiate poor patient outcomes.

Methods:

A pre/post-simulation quality improvement project was performed within a tertiary hospital Post-Anesthesia Care Unit in Upstate New York to evaluate the effect of simulation on feelings of confidence and preparedness in patient de-escalation with PACU nurses and patient care technicians. The project evaluation included the Thackrey’s Clinician Confidence in Coping with Patient Aggression …

Educating Nursing Faculty In Mindfulness Practices To Reduce Students’ Anxiety Pre-Simulation, Virginia Gonzalez

Doctor of Nursing Practice Projects

This DNP project examines how mindfulness training for associate degree nursing faculty can enhance educator self-efficacy in implementing teaching methods that reduce anxiety among nursing students before simulation exercises. The primary issue identified is the lack of faculty training in pre-simulation facilitation practices, which is crucial for ensuring students are adequately prepared. Using a pre-test/post-test design, this initiative evaluated changes in educator mindfulness self-efficacy among 14 faculty members. Results indicated a significant improvement in self-efficacy scores. The pre-test mean score was 3.36, which rose to a post-test mean score of 4.60. These project results demonstrate that mindfulness training effectively enhanced …

Evaluating The Use Of A Standardized Prebriefing Tool With Novice Simulation Facilitators, Ciara Berry

Doctor of Nursing Practice Projects

The International Association for Clinical Simulation and Learning (INACSL) Best Practice Standards related to prebriefing recommends establishing a prebriefing plan to prepare the learners for a simulation activity. A simulation briefing should orient the learner, promote learner engagement, and reinforce psychological safety. The nursing faculty’s unfamiliarity with an established prebriefing tool at the clinical site and reliance on the single simulation educator resulted in self-guided briefings and reduced the faculty facilitators' competency. The quality improvement project aimed to reorient nursing faculty in an associate degree nursing program to a prebriefing tool available at the clinical site. After reorientation, the PI …

Debriefing Orientation For Novice Simulation Faculty, Cindy M. Carter

Doctor of Nursing Practice Projects

Faculty new to the simulation environment lack the knowledge, skills, and confidence to deliver proper debriefing methods. The Doctor of Nursing Practice (DNP) project’s problem is the need for a standardized, evidence-based debriefing process in the undergraduate RN program at the College of Nursing in Oklahoma. The study aims to follow the International Nursing Association for Clinical Simulation and Learning (INACSL) best practices to implement a debriefing simulation for novice faculty to improve faculty self-efficacy with the debriefing process (Decker et al., 2021). The DNP student evaluated faculty using pre-and post-tests containing questions from the Debriefing Assessment for Simulation in …

Navigating Change: Cultivating Faculty Support For Curriculum Revision Through The 4ms Framework, Sarah Dearing

Doctor of Nursing Practice Projects

Public campaigns have increased awareness of Alzheimer’s disease and other dementias, however, education for healthcare providers concerning brain health and appropriate screenings to identify elderly patients at risk is not present. This curricular policy change project outlines the need for faculty buy-in to complete a curriculum change that addresses the lack of geriatric-evidence based education within an Associate of Applied Science in Nursing (AASN) program. Qualitative data identifies the amount of geriatric-evidence based education present in the current AASN curriculum map. Using Lewin’s change management theory (CMT) and the Cognitive-Affective-Social Theory of Learning Environments (CASTLE), an educational module teaching the …

Enhancing Family Nurse Practitioner Education Through End-Of-Life Simulation: A Quality Improvement Project, Deborah Jamison

Doctor of Nursing Practice Projects

Providing compassionate and effective end-of-life care is a crucial skill for Family Nurse Practitioners (FNP) students (Collins & Small, 2019). However, many students experience significant anxiety and lack confidence in such challenging situations. The problem identified for the Doctor of Nursing Practice (DNP) Quality Improvement (QI) project is the lack of training focused on end-of-life care in the FNP program at a College of Nursing (CON) within an academic clinical center. The project’s purpose was to improve confidence and anxiety levels among FNP students in providing end-of-life care. The project aimed to create an inventive and immersive end-of-life simulation with …

Quality Improvement Project: The Bidirectional Relationship Among Type Ii Diabetes Mellitus And Periodontal Disease, Sarah Martinez

Doctor of Nursing Practice Projects

Individuals with Type 2 Diabetes Mellitus (T2DM) are at increased risk for oral health conditions such as periodontal disease. Moreover, there is an established bidirectional relationship that has been well documented in the literature among periodontal disease and T2DM. However, oral health is rarely being discussed with patients who have T2DM from the primary care setting. The objective for this Doctor of Nursing Practice (DNP) project was to bridge the gap in this area by assessing the efficacy of implementing an educational program to promote education and awareness in individuals with T2DM who are at risk for periodontal disease. This …

Improving Hypertension Management In The Family Care Practice Through The Education Of Clinical Staff On Jnc-8 Guidelines, Shiny Michael

Doctor of Nursing Practice Projects

Hypertension is a major public health challenge, contributing significantly to global morbidity and mortality. Despite the availability of JNC-8 guidelines, adherence in clinical practice is often lacking. This project aimed to improve hypertension management in a primary care setting by educating clinical staff on the JNC-8 guidelines to enhance adherence to evidence-based practices. The primary purpose of this project was to address the lack of knowledge and suboptimal hypertension control through targeted educational interventions for clinical staff. The methodological approach involved a pre- and post-intervention design, with educational sessions conducted for medical assistants. Data on blood pressure control and staff …

Increasing High-Alert Medication Administration Competence In Undergraduate Nursing Students Using An Unfolding Obstetrical Simulation, Jenna A. Warf

Doctor of Nursing Practice Projects

This DNP project aimed to increase medication competence in undergraduate nursing students through an unfolding high-fidelity simulation. Before the implementation of this project, students at the project site had experienced minimal exposure to obstetrical nursing care and medication administration. This quality improvement project occurred at a community college in Texas, with undergraduate nursing students (n=18). The participants completed an Evolve pretest, unfolding high-fidelity simulation, Simulation Effectiveness Tool-Modified (SET-M) survey, and an Evolve posttest. The unfolding simulation consisted of a three-part simulation with a preeclamptic obstetrical patient that started at a physician’s office, progressed to triage, and ended as an inpatient …

Enhancing Patient Throughput From Emergency Department To Inpatient Unit With Electronic Handoff Implementation, George Hanania

Master's Projects and Capstones

Background: This evidence-based improvement project aimed to address communication issues during information exchange among healthcare professionals and the operational impacts of ineffective nurse-to-nurse reports among the emergency department (ED) to the inpatient units at a northern California hospital-based system hospital in San Leandro. The impacts of miscommunication and ineffective ways of giving nurse-to-nurse reports over the phone can result in delays in treatment and diagnosis, leading to ED overcrowding and decreased throughput.

Problem: Communication issues during information exchange, specifically operational impacts of ineffective nurse-to-nurse report/handoff between the ED and inpatient units.

Interventions: This project aimed to implement an electronic handoff …

Interprofessional Collaboration For Nurse Leaders: Practical Applications To Enhance Team Effectiveness On Telemetry, Paul Alegria

Master's Projects and Capstones

Abstract

Background: According to the Interprofessional Education Collaborative (IPEC), there are four core competencies that promote team engagement and collaboration among professionals: 1. Establish shared values 2. Clarify roles and responsibilities 3. Effective communication 4. Teamwork. Together, the competencies create structure and team integration that potentiates favorable outcomes in work culture and patient care when operating in complex, quality-based care settings. The setting for this quality improvement project is on a telemetry unit, assistant nurse manager (ANM) team in the greater Sacramento region of California.

Problem: The Gallup Q12 is an employee engagement survey that identifies inter-relational domains of influence …

Implementing Joy In Practice And Addressing Nurse Burnout, Courtney Repetto

Master's Projects and Capstones

Abstract

Background: This quality improvement project, a beacon of hope in the face of nurse burnout, examined its effects and how nurse leader engagement and the transformative Joy in Practice Initiative can promote wellness, joy in practice, and significantly improve patient outcomes. Problem: According to the Institute of Healthcare Improvements (IHI) 2019 National Forum on Quality Improvement in Healthcare (IHI, 2019), burnout can be characterized by depersonalization, emotional exhaustion, and lack of personal accomplishment. Since the COVID-19 pandemic, nurse burnout rates have been at an all-time high, posing a significant threat to patient care. This has revealed alarming results: Nurse …