Nursing Commons^™

Lost In Interpretation: The Lived Experience Of Nurse Interpreters In The Clinical Setting, Byron Batz

Dissertations

The use of language interpreters in the health care setting constitutes a vital part of provider-patient communication but remains a relatively unexplored phenomenon. Registered nurses (RNs) are often called upon to serve as interpreters when linguistically diverse patients constitute a large segment of the patient population. That RNs serve simultaneously in an interpreter role – in addition to clinical and advocacy roles – is a complex facet of contemporary nursing practice in a diverse U.S. culture. The purpose of this qualitative descriptive study was to examine the lived experience of RNs serving as interpreters in health care institutions in Southern …

Nursing Student Experiences During A Clinical Re-Assignment To Long Term Care In The Omicron Wave Of The Pandemic, Lisa J. Doucet, Paula D'Eon

Quality Advancement in Nursing Education - Avancées en formation infirmière

Background: The peak of the Omicron wave of COVID-19 created a sudden and unanticipated shortage of healthcare workers, particularly in long term care (LTC) triggering the provincial government’s call for aid. This culminated into a collaboration between universities and government to engage undergraduate nursing students to assist by re-assigning their clinical placements. This required a shift in location to LTC from acute care, and time frame, from end of semester to mid-semester.

Purpose: The purpose of this descriptive qualitative study was to explore nursing students’ experiences at one university who participated in a clinical reassignment during the peak …

Improving Handoff Communication In The Emergency Department, Amy Shepherd

Doctor of Nursing Practice Projects

Ineffective handoff communication has been recognized for years as a practice issue and is the most frequently reported cause of sentinel events in U.S. hospitals (Dufault et al., 2010) and responsible, at least in part, for 30% of all malpractice claims (Fucik, 2019). The development of standardized tools has been identified as a key component to improving handover practice. For this project, a standardized SBAR tool was modified for a local emergency department. The intervention was a process change in the emergency department to utilize an SBAR tool during handoff reports. The project was implemented by educating staff on the …

Improving Nursing Shift Handoff Reports: A Quality Improvement Project, Nathan Mm Secrest

Master's Projects and Capstones

Nursing shift-to-shift handoff report can greatly impact a patient’s quality of care. According to the Joint Commission, “an estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off” (Inadequate handoff communication, 2017). In total, this quality improvement (QI) project worked with three hospital inpatient units on three different floors in an urban California (CA) city. Each unit and even shifts within each unit varied, leading to the conclusion that interventions should be trialed by units with the most buy-in, then adjusted to the unique needs of each unit. For our main intervention we …

Home Health Care Cahps® Survey: Predicting Patient Experience Performance, Stephanie Ballengee, Girlyn Cachaper, Kim S. Bradley, Hessamaldin Sadatsafavi, Ralitsa S. Maduro, Merri K. Morgan, Kathie S. Zimbro

Patient Experience Journal

Our home health (HH) division has collected Home Health Care CAHPS® Survey (HHCAHPS) data since 2011. To date, HH providers have not met performance thresholds related to patient experience. This study aimed to explore HHCAHPS composite measures and specific questions to predict 1) overall rating of care provided by the agency (Care Rating) and 2) willingness to recommend home health agency to family and friends (Recommend Agency). We also explored survey comments to identify specific themes related to positive and negative patient experiences. Logistic regression (N = 7 268) revealed being treated with courtesy and respect, and providers being informed …

Mystay – Development Of Nurse-Facilitated Condition-Specific Multimedia Resources To Facilitate Patient Participation In Postoperative Care, Jo Mcdonall, Anastasia F. Hutchinson, Natalie Heynesbergh, Bernice Redley, Richard De Steiger, Damien Khaw, Mari Botti

Patient Experience Journal

Improved postoperative outcomes and the global drive toward the provision of patient-centred care underpins efforts to enhance the nature and capacity of patient participation in acute postoperative hospital care. In this paper, we describe the design, framework and processes used to develop a modular, procedure-specific, digital health intervention platform aimed at improving the patient experience and patient participation in care following surgery. The intervention, a multimedia application MyStay, uses bedside delivery of audio-visual and text-based information to engage postoperative patients to better participate in their care. MyStay modules are developed using an iterative, multi-method approach intended to balance procedure-specific best …

Implementing A D/Deaf Educational Module For Graduate Nursing Students, Brenda J. Pauley

Dissertations

Problem: Nurse practitioners lack knowledge and skills to effectively communicate with D/deaf individuals which potentiates risk for health disparities and gaps in care. Graduate nursing programs rarely incorporate D/deaf-focused education in their curriculums.

Methods: This descriptive quality improvement project implemented the first D/deaf-focused educational online module at a Midwestern university’s College of Nursing. A purposive sample of 38 BSN-DNP students enrolled in the Spring Intensive completed a pre- and post-education survey. Both surveys assessed students’ D/deaf perceptions through Lewis and Keele’s (2020) D/deaf and Hard of Hearing Interaction Beliefs Scale for Registered Nurses (DdHH-IBS/RN) and evaluated students’ knowledge through a …

Civility And Communication Interventions To Improve Patient Outcomes, Lane Denney

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Communication in health care is vital for the successful care of patients and their outcomes while they are hospitalized. Healthcare workers are responsible for communicating patient information whether it is between change of shifts or reporting to a patient’s provider. It is important that this information is communicated effectively. This review evaluates how nurses communicate in shift- report and how this affects patient outcomes and civility between nursing units and teams. Overall, bedside shift reports promoted the best patient outcomes and increased teamwork on hospital units.

Communicating Comfort In Crisis: A Literature Review On Overcoming The Emergency Room Environment To Foster The Nurse-Patient Relationship, Faith G. Davenport

Senior Honors Theses

The average emergency room patient is not receiving the compassionate nurse-patient communication that patients experience on other hospital floors. Fewer positive nurse-patient interactions prompt patients to state that they feel uncomforted and dissatisfied on hospital exit surveys, inciting hospital management to investigate how to reverse this trend to retain their federal funding. Emergency room nurses cite multiple barriers inherent in their work environment that prevent them from building rapport with their patients, including a layout not conducive to private conversations, strict time constraints, and a fluctuating workload. Working for a prolonged period under these conditions is driving many nurses to …

Nurse Practitioner-Led Care Pods: A Team Communication Enhancement Model, Miranda Saint-Louis, Miranda Saint Louis

Doctor of Nursing Practice (DNP) Projects

Background: Communication has become a key performance measure in the shift to value-based healthcare. Given the impact of communication failures on patient harm, length of stay, and dissatisfaction with care, new models of care with better communication through structured teamwork and interdisciplinary collaboration are needed.

Problem: In a 16-bed geriatric medical/surgical unit of a New York City multispecialty community hospital, the workflow structure unintentionally created inconsistent handoff communication, gaps in continuity of care, missed care events, and inattention to the patient’s priorities in the care plan. A gap analysis identified communication deficiencies that impacted team effectiveness and patient care …

Burnout In The Nursing Profession: Extant Knowledge And Future Directions For Research And Practice, Sara Labelle

Communication Faculty Articles and Research

Burnout is a psychological state resulting from prolonged psychological or emotional job stress, and is a culmination of three factors: emotional exhaustion, depersonalization, and reduced personal accomplishment. Due to the nature of the “people-work” they must constantly perform, along with a highly stressful and unpredictable work environment, nurses have alarmingly high rates of burnout among members of their profession. Given the importance of research on burnout to understanding the context-specific stressors and challenges of nursing, this review offers a synthesis of research published in the last decade in both nursing and communication journals, with an emphasis on discussing opportunities for …

Disruptive Communication Among The Interdisciplinary Team: Gaining Insight And Providing Nurse Education, Kristen Marie Anderson

Doctor of Nursing Practice Scholarly Project

The purpose of this study is to identify what types of disruptive behavior nurses are experiencing, discuss outcomes of disruptive behavior, and educate healthcare providers and administrators of disruptive communication. Understanding the consequences of disruptive communication can help educators articulate the need for training in conflict management and therapeutic communication methods. It can also aid healthcare providers to be more conscious of their behavior in the professional setting. Seven research questions related to communication were developed and analyzed in this study. The author developed a pre-education survey that included demographics, multiple-choice questions, and open-ended questions to assess the nurses' knowledge …

Increasing Comfort Of Mychart Patient Messaging In An Outpatient Oncology Clinic, Katherine Herdzik

Master of Science in Nursing Scholarly Project

Increasing Comfort of MyChart Patient Messaging in an Outpatient Oncology Clinic

Katherine Herdzik, BSN, RN

Abstract

Electronic patient portals have provided increased access to the electronic health record and patient information. A feature within the portal is a messaging system, creating a secure method of communication between and patient/family member and their care team. Scholarly literature has suggested that this method of communication helps to increase trust between the patient and providers, enhancing the healthcare experience. This study focuses on educational review to increase comfort with the MyChart messaging portal for care managers and nurse practitioners in an outpatient pediatric …

Exploring Therapeutic Nurse-Patient Communication: Techniques And Barriers, Pierina Rossini

Senior Honors Theses

Effective nurse-patient communication, also described as therapeutic communication, is essential for providing high quality nursing care. It increases patient satisfaction and health, decreases patient anxiety and disease symptoms, and increases patient cooperation and compliance to treatment. Some therapeutic communication techniques include attentive listening, empathy, silence, focusing, open-ended questions, clarification, exploring, clarifying, and summarizing. Unfortunately, there are barriers to therapeutic communication that have been identified. Research regarding nurse-patient therapeutic communication, consisting of secondary, qualitative, descriptive data, points to several barriers to therapeutic communication. Some of the barriers to therapeutic communication include nurse-patient gender difference; patient physical discomfort; nurse-patient language, culture, and …

Dnp Final Project: Implementing Teamstepps Training: Using Evidence To Impact Teamwork In An Acute Care Hospital, Nana Baah Adjei

DNP Final Reports

Background: Medical errors are the third leading cause of death in the United States. Patient morbidity and mortality will decrease when institutional efforts result in the implementation of action plans which reduce medical errors. Teamwork, education, and training through structured initiatives are the most effective mechanism to improve patient safety. Purpose: The project aims to impact the perception of communication among newly hired medical surgical nursing and support staff. The acute care hospital is a 200-bed tertiary care hospital. Intervention: The intervention consists of the registered nurses and support staff participating in an innovative, six-hour, interactive TeamSTEPPS fundamentals course. Results: …

Development And Validation Of A Scale To Measure Nurse/Medical Resident Physician Collaboration, Bruce St. Amour, W. Brady Dehart

HCA Healthcare Journal of Medicine

Introduction: The purpose of this pilot study is to investigate the reliability of an interprofessional collaboration measurement scale used for nursing interactions with resident physicians. To date, the collaboration between nurses and residents has not been adequately investigated and a validated tool specifically for this purpose is not yet available. Our objective is to adapt a previously validated interprofessional scale for health care settings to the specific nurse/resident physician collaboration.

Methods: In 2019, nurses from two hospitals were contacted via email and were invited to complete an anonymous survey that asked about the nurses’ interaction and collaboration with resident physicians. …

Implementing Inter-Professional Patient-Family Centered Plan Of Care Meetings On An Inpatient Hospital Unit, Nicolas Hernandez, Alice Fornari, Sage Rose, Leanne Tortez

Patient Experience Journal

Inpatient plan of care meetings support efforts to encourage collaborative practice and patient-family centered care and result in an effective strategy to enhance communication and patient satisfaction. Clinical team members participated in patient/family centered plan of care meetings at a community hospital in a selected inpatient unit with full time hospitalist physicians. Quantitative data were gathered pre/post implementation from the external Hospital Consumer Assessment of Health Care Providers (HCAHPS) survey. HCAHPS data were collected independently, specifically for questions related to communication between patients, family members/guardians and the medical team and also the effects of care transition. There was a slow …

Cultural Communication For New Nurse Residents: K.I.N.D Communication Toolkit, Jennifer Caraballo

Doctor of Nursing Practice (DNP) Projects

Background: Microaggressions can create a hostile work environment and decrease rapport and functioning in clinical and personal relationships. Exposure to micro aggression and implicit bias results in micro trauma and possible compassion fatigue by medical staff. Symptoms can include headaches, poor sleep, depressions, and anxiety, similar to compassion fatigue.

Purpose: To develop a toolkit for healthcare staff to use as educational material to facilitate for cultural communication and cultural humility.

Methods: Nurses that were enrolled in a nurse residency program at a level 1 trauma center participated in the education of a communication toolkit related to K.I.N.D …

Can The Implementation Of Interprofessional Rounds Improve Hospital Throughput Efficiency?, Rebecca Howdyshell

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Abstract

Efficient throughput processes are a vital part of providing cost effective, safe, quality patient care. Research has shown interprofessional rounds can have success at improving throughput processes. A rural, not-for-profit, 255 bed hospital in a Mid-Atlantic State was experiencing issues with throughput/patient flow. The aims of this quality improvement project were 1). to implement Interprofessional Rounds on the Progressive Care Unit (PCU); 2). To design and build a working Interprofessional Rounds template into meditech to guide Interprofessional Rounds and streamline discharge documentation; 3). to increase the amount of discharge orders entered between 0700 and 1300 by ten percent; and …

Improving Nursing Communication Outcomes Through The Tell-Us Card, Brittney Pilker, Jillian Cule, Laura Le, Nina Park, Jeffrey Salao, Maricarmen Reyes

Master's Projects and Capstones

Nursing communication plays a pivotal role in patient-centered care. However, statistics have shown that failures in communication exist in more than 20% of all hospital settings (Sethi & Rani, 2017). Within the explored microsystem, a gap in patient communication was identified through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Reports revealed that the microsystem was performing at 69%, which is 11% below the national average for nursing communication (Centers for Medicare and Medicaid Services [CMS], 2018). After performing a microsystem assessment, there was a measurable communication opportunity between the patients and nurses. It was determined that …

Improving Nursing Communication Outcomes Through The Tell-Us Card, Jeffrey Salao, Nina Park, Laura Le, Brittney Pilker, Jillian Cule, Maricarmen Reyes

Master's Projects and Capstones

Abstract

Nursing communication plays a pivotal role in patient-centered care. However, statistics have shown that failures in communication exist in more than 20% of all hospital settings (Sethi & Rani, 2017). Within the explored microsystem, a gap in patient communication was identified through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Reports revealed that the microsystem was performing at 69%, which is 11% below the national average for nursing communication (Centers for Medicare and Medicaid Services [CMS], 2018). After performing a microsystem assessment, there was a measurable communication opportunity between the patients and nurses. It was determined …

"Improving Nursing Communication Outcomes Through The Tell-Us Card", Jillian Cule, Jeffrey Salao, Nina Park, Laura Le, Brittney Pilker, Maricarmen Reyes

Master's Projects and Capstones

Nursing communication plays a pivotal role in patient-centered care. However, statistics have shown that failures in communication exist in more than 20% of all hospital settings (Sethi & Rani, 2017). Within the explored microsystem, a gap in patient communication was identified through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Reports revealed that the microsystem was performing at 69%, which is 11% below the national average for nursing communication (Centers for Medicare and Medicaid Services [CMS], 2018). After performing a microsystem assessment, there was a measurable communication opportunity between the patients and nurses. It was determined that …

Interprofessional Education: How Curriculum Influences And Develops Future Healthcare Professionals, Karen Keune

CUP Ed.D. Dissertations

The value of higher education is a topic of great consideration and discussion, not only for current and future students, but also for legislators, educators, and employers. A college degree is more than a pathway toward advanced knowledge in a given subject; it is a component of a larger outcome beyond a diploma, it's a job. While the scale of employment opportunities appears to rise for those with a college degree, it is not enough to guarantee security for new graduates, no matter their topic of study. More than a competency in the field of study is required to prove …

Improving Communication To Reduce Patient Falls In A 48-Bed Medical-Surgical Unit, Christian Gella

Nursing and Health Professions Faculty Research and Publications

Abstract

Problem: Patient falls has been associated with increased morbidity, mortality and decreased quality of life. The increase in total patient falls for 2018 relative to 2017, and a spike of 10 patient falls for the month of June 2018 from a baseline of 5.3 falls per month has gained greater attention to reduce patient harm from falls while hospitalized. Prevention of falls minimizes patient exposure to the possibility of being injured. Despite efforts to curtail patient falls, improvement in communication is essential to address the safety issues surrounding improving quality of care practices, and consequentially reduce un-reimbursable hospital costs …

Improving Communication: Huddling For Change, Harnoor Chahal

Master's Theses

The purpose of this communication improvement project is to incorporate huddles between interdisciplinary departments within a microsystem in order to improve customer satisfaction by decreasing the number of grievances. Based on the increasing number of grievances due to delayed hospital discharge, which results from a lack of communication between team members, there is an increased need for communication between the microsystem. By implementing weekly huddles between the Inpatient and Outpatient nurses, not only will there be increased care-coordination, but there will also be a decreased delay in discharge from the hospital caused by missed or no communication. Evidence-based practice indicates …

Improving Pediatric Oral-Systemic Health Through Motivational Interviewing: An Interprofessional Training Intervention, Oksana Prodan

Doctor of Nursing Practice (DNP) Projects

Introduction: In response to the prevalence of early childhood carries (ECC) in the United States, recommendations were established for pediatric primary care providers to routinely incorporate oral-systemic health promotion services into clinical practice. An interprofessional education project was developed between Advanced Practice Registered Nurses (APRNs) and dentistry students in San Francisco to assist trainees in the effective delivery of oral systemic health promotion services. Improving health promotion communication skills was identified as an area of need for both sets of learners. Therefore, the IPE activity was designed to incorporate Motivational Interviewing (MI) into the training along with pediatric oral …

The Interactive Patient Careboard: A Technological Innovation To Improve Patient Safety, Perla Q. Baldugo

Master's Projects and Capstones

Problem: An innovative method to communicate with the patient and between interdisciplinary team members is the use of the interactive patient careboard (IPC) which has declined since its implementation. Concurrently, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores for the med surg unit need improvement. The low HCAHPS scores in communication suggested to nursing leadership that revitalizing use of the IPC could lead to improvements in the scores. The ideal shift handoff includes IPC as a focal point of communication. The RN is expected to display the careboard during handoff and identify for the patient the healthcare …

Improving Communication In A Virtual Team: A Quality Improvement Project, Deepali Addagarla

Master's Projects and Capstones

Problem: Data analysis based on two surveys revealed team communication, interdependence, technology interfaces, and integration as the quality gaps in the Virtual Surveillance Team. When compared with traditional in-person teams, a virtual working team faces different types of communication challenges.

Context: The virtual surveillance team in the regional quality department at Oakland monitors both Advance Alert Monitor (AAM), a statistical model developed by the Kaiser Permanente (KP) Division of Research (DOR) that is used to predict an individual’s likelihood of deterioration, and eHospital care gaps for Kaiser Foundation Hospitals in Northern California (KFH, NCAL). The latest evaluation from DOR of …

Patient Acceptance Of Remote Scribing Powered By Google Glass In Outpatient Dermatology: Cross-Sectional Study, Sandra Odenheimer, Deepika Goyal, Veena Jones, Ruth Rosenblum, Lam Ho, Albert Chan

Faculty Publications

Background: The ubiquitous use of electronic health records (EHRs) during medical office visits using a computer monitor and keyboard can be distracting and can disrupt patient-health care provider (HCP) nonverbal eye contact cues, which are integral to effective communication. Provider use of a remote medical scribe with face-mounted technology (FMT), such as Google Glass, may preserve patient-HCP communication dynamics in health care settings by allowing providers to maintain direct eye contact with their patients while still having access to the patient’s relevant EHR information. The medical scribe is able to chart patient encounters in real-time working in an offsite location, …

Multifarious Interventions To Reduce Falls On The Medical-Surgical Units, Wenjie Ying

Master's Projects and Capstones

The CNL project was conducted on the 56-bed adult medical-surgical units in a trauma center. There were total eight fall incidences from January to February. The SWOT analysis, stakeholder analysis, pre-educational survey, cost-effective analysis and root-cause analysis suggested in-depth training on multifaceted fall prevention. The objectives include reducing falls by 50%, increasing staff’s adherence to fall prevention protocols, boosting staff’s confidence in patient mobility, improving staff responsiveness and communication with meds in HCAHPS, and enhancing knowledge of medications’ side effects by May 14, 2018. The literature reviews indicated that the multicomponent preventative measures to prevent falls along with leadership supports …