Nursing Commons^™

Hospital Administrators' Strategies For Reducing Delayed Hospital Discharges And Improving Profitability, Sheree Boyd

Walden Dissertations and Doctoral Studies

Inefficiencies in leadership and limited leadership strategies in hospitals contribute to delayed hospital discharges and an increased financial burden on a hospital. Three administrators from 2 hospitals who are part of a hospital conglomerate in Chicago, Illinois were selected for interview in this qualitative multiple case study to explore how hospital discharge strategies reduce delayed hospital discharges and improve profitability. Contingency was the primary theoretical theory for this study. The purposive sampling consisted of the selections of individual who were knowledgeable and had experience to organize, manage, and implement processes in an organization. Data collection occurred using face-to-face semistructured interviews, …

Electronic Communication Among Anesthesia Providers, Joseph K. Wells

Doctoral Projects

Facilities in the United States are utilizing electronic communication devices (ECDs) for their nursing staff on intensive care units, general medical-surgical floors, and chemotherapy floors, but it is underutilized in the operating room where seconds truly matter (Wu et al., 2012). Situations arise daily within operating rooms that require quick and decisive communication to avoid poor patient outcomes. The ultimate goal is to prevent poor patient outcomes by enhancing communication among anesthesia providers.

This doctoral project evaluated an anesthesia group in southeast Mississippi regarding their satisfaction with current devices used for communication. This anesthesia group utilized smart phones and public …

Use Of A Handoff Communication Tool Between Certified Registered Nurse Anesthetists, Anesthesiologists, And Post Anesthesia Care Unit Nurses, Rachel Louise Johnson

Doctoral Projects

Ineffective communication in the post-anesthesia care unit (PACU) is considered to have incidences of increased error, mortality, morbidity, which leads to decrease patient outcomes and quality of care. Therefore, the purpose of this study was to introduce a structured, standardized, and consistent handoff tool to Certified Registered Nurse Anesthetists (CRNA), Anesthesiologists, and Post Anesthesia Care Unit Nurses (PACU) that may result in favorable perception of usage. Without a structured handoff tool, the organization risks the occurrence of increasing errors when the message is not transmitted effectively and efficiently every time. Distractions leave the handoff susceptible to a breakdown during the …

A Needs Assessment For The Development Of The Time Anesthesia Handoff Tool, Courtney K. Gibney

College of Science and Health Theses and Dissertations

Standardized handoff is critical to providing safe and effective patient care. Limited studies assess the need for developing a handoff tool for anesthesia providers.

The purpose of this descriptive study was to assess the need for a standardized anesthesia handoff tool and to identify the most essential components to develop an anesthesia handoff tool.

Descriptive survey design was utilized. Anesthesia providers were asked to complete an online survey.

Fifty-three of 82 (64%) respondents did not currently use a systematic process during anesthesia handoff. Most (73%) felt they were given inadequate information and forty (48.8%) sometimes discovered information that was not …

Use Of The Patient Whiteboard To Improve Communication Of Pain Medication Schedule, Carmela Gonzalez-Shalaby Msn, Rn

Master's Projects and Capstones

Abstract

Despite advances in treatment, pain remains a significant problem in healthcare today. Sub-optimal pain management results in poor patient outcomes and patient satisfaction, culminating in decreased quality of life and financial loss for the health care facility. An important component of pain management is transparent and timely health care team/ patient communication. This project aims to improve patient satisfaction in pain management by incorporating pain medication last given and next available times on patient whiteboards. The targeted floor was a busy post-op medical floor in a medium sized community hospital. Staff were educated with short educational sessions, educational pamphlets, …

The Use Of Personalized Whiteboards In The Inpatient Acute Care Setting And Their Effect On Patient And Nurses Perception Of Communication, Cheryl Karn

Master's Projects and Capstones

A microsystem assessment of two inpatient medical-surgical wards in a medical facility determined a majority of nurses reported dissatisfaction with the amount and type of communication with the interdisciplinary team. This, along with a review of Press-Ganey scores from the inpatient wards, revealed patients reported decreased satisfaction when asked if “nurses kept me informed”, compared to previous quarterly reports as well as other VA facilities. Multiple studies have shown the benefit of personalized whiteboards (PWs) at the patient bedside in improving not only communication but also safety and patient outcomes. A PW was developed by the Clinical Nurse Leader …

Developing Therapeutic Communication Skills: Integration Of Standardized Client Simulation In An Associate Degree Nursing Program, Kristine Weber, Timothy Farrell

UNLV Theses, Dissertations, Professional Papers, and Capstones

By the year 2020, it is projected that there will be a shortage of 300,000 to one million registered nurses in the United States (Juraschek, Zhang, Ranganathan & Lin, 2012). Therapeutic communication skills are a fundamental and integral part of any registered nurse’s practice. Despite the importance of therapeutic communication, evidence suggests that the lack of skill development in nursing programs is having an adverse effect on the NCLEX-RN pass rate of graduating registered nurses. Identifying and addressing shortfalls in effective communication offers an opportunity to improve this pass rate. Learning to effectively communicate in a simulated situation will provide …

Enhancing Nurse-Physician Communication And Collaboration, Pamela D. Missi

Graduate Theses, Dissertations, and Capstones

In healthcare organizations today, creating a culture of safety is critically important. Communication failures among healthcare providers have been linked to 70% of annual sentinel events. Seventy-six percent of individuals experiencing a sentinel event die (Joint Commission, 2009). Lack of good communication behavior between nurses and physicians has been recognized as a cause of preventable harm to patients (Institute of Medicine, 2004; Zwarenstein & Reeves, 2006). In hospital settings, communication failures are linked to increases in length of stay, patient harm, resource utilization, more rapid turnover, and caregiver dissatisfaction (Dingley et al., 2008). Numerous national organizations and commissions have officially …

Heart Huddle: Increasing Cohesiveness In Ccu And Cvtu, Ashley Douvier

Nursing Posters

The American Association of Critical Care Nurses identifies six standards for a healthy work environment, two of which are skilled communication and true collaboration. CCU and CVTU are two separate units staffed by one Charge RN. A need to improve communication and collaboration has existed throughout both units. Thus, Heart Huddle has been developed. The objective of Heart Huddle is to bring cohesiveness to CCU and CVTU through improving communication and collaboration, which is imperative to a healthy work environment.

Moving Weekly Team Conference To Bedside, Joyce Belanger

Nursing Posters

CMS has specific requirements for all Inpatient Rehab Facilities. Weekly team conferences on the patients is one of the requirements. Team members required are Dr, LSW, PT, OT, SLP and RN. Our Practice Nurse (RN) attended conferences, as she has working knowledge of the patient. Our challenge was to get the bedside nurse, instead of the practice nurse, to attend the weekly conference.

Education Program For Nurses Working In An Immigration Detention Facility, Dr. Tiney Elizabeth Ray

Walden Dissertations and Doctoral Studies

Nursing response to medical emergencies has been an ongoing issue in immigration detention centers. Lack of teamwork and poor communication with medical and security staff have resulted in detainees sustaining injuries during medical emergencies. This project was developed to persuade Immigration and Customs Enforcement Health Service Corps (IHSC) leaders to consider piloting the TeamSTEPPS emergency response curriculum for nurses working in the immigration detention center. Tuckman and Jensen's model of group development will provide guidance to IHSC leaders in understanding the transformational stages of forming a successful team. TeamSTEPPS will address gaps in emergency health care competency by improving collaboration, …

Impact Of Simulation On Nurses' Satisfaction, Confidence, And Communication In Neonatal Resuscitation, Kathryn Rudd

Walden Dissertations and Doctoral Studies

Teamwork and communication in clinical practice improves with simulation using the TeamSTEPPS program. However, there is limited research about simulation efficacy for improving neonatal resuscitation through enhanced communication. Based on a needs assessment and literature review specific to quality improvement strategies for neonatal resuscitation, an enhanced neonatal resuscitation provider (NRP) course was infused with TeamSTEPPS communication strategies, and an NRP case was adopted for simulation training. Also, utilizing clinician feedback, the flow of the resuscitation documentation was revised. The purpose of this project was to evaluate the perceived level of confidence, satisfaction, and communication skills in nurses performing neonatal resuscitation …

A Practice Improvement Project To Improve Knowledge And Perceptions Of Palliative Care Among Patients With Heart Failure And Cancer In The Acute Setting Using Video Enhanced Education, Crystal F. Spellman

DNP Projects

Background: Clear communication of the purpose and benefits of palliative care can reduce barriers to acceptance of such services for patients and families. The purpose of this practice improvement project was to assess and improve knowledge and perceptions of palliative care among patients with a diagnosis of heart failure and cancer in the acute setting using a video enhanced education intervention. Methods: This practice improvement project took place at a 555 bed teaching hospital. 18 patients referred to an inpatient palliative care consult service in the acute care setting with a diagnosis of either heart failure or cancer participated. …

Making A Difference: Evidence Based Palliative Care Education For Neonatal Nurses, Sherry Elaine Pye

Walden Dissertations and Doctoral Studies

The death of a neonate is a life-changing and tragic experience for the individuals involved in the final moments of the infant's life. As the frontline provider in this clinical scenario, the bedside nurse supports the patient and family through their individual journey of loss. If the nurse does not possess the palliative care educational background and communication skills to support this unique care delivery process, the journey of death can evolve into a particularly negative experience for the parents and the nurse. This specific delivery of care concern was identified and gleaned from a parental bereavement exit interview after …

Improving Perinatal Team Communication To Decrease Patient Harm With Team Strategies And Tools To Enhance Performance And Patient Safety Training, Raquel Maria Walker

Walden Dissertations and Doctoral Studies

During childbirth, multiple providers deliver care at the bedside that requires optimal teamwork and communication to prevent patient harm. The complexity of caring for obstetrical patient demands a well-coordinated team to relay information and respond to conditions that can change quickly during childbirth. A patient safety strategy to prevent perinatal harm is Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) training. TeamSTEPPS is an evidence-based program based on crew resource management (CRM) principles developed in the aviation and military industries. This process improvement project used the Plan-Do-Study-Act framework and Kotter's change theory to implement TeamSTEPPS training after …

Assent Described: Exploring Perspectives From The Inside, Rebecca D. Poston

Ellmer School of Nursing Faculty Publications

Purpose- The purpose of this study was to describe the informed consent and assent experience for oncology research from the perspective of the participants: adolescents, their parents, and their physician providers.

Design & Methods- This descriptive mixed-methods study included the pilot use of the Quality of Informed Consent Questionnaire (QuIC) with an adolescent population and semi-structured interviews with adolescents, their parents, and their physician providers within 48-72 hours of the informed consent and assent discussion for a pediatric oncology clinical trial and again 6-9 weeks later. Results: Adolescents and their parents scored considerably lower on part A of the QuIC …

Handoff Communication In The Emergency Department, Kristen Matichko

DNP Forum

The communication of patient information through use of handoff ensures continuity of care and patient safety. A study of hand-off reports between pre-hospital personnel and staff in the emergency department revealed a lack of complete or formal information dialogue. Nurses play a vital role in the process of communication and information exchange through the use of handoff despite minimal guidelines for that exchange in current nursing practice. The pre-hospital hand-off informational exchange impacts patient safety as well as the planning and implementation of nursing care based upon that information.

The sample used was from a convenience sampling of patients arriving …

Implementation Of A Debrief “Takeaway” Board, Carly A. Skeath

Master's Projects and Capstones

Abstract

My original focus of my project was to implement Team STEPPS, to help improve the communication and teamwork within our entire perinatal service department. However, as I started I ran into barriers with time and with other projects put out by our management that needed to take president. It is then that I decided to narrow my focus on one aspect of Team STEPPS which we are already implementing, and that is debriefs. As a member of the Perinatal Patient Safety Program (PPSP), I was able to learn about all the takeaway’s we received from debriefs that had occurred, …

Improving Hand Off Communication To Enhance Patient Outcomes And Staff Satisfaction, Karin Weinstock

Master's Projects and Capstones

Abstract

The specific aim statement is: Improving hand off communication to enhance patient outcomes and staff satisfaction 50% by August 6. Staff had 100% participation. Reduction in unnecessary appointments occurred and a structured standardized hand off form with situation, background, assessment, and recommendation (SBAR) was implemented at the start date. The clinic has 2 exam rooms, 1 lab, a reception area, and two small offices. The majority of the clients are Hispanic females ages 15-25. The non-profit clinic provides free medical services to the community. Evaluation methods yielded quantitative and qualitative results through chart audits and direct observations.

In-services, one-to-one …

Using Technology To Improve Diabetes Self-Management Within A Federally Qualified Community Health Center, Lisa Diane Morgan

Doctoral Projects

The Patient Centered Medical Home (PCMH) concept places the patient and family at the center of healthcare. The patient becomes actively involved in their own care. One aspect of PCMH is managing care and increasing chronic disease self-management. Diabetes, a chronic disease, is a leading diagnosis among the patients served by the federally qualified community health center (FQCHC). The prevalence of diabetes in Mississippi in 2012 was 12.3%. The purpose of this DNP Capstone project was to implement a pilot study to increase diabetes self-management knowledge. The program utilized the current technology of text messaging to send biweekly supportive and …

Improve Intra-Operative Nurse-To-Nurse Communication Using A Safety Checklist, Silvinita Tadeo Rowe

Doctoral Projects

Poor and inadequate handoff, or transfer of care of the surgical patient care from the primary to the relief operating room registered nurse circulators, can result in irreversible patient harm, or sentinel events, such as retained foreign items. In this study, Rogers' diffusion of innovation theory was the framework for implementing the handoff safety checklist. Also, Donabedian's structure process and outcome was the model to investigate the feasibility, acceptability, and improvement in the quality of patient handoff communication and improvement of nurse satisfaction over time. Nineteen-statement surveys, conducted at multiple timeframes, were completed by volunteer operating room nurse participants. In …

Coping Mechanisms Of Children With Atopic Dermatitis, Whitney A. St. Mary

Honors Theses

This was a qualitative study that explored the lived experience of parents who had children with atopic dermatitis, otherwise known as eczema. The study had seven volunteer participants and the objective of this study was to determine any coping mechanisms used to overcome the negative aspects of atopic dermatitis. Volunteers were obtained from the Oak Grove Family Clinic. Phone interviews were then conducted and the participants were asked a series of eight questions. After the interviews concluded the researcher then transcribed the interviews and determined common themes from parents’ responses. All of the parents discussed how using unscented lotion, preventing …

A Measure Of Soft Skill Gains Acquisition With Engagement In Baccalaureate Nursing Programs, Wendy J. Williams-Buenzli

Dissertations

This dissertation examined soft skill acquisition from engagement in baccalaureate nursing programs. Baccalaureate nursing programs prepare nurses to be the future leaders of nursing practice. Soft skills include critical thinking, interpersonal communications, and ethical decision-making. To explore the acquisition of soft skills, this research study analyzed data from the National Survey of Student Engagement to explore for gains in critical thinking, ethical decision-making, and critical thinking. After gains scores were identified, then correlations were run to identify key engagement indicators. The findings of the study found gains in soft skill behaviors from freshman year to senior year of baccalaureate education. …

Intraprofessional Nursing Communication And Collaboration: Apn-Rn-Patient Bedside Rounding, Rita M. Herm-Barabasz

UNLV Theses, Dissertations, Professional Papers, and Capstones

Executive Summary

Leading advisory agencies have long advocated that health care must be safe and effective (Institute of Medicine [IOM], 2001). In order for health care to be safe and effective, good communication and collaboration are essential. Research has found that in health care, poor communication and teamwork failures are the major contributors to adverse events (Cornell, Townsend-Gervis, Vardaman, & Yates, 2014; The Joint Commission, 2011; O’Leary, 2012). Such communication-related adverse events can cause avoidable injury, loss of life, and financial devastation. In light of advanced practice nurses’ (APN) increasing contribution in care management, and in order to ensure delivery …

Implementation Of An Advance Directive Protocol In A Primary Care Setting, Gloria Dillman

Evidence-Based Practice Project Reports

Despite the passage of the Patient Self-Determination Act in 1992, only 15% of the United States population has completed an advance directive (AD). This statistic will be exaggerated with the future growth of older adults in the year 2030, at which time this portion of the population is expected to double to 72.1 million people. Without an AD, patients lose their autonomy and may be subjected to costly, life prolonging treatments that they would never choose for themselves. The unnecessary costs and unwanted treatment are preventable with an AD, and primary care providers are in a prime position to initiate …

The Use Of Teamstepps® In The Development And Implementation Of Staff Nurse Councils, Katreena Collette Merrill

Journal of Undergraduate Research

1. TeamSTEPPS training: As a result of this project, 395 number of students received training on TeamSTEPPS. Students created case studies and role play videos about communication in healthcare.
2. In addition to the effect on the senior undergraduate nursing students and family nurse practitioner graduate students, we were able to implement TeamSTEPPS into a new interprofessional education course STDEV 214R.
3. As a result of this project, we were contacted by the Agency for Healthcare Research Quality for an interview on how we have applied TeamSTEPPS. Results of the interview will be posted on the web site in 2015 citing Brigham Young …

Cultural Competency At The Bedside: Developing A Plan Of Care For Limited English Proficiency Patient Populations, Jenna Czech

Nursing Posters

To improve nursing skills and competency in caring for culturally diverse and limited English proficiency patient populations.

Developing Cultural Competence, Patricia Blonigen-Heinen, Roberta Basol

Nursing Posters

Caring for patients from many cultures is an important part of health care today. Why learn about cultural competencies? Because developing cultural competencies benefits everyone. You can: help patients receive more effective care; help your facility meet standards of The Joint Commission; and improve your job performance.

I Heard It Through The Grape Vine, Terri Mccaffrey

Nursing Posters

Purpose Statement: Patients who are informed and active in their care are more likely to follow recommendations. Providers play a vital role in accomplishing positive communication with cleft team and families.

Vcu Health: Adult & Pediatric Inpatient Pain Communication Guide (Algorithm), Veronica Nolden, Jessica Keiser

VCU Health Nursing

Abstract Related to Algorithm:

Description/Background

Improving pain management is a priority for all healthcare providers, yet the process for how pain is assessed, reported and resolved often lacks a defined process. This lack of structure can lead to delays in pain control for patients and frustrations within healthcare teams. In an effort to facilitate patient-centered care, an interdisciplinary workgroup was constructed to address this process.

Action

In order to eliminate delays and define a process for pain management, an interdisciplinary workgroup utilized performance improvement processes to develop a communication algorithm. The group membership included nurses, physicians, advanced practice providers, nursing …