Nursing Commons^™

Reducing Patient Falls In A Skilled Nursing Facility, Mariah De Los Santos

All Doctor of Nursing Practice (DNP) Scholarly Projects

Falls in skilled nursing facilities (SNFs) pose a significant safety risk, causing injuries, extended stays, and increased morbidity mortality. With a fall rate 6.08 per 1,000 patient bed days, exceeding the national benchmark of 5.3, this project aimed to reduce falls using an evidence-based prevention bundle in a facility lacking a comprehensive fall prevention program. A literature review indicated multifaceted fall prevention bundles reduce falls in SNFs. Key components include risk assessment tools, patient education, post-fall huddles, and purposeful hourly rounding. This quality improvement project used Deming's Model for Improvement and the OhioHealth Change Management Model. An interprofessional team of …

From Knowledge Gap To Empowerment: Patient-Operated Insulin Pump Management For Bedside Nurses, Bernadette J. Amao

Doctor of Nursing Practice Projects

Acute care nurses often struggle with the complexities of managing patient-operated insulin pumps (PIPs) due to limitations in training. With the rising prevalence of insulin pumps, equipping nurses with the necessary skills to navigate these devices effectively is essential. This quality improvement project addressed this critical gap by enhancing bedside nurses' self-efficacy in PIP management. Drawing upon Bandura's self-efficacy theory, this project hypothesized that targeted educational interventions could significantly improve nurses' confidence in managing PIPs. A four-week educational program was implemented to cover basic knowledge, troubleshooting, and patient interaction aspects of insulin pump management. The intervention tool was designed to …

Asthma And Peak Flow Assessments Based On Nhlbi Asthma Guidelines, Julia Gliceria Almario Regalado

Doctor of Nursing Practice (DNP) Projects

Background: Asthma exacerbations are consequences of poor asthma control. Asthma guidelines-grounded interventions can improve adherence to asthma guidelines and assessments in primary care settings. The goals of asthma management are to optimize asthma control, minimize the risk of asthma exacerbations, and minimize the adverse effects of asthma medications.

Local Problem: A primary care practice in Northern California had frequent office visits for acute asthma symptoms. Ongoing asthma control monitoring is a key performance indicator of high-quality asthma care.

Methods: The quality improvement evidence-based observational project examined the effectiveness of interventions. The pre-and post-survey assessments collected clinician knowledge and adherence, and …

Optimization Of Triage Documentation In A Large Urban Emergency Department, Monica Reynoso-Prieto

Master's Projects and Capstones

Problem California ranks ninth nationwide in terms of longest emergency department wait times. The project aims to reduce patient triage times by refining the workflow of triage documentation, achieved through strategic rearrangement of triage documentation questions. Context This quality improvement project took place in the emergency department of a large urban Bay Area hospital. Intervention The intervention was implementation of changes to the triage documentation based on staff feedback from an opinion survey, such as: elimination of redundant questions, consolidation of related categories, and logical reorganization of triage topics. Measures Measures used in the project were triage times and pre …

Pain Assessment And Reassessment Documentation Improvements In Medical-Surgical Units, Alicia Espinoza

Master's Projects and Capstones

Problem Pain management is essential when providing quality care, and adequate documentation of pain assessment and reassessment with administration of opioid pain medications by nurses is necessary for patient safety and satisfaction. Context Nurses play a pivotal role in providing safe and effective administration of opioid pain medication and documentation of pain assessments. This quality improvement (QI) project aimed to increase opioid medication administration assessment and documentation compliance rate for nurses to 90% or greater in two medical-surgical units. Intervention A knowledge check survey was utilized to assess nurse understanding of required data needed to document, and timing for documentation …

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 …

Evaluating Nurses’ Turnover Intention And Organizational Commitment Following Stroke Unit Staffing Changes: An Evidence-Based Quality Initiative, Heather Tatusko

Doctor of Nursing Practice Scholarly Projects

Nurses are known to be overworked, overwhelmed, undervalued, and understaffed at dangerous levels throughout various inpatient hospital units across the United States (U.S.). Hospital registered nurse (RN) turnover is a significant issue that has accelerated since the COVID-19 pandemic, resulting in economic impacts and other burdens for organizations, individuals, and communities. Evidence suggests that evaluating Registered Nurses’ Turnover intention (NTI) and Organizational Commitment (OC) can help maintain a ready and capable team of skilled RNs; however, most healthcare organizations (HCOs) do not collect or analyze NTI and OC data and focus on staffing numbers and monetary incentives to get adequate …

Defining Best Practices And Validation For Curriculum Mapping, Hannah Smith, Jesse Chittams

College of Nursing Faculty Papers & Presentations

The alignment of curriculum content with standards is a quality improvement measure used to identify gaps or overlaps in academic content. Curriculum mapping results, while commonly used, are rarely reported. Undergraduate faculty mapped 11 courses in a single timepoint using a web-based curriculum mapping tool. Quantitative results were calculated and compared to defined client needs categories. A validation analysis was performed by mapping one course in triplicate. Faculty feedback following the exercise was obtained by online survey. Three client needs categories were determined to be marginally out of range in the initial analysis of the quantitative mapping data. The curriculum …

Implementing Fall Prevention Safety Agreement And Fall Tips To Improve Patient Safety With Postoperative Cancer Patients, Marguerite Ndoko

Doctor of Nursing Practice Final Project Abstract

PURPOSE

This quality improvement project aimed to implement targeted fall prevention interventions within an oncology surgical unit to reduce the rate of patient falls by 30%.

BACKGROUND

Hospital patient falls are a major safety concern, particularly in oncology surgical patients due to postoperative weakness and altered mobility. Consistent high fall rates in the unit prompted targeted interventions to address this risk.

METHODOLOGY

Two interventions were implemented over 14 weeks using PDSA cycles. Patient Fall Safety Agreements (PFSA) were initiated between patients and bedside nurses upon admission, while fall Tailoring Interventions for Patient Safety (TIPS) were posted in patient rooms to …

Implementation Of A Standardized Suicide Screening Process In A University Student Health Clinic: A Quality Improvement Project, Addie Grace Strong, Kathryn Dambrino, R. David Phillippi, Linda Wofford

DNP Projects

Background: Suicide is a leading cause of death among college age students, prompting the need for evidence-based screening tools like the Columbia Suicide Severity Rating Scale (C-SSRS) to enable early detection and timely intervention. Inconsistencies in suicide screening may pose a risk of missed intervention opportunities. This Doctor of Nursing Practice project specifically aimed to improve the quality and consistency of suicide screening in a university student health clinic by implementing the C-SSRS tool into the clinic workflow during mental health appointments. Methods: Employing a quality improvement framework, this scholarly project followed the Institute for Healthcare Improvement Model for Improvement …

Mychart Patient Portal Utilization, Sherri Uteck

MSN Student Capstones

No abstract provided.

School-Based Virtual Care, Jill Held

MSN Student Capstones

No abstract provided.

Improve Compliance Of End-Tidal Co2 Monitoring During Cardiac Arrest, Kathryn Lauren Helms

MSN Student Capstones

No abstract provided.

Decreasing Patients Falls In The Medical-Surgical Population Using Hester Davis Scoring, Jessica Meares

MSN Student Capstones

No abstract provided.

Real-Time Feedback For Hand Hygiene, Joo Ran Park

MSN Student Capstones

No abstract provided.

Standardization Of Work For Medical Assistants In An Ambulatory Setting, Meredith Wellington

MSN Student Capstones

No abstract provided.

Standardizing The Discharge Process To Reduce Copd Readmission Rates, Kristine Doligosa

Doctor of Nursing Practice Scholarly Projects

Background: Frequent acute exacerbations of chronic obstructive pulmonary disease (AECOPD) can lead to unfavorable patient outcomes and costly readmissions. Inadequate patient support during discharge and an inconsistent discharge process are factors contributing to high readmissions in this population.

Purpose: This quality improvement project aimed to reduce COPD-related hospital readmissions by standardizing the discharge process for patients admitted with AECOPD and identify patient risk factors for readmission.

Methods: Following a quantitative and quasi-experimental design, this project standardized the discharge process for patients admitted with AECOPD using the Re-Engineered Discharge Toolkit components and a discharge care bundle. The project was …

Reducing Falls In Adults On A Neurology Unit: An Evidence Based Quality Improvement Project, Kari Congenie, Sandra Scheidenhelm, Rachel Zastrow

DNP Scholarly Projects

BACKGROUND: Falls are a common concern in hospitalized adult patients affecting quality of life, length of stay, and cost.

LOCAL PROBLEM: A quality audit at a community hospital identified increased falls/falls with injury rates on a medical-surgical unit.

METHODS: A quality improvement initiative was implemented using a fall prevention toolkit to understand its effect on total fall/fall with injury rates, nursing knowledge, and nurse perceived efficacy.

INTERVENTIONS: The Fall Tailoring Interventions for Patient Safety (TIPS), an evidence-based toolkit, was implemented over five months.

RESULTS: Knowledge quiz scores were similar pre- and post-education. Fall rates and calls to the …

Outpatient Fall Prevention In Ambulatory Adults 65 Years Old And Over, Dorothy L. Osborne-White

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: In the United States (U.S.), falls are the leading cause of injury among adults 65 and over, resulting in 36 million falls yearly (Moreland et al., 2020). According to the Centers for Disease Control and Prevention (CDC, 2023), one in four older adults experiences a fall each year. Falls are the world's second most prominent cause of accidental deaths (World Health Organization [WHO], 2021). Falls are the leading cause of both fatal and non-fatal injuries among older adults (Moreland et al., 2020).

Methods: A quality improvement project that included a fall bundle was implemented in a primary clinic. A …

The Benefits Of Prenatal Education Via Virtual And Mobile Applications Before, During, And After Pregnancy: A Quality Improvement Project, Lindsay Farland

Master's Theses and Capstones

Background: The advancements of technology has led to a substantial increase in the use of pregnancy applications among expecting parents. Studies indicate that a majority of pregnant individuals utilize virtual education platforms for various purposes, including accessing information on nutrition, exercise, baby development, and pregnancy symptoms. Despite the potential benefits, participation in these platforms remains low, emphasizing a need for enhanced resources and engagement strategies. Research shows that engagement with antenatal education through mobile applications can lead to improved maternal and fetal outcomes, such as reduced rates of caesarean births and fewer complications related to hypertension or preeclampsia.

Methods: …

A Quality Improvement Initiative To Reduce Preanalytical Blood Gas Errors, Layla Haver Newbrough

Graduate Theses, Dissertations, and Problem Reports (ETD)

Abstract

Introduction: Laboratory testing is one of the most commonly performed procedures in healthcare and resulting data are paramount to clinical decision making. Background: Preanalytical blood gas laboratory errors often stem from the incorrect recording of a patient’s fraction of inspired oxygen (FiO2) within the laboratory collection application. Incorrect FiO2 may cause erroneous results or delays in reporting results that have the potential to negatively impact patient safety and medical management.

Purpose: The purpose of this quality improvement initiative was to reduce the occurrence of preanalytical blood gas laboratory errors. Methods/Interventions: This initiative combined modification of the laboratory collection application …

Scares: A Clinician Guide To Spinal Cord Awareness, Response, And Emergency Support Creation And Implantation Of Scares Protocol Among Hospitalist Advanced Practice Providers, Brittany Biega

DNP Scholarly Projects

While they are more common in patients with oncological disease and trauma, SCE still exist among patients without these comorbidities. Less has been established regarding care protocols in this population. The absence of standardized procedures has been linked to preventable, adverse patient outcomes, including cases of permanent damage due to delayed treatment. This project employs Lean Six Sigma methodologies and Johns Hopkins Evidence- Based Practice to devise a robust SCE protocol, aimed at standardizing care and improving patient outcomes. A multidisciplinary team including general medicine, neurology, neurosurgery, and neuroradiology developed “Spinal Emergency Management Guidelines” protocol, which was implemented within the …

Improving Patient Engagement Post-Percutaneous Coronary Intervention Using The Systematic Introduction Of A Cardiac Rehabilitation Bundle In A Community Hospital: A Quality Improvement Project, Rebecca Vela

Doctor of Nursing Practice Final Project Abstract

PURPOSE This quality improvement project aimed to increase patient participation and program completion rates in cardiac rehabilitation (CR) following percutaneous coronary intervention (PCI) by 10% of the historical baseline within 3 months.

BACKGROUND Heart disease is the leading cause of death in the United States. PCI is a standard treatment for symptomatic heart disease. CR is a post-PCI secondary strategy proven to reduce mortality and improve quality of life. The project addressed below-average CR attendance at a community hospital in the greater Houston area.

METHODOLOGY An evidence-based, multidisciplinary bundle that included education, signage, defined quality metrics and dashboard, patient-centered care, …

Using Education To Improve Glycemic Management Within An Emergency Department, Rebecca Olson

Master's Theses and Capstones

Background: Patients with diabetes mellitus (DM) frequently visit acute care facilities for a variety of reasons. Proper management of this comorbidity increases patient safety, satisfaction, and quality care. Patients with persistent dysglycemic events in acute care facilities have an increased risk of complications and death during their stay. Lack of education can contribute to gaps in proper management within this population and therefore must be improved for better patient outcomes.

Methods: The Plan-Do-Check-Act design from the A3 Problem Solving model was used to guide a quality improvement project which focused on improving staff education and confidence surrounding glycemic management. The …

Improving Postpartum Depression Education Within The Microsystem, Mackenzie A. Sturdevant

Master's Theses and Capstones

BACKGROUND: Postpartum depression (PPD) is a significant mental health issue affecting a substantial percentage of new mothers, ranging from "baby blues" to severe forms like postpartum psychosis. Maternity nurses play a crucial role in early detection and education due to the gap in postpartum care follow-up appointments, which can delay necessary interventions.

LOCAL PROBLEM: Despite the critical role of maternity nurses, there is variability in their preparedness to educate and support patients regarding PPD during the immediate postpartum period. This study aims to enhance maternity nurses' knowledge and confidence in providing PPD education through a quality improvement (QI) project within …

Increasing Education And Staff Knowledge Of Delirium Care: An Evidence-Based Quality Improvement Project, Serena Martinath

Master's Theses and Capstones

Introduction At a small, community hospital in Massachusetts a gap analysis was conducted leading to a quality improvement project to increase staff education and knowledge regarding delirium and evidence-based best practices for delirium care. Delirium is a growing, often under recognized medical condition that occurs in hospitalized patients (Loftus & Wiesenfeld, 2017). Delirium is characterized by acute changes in congnition, level of consciousness, and attention (Loftus & Wiesenfeld, 2017). A better understanding of this condition is expected to result in improved patient care.

Methods The clinical microsystem studied in this gap analysis project was assessed by using the AHRQ Gap …

Enhancing Postpartum Depression Screening Tools To Improve Maternal Mental Health Outcomes: A Quality Improvement Initiative, Jillian Squires

Master's Theses and Capstones

Abstract

BACKGROUND:

Postpartum depression (PPD) is a prevalent and serious condition affecting new mothers, often underdiagnosed due to challenges in traditional screening methods. Early detection and intervention are crucial for improving maternal and infant health outcomes.

LOCAL PROBLEM:

On the maternity unit, existing PPD screening processes were insufficient, with significant barriers including patient reluctance to disclose mental health concerns, leading to missed or inadequately addressed PPD cases.

METHODS:

This quality improvement (QI) project utilized the Plan-Do-Study-Act (PDSA) framework. Pre-intervention surveys were conducted to identify current challenges and perceptions. An at-home PPD screening tool using the Edinburgh Postnatal Depression Scale (EPDS) …

Sensory Modulation Training To Reduce Restrictive Interventions On An Acute Inpatient Psychiatric Unit At A Secure Psychiatric State Hospital: A Clinical Nurse Leader Quality Improvement Project, Fionna Norman

Master's Theses and Capstones

Abstract

Background: Symptoms of severe mental illnesses can result in Personal Safety Emergencies (PSE’s) in the acute in-patient psychiatric setting. As part of treatment of PSE’s, restrictive interventions such as seclusion are utilized in current practice to maintain the safety of the patient, peers, staff, and the environment. Evidence-based research has shown restrictive interventions can cause physical and psychological harm to both patients and staff. Reducing restrictive interventions continues to be a priority to create the most therapeutic environment possible. Evidence-based research has shown that sensory modulation is a non-restrictive intervention that can reduce the use of restrictive interventions, decrease …

Non-Clinical Perspectives On Sepsis: A Project For Enhanced Awareness, Anjali Kumari Singh

Master's Projects and Capstones

Problem: This project aimed to enhance non-clinical staff knowledge of sepsis through a targeted awareness campaign, while also seeking to uphold or enhance the organization's sepsis-related performance.

Context: Clinical Nurse Leader students conducted a microsystem assessment in five crucial non-clinical departments of an urban Bay Area hospital, each playing a vital role in the organization's efficiency at different levels.

Intervention: During Sepsis Awareness Month, a sepsis awareness campaign was implemented. This involved a concise presentation on sepsis, its consequences, and the significance of awareness in each department. Additionally, informational fliers detailing sepsis signs and symptoms were distributed.

Measures: A pre-and …

Campaigning Beyond: Sepsis Awareness Among Non-Clinical Staff, Cynthia Wong

Master's Projects and Capstones

Problem: Sepsis stands as the foremost cause of illness and death among hospitalized patients globally, yet a considerable number remain oblivious to this critical condition. Based on the pre-implementation survey among non-clinical staff members of an urban hospital, awareness of sepsis must be heightened to ensure swift recognition and response.

Context: The project conducted takes place in five distinct non-clinical departments at a large hospital organization in Northern California. Each department plays an essential role in the holistic and efficient functioning of the organization to provide quality patient care.

Interventions: A sepsis awareness campaign was implemented throughout the month of …