Nursing Commons^™

Developmental Positioning In The Nicu, Megan Litteken

MSN Capstone Projects

For at least the past decade, one in ten infants born in the United States have delivered prematurely or before the 37^th week of gestation (March of Dimes, 2024b). As a result, there are a variety of both short- and long-term effects on the infant that include both physical and neuromotor developmental delays requiring follow-up after discharge (March of Dimes, 2024b). The extent of these delays depends on how early the infant is born and any associated congenital factors; however, the care provided in the Neonatal Intensive Care Unit (NICU) may help reduce the effects or length of these …

Reducing Compassion Fatigue On A Cardiac Telemetry Unit, Nicole Rocio Garzon

Master's Projects and Capstones

Abstract

Background: Compassion fatigue (CF) among nurses is a significant concern affecting both individual well-being and patient care outcomes. Findings from a 2020 national survey found two-thirds of nurses (62%) struggle with CF and even a high rate for those nurses under the age of 25 years. Through a review of current literature and case studies, the effectiveness of these interventions in reducing stress, enhancing resilience, and improving overall job satisfaction among healthcare professional is examined. Practical implications for implementing these interventions in healthcare organizations are discussed, emphasizing the potential for creating supportive environments that foster emotional and mental well-being …

Patient-Reported Outcomes From The Phase Iii Himalaya Study Of Tremelimumab Plus Durvalumab In Unresectable Hepatocellular Carcinoma, Bruno Sangro, Peter R. Galle, Robin Kate Kelley, Chaiyut Charoentum, Enrico N. De Toni, Yurii Ostapenko, Jeong Heo, Ann-Lii Cheng, Andrea Wilson Woods, Charu Gupta, Jayne Abraham, Carrie L. Mccoy Phd, Rn, Anp-Bc, Nikunj Patel, Alejandra Negro, Arndt Vogel, Ghassan K. Abou-Alfa

Publications

PURPOSE:

In the phase III HIMALAYA study (ClinicalTrials.gov identifier: NCT03298451) in unresectable hepatocellular carcinoma (uHCC), the Single Tremelimumab Regular Interval Durvalumab (STRIDE) regimen significantly improved overall survival versus sorafenib, and durvalumab monotherapy was noninferior to sorafenib. Patient-reported outcomes (PROs), a secondary outcome from HIMALAYA, are reported here.

METHODS:

Participants were randomly assigned to receive STRIDE, durvalumab, or sorafenib. PROs were assessed (preplanned secondary outcome) using the European Organization for Research and Treatment of Cancer 30-item Quality of Life Questionnaire and the 18-item HCC module. Time to deterioration (TTD), change from baseline and improvement rate in global health status/quality of life …

Addressing Medication Adherence Barriers In Hispanics Diagnosed With Diabetes Type Ii, Solmayra Solis

Doctor of Nursing Practice Final Project Abstract

The purpose of this scholarly project was to identify and mitigate the barriers of medication adherence in an underserved population of Hispanic patients diagnosed with Type II diabetes through a nurse-driven telephone follow-up program. The program aims to assess and offer solutions available in the clinic to barriers of medication adherence. The project was implemented at the non-profit Christ Clinic located in Katy, TX. About 94% of the population are Spanish-speaking Hispanics and 200% below the federal poverty level. The patients do not have insurance due to their immigration status. Of the 5,000 clinic patients, an estimated 40% are non-medication …

A Nursing Education Intervention For Delirium Prevention, Sarah Eckles

Doctor of Nursing Practice Projects: College of Nursing

Background

At a large, tertiary care hospital in the Midwest, it had been anecdotally noted that delirium or acute encephalopathy cases were increasing. Specifically, inpatient neurology consultations for delirium were on the rise. This data had been confirmed by hospital administration. Delirium has been identified as a well-known problem in elderly, hospitalized adults—most notably in elderly, postoperative adults. It can cause a cascade of additional complications for elderly patients. Delirium prevention is known to be the best method to combat delirium incidence. Prevention has been proven to occur by way of non-pharmacologic, early interventions by nursing. Bedside nursing staff must …

Education And Training On Naloxone Administration For Healthcare Professionals: An Integrative Literature Review, Remigus C. Nwaokoro

DNP Qualifying Manuscripts

Abstract

Background: Healthcare professionals’ lack of knowledge and confidence in administering naloxone affects their willingness to inform at-risk patients about its use in the event of an overdose. The lack of understanding and confidence in using naloxone delays efforts to inform at-risk patients about this life-saving treatment for opioid overdose. This integrative literature review aimed to answer the following question: Do increased education and training enhance healthcare professionals' knowledge and confidence in administering naloxone and decrease the rate of opioid overdose fatalities?

Methodology: A comprehensive search of the literature (2019 and 2024) was conducted to identify studies of education …

Optimizing Care Delivery: Determining The Impact Of A Mobile Interpreter App On Patient Satisfaction, Leslie M. Bright

Doctoral Dissertations and Projects

Introduction: Patients with limited English proficiency (LEP) experience increased health disparities including poorer health outcomes, lack of access to quality healthcare services, and decreased patient satisfaction related to cultural and language barriers.

Purpose/Significance: The purpose of this project was to determine the impact of a technology-based mobile app used for medical interpreter services on patient satisfaction in patients with LEP during urgent care visits.

Methods: The project design consisted of a mobile interpreter app used for medical translation services during urgent care visits. Pretest and posttest patient satisfaction questionnaires were administered before and after the mobile app use to determine …

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 …

Improving The Quality Of Nursing Documentation Among Nurses In Home Healthcare, Mavis Amponsah

Doctor of Nursing Practice Final Project Abstract

PURPOSE

Accurate nurses’ notes are important for patient safety, complete nursing care, coordination and continuity of care, communication, reimbursement, and regulatory requirements. The purpose of this quality improvement project was to use standardized training to improve the percentage of nurses’ notes that pass auditing by 50%. The project also aimed at reducing by 50% the number of notes returned by reviewers to nurses because they were incomplete.

BACKGROUND

The project was implemented in a home healthcare agency with an average of 200 patients and 30 field nurses. Current nurses’ notes returned as incomplete were 30%.

METHODOLOGY

A training program was …

Prospectus For Expected Discharge Date Accuracy (Edd) – Prepare To Go, Mary Jane D. Esmilla Msn, Bsn, Rn

Master's Projects and Capstones

Problem: Accurate Expected Discharge Date (EDD) estimates are not just numbers on a chart. They are crucial for optimizing operations, reducing readmission risk, creating safe, timely discharge plans, identifying obstacles, providing transitional care, and enhancing patient satisfaction (Piniella et al., 2023). A hospital-based organization conducted a quality improvement project to improve EDD predictions and discharges, significantly improving patient satisfaction and outcomes. The project had shown that a 12% increase in accuracy, achieving 60% from the baseline of 48%, can be achieved through strong collaboration, transparent communication, and commitment to real-time documentation.

Context: A team analysis improved EDD accuracy, patient satisfaction, …

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 …

Standardizing Critical Skills And Competency Validation To Promote Self-Efficacy Among Rapid Response Nurses, Kelli Dail Baker

Doctoral Dissertations and Projects

Competency validation is a key component of supporting nurses with necessary skills to provide care for their patients. However, many healthcare organizations do not have a standardized process for determining which skills are evaluated and the method by which evaluation occurs. To address competency validation among rapid response nurses (RRNs), this evidence-based practice project was proposed to increase self-efficacy. This project involved a thorough data review of all rapid response skills, categorizing all interventions based on quantity and acuity, and holding a hands-on educational fair for a set of standardized skills. A quasi-experimental design was used to collect data pre- …

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 …

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 …

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 …

Improving Firefighter Health Through Education In Sleep Science, Elisabeth J. Filiss

Master's Projects and Capstones

Sleep impacts all aspects of life, from mental health to physical well-being to job performance. Nowhere is this more important than in the fire service, where extreme working conditions are the norm. One of 44 stations in a large fire department (XFD), Firehouse X, has 21 full-time members, six on duty per shift. A microsystem assessment of Firehouse X revealed poor sleep habits and environmental factors that are not conducive to quality sleep. The role of sleep in the fire service has recently been examined, and interventions aimed at improving firefighters’ sleep have been recommended.

This quality improvement project implemented …

Decreasing Inappropriate Wound Consults, Arpita Hinton

Master's Projects and Capstones

Abstract

Background: This project was centered around the wound nurses and their workload. It also highlighted the opportunity for education for frontline staff. The wound nurses at this northern California hospital are a group of five nurses that support the whole hospital. Usually there are two staffed per day to support a facility that continues to have three to four overflow areas open to accommodate its high census.

Problem: My project focused on decreasing inappropriate wound consults. There are many consults places that do not need the intervention of a skilled wound nurse. These consults lead to time that is …

Implementing The "Baby Drop Bundle", Natalie Aguirre

Master's Projects and Capstones

Problem: Falls are a preventable type of trauma that may lead to serious injury, prolonged hospital stays, and non-reimbursable costs to the organization. While there are established fall prevention policies for ambulatory patients, infants dropped by their caregivers are largely excluded.

Context: This quality improvement project aims to decrease newborn drops by implementing the “Baby Drop Bundle”. The bundle allows caregivers and bedside providers to partner in creating a safe environment for the patient.

Interventions: The Clinical Nurse Leader (CNL) will provide a brief in-service during the morning safety huddle to introduce the bundle to staff. The bundle includes educational …

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 …

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 …

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 …

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 …

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 …

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 …

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 …