Family Practice Nursing Commons^™

Testing A New Workflow To Integrate The Voice-Of-The-Customer In Readmission Analysis For Skilled Nursing Facility Readmissions From Home, Stephanie Edurese Bilbao

Master's Projects and Capstones

Abstract

There are multiple layers of oversight across the healthcare delivery system. Measuring acute hospital readmissions has been identified as an important outcome measure of quality care. Our patients are one of the major stakeholders in the healthcare system. One role of a clinical nurse leader is to integrate evidence-based leadership practices that identify and assess outcomes, mitigate risk, enhance health promotion, deliver highly effective patient care, and ensure transparent relationships with stakeholders. Rationales for examining and re-designing the readmission analysis workflow based on the customer’s experience are discussed in this paper. The global aim of the project is to …

The Changing Face In The Workplace: The Arrival Of The Millennial Generation, Sarah Clonch

The Eleanor Mann School of Nursing Undergraduate Honors Theses

The entrance of the Millennial generation into the nursing workforce signifies a bright future for the nursing profession and the nursing workforce. This study began with a current review of available research that identified the Millennial generation and their views toward job satisfaction and work engagement, as compared with Baby Boomer and Generation X nurses.

PubMed, CINAHL Complete, and Google Scholar databases were employed to find 15 peer-reviewed articles for evaluation. The research findings suggest that Millennial nurses have lower rates of job satisfaction and work engagement, compared to nurses of older generations. Overall, the extracted data results were significant …

Evaluating Va Nurse Acceptance Of Virtual Healthcare Technology During The Coronavirus Outbreak, Francesca Bryan-Couch

Doctor of Nursing Practice Scholarly Projects

At a regional Veterans Administration (VA) hospital, nurses performing case management were unable to perform face-to-face visits with patients due to coronavirus. Care coordination and discharge planning efforts occurred through telephonic case management to preserve personal protective equipment and reduce transmission rates through social distancing. Trust and rapport between patients and nurses were reduced without personal contact. Peplau’s theory of interpersonal relations described six nurse roles and three phases of relationship development required to create therapeutic nurse-patient relationships. Connectedness was a key concept considered to be the path to a successful meaningful therapeutic nurse-patient relationship (Hrabe, 2005).

To evaluate current …

Effectiveness Of Ehr-Depression Screening Among Adult Diabetics In An Urban Primary Care Clinic, Filipina C. Schnabel Md, Mph, Msn, Fnp-Bc, Danielle Aldridge Msn, Fnp-C, Laura Reed Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

Background Diabetes mellitus (DM) and depression are important comorbid conditions that can lead to more serious health outcomes. The American Diabetes Association (ADA) supports routine screening for depression as part of standard diabetes management. The PHQ2 and PHQ9 questionnaires are good diagnostic screening tools used for major depressive disorders in Type 2 diabetes mellitus (DM2). This quality improvement study aims to compare the rate of depression screening, treatment, and referral to behavioral health in adult patients with DM2 pre and post-integration of depression screening tools into the electronic health record (EHR).

Methods We conducted a retrospective chart review on patients …

Effect Of A Self-Care And Self-Awareness Education Program On Resilience To Burnout And Depression In Clinically Experienced Nursing Students, Andrew Taylor

Undergraduate Honors Theses

The purpose was to examine the effect of a self-care educational intervention on nursing student resilience and thus the potential for compassion fatigue, depersonalization, burnout, depression, and inadequate self-care. A one-group pretest-posttest research design was applied to a convenience sample of 104 nursing students near the end of their last semester in a baccalaureate nursing program. The measurements were demographics, a psychometric resilience scale, program evaluation, and reflection question. The intervention was a standardized, intensive 30 min training program on the high degree of stress and burnout nurses face and the core self-care methods that can promote resilience to these …

Empowering Nurses Of Minority In The Face Of Incivility And Bullying: Through The Lens Of Phenomenology, Corrine Floyd

Dissertations

Abstract

Up to 85% of nurses have reported exposure to incivility in the workplace (Hunt & Marini, 2012). The often-subtle nature of incivility toward nurses in a minority population may partially explain why it remains a problem. Healthcare organizations realize the need for civility to counter the high turnover rate, staff shortages, and low job satisfaction reported by nurses, but lack understanding of how nurses of a minority population perceive incivility and bullying. This study aimed to answer the research question how do nurses with minority representation experience incivility and bullying versus empowerment in the workplace? A descriptive phenomenological design …

A Case For Delirium Risk Prediction Models To Aid In Triaging Resources To Those Most At Risk An Integrative Literature Review, Tammy Perttula

Nursing Masters Papers

Abstract

Delirium is a complex syndrome resulting from compounding effects of acute illness, comorbidities, and the environment. It results in adverse outcomes: elevated mortality rates, length of stay, readmissions, institutionalization, long-term cognitive changes, and diminished quality of life. The rate of iatrogenic delirium is astounding, ranging from 10%-89%. There are no curative treatments; thus, primary prevention is the key. The purpose of this literature review is to identify and critique the research for the accuracy of risk stratification and feasibility in practice. Support for interventions that prevent delirium is mounting; however, interventions are resource-intensive and often not implemented. Researchers have …

Point-Of-Care Reminders To Prompt Provider Adherence With Diabetes Care Guidelines For Adults, Eric E. Spohn

Evidence-Based Practice Project Reports

Diabetes is a complex, chronic illness, and a leading cause of morbidity and mortality (ODPHP, 2019). Gaps in diabetes care exist between clinical guidelines and interventions provided in the clinical setting (ADA, 2015; Chauhan et al., 2017; Renders et al., 2001; Worswick et al., 2013). Improved diabetes management strategies and interventions among healthcare providers are essential to close the quality gap. The purpose of this evidenced-based practice (EBP) project was to prompt providers to adhere to diabetes care guidelines using a paper point-of-care reminder over a 12-week period. Provider performance rates covering four specific guidelines were measured: HbA1c, microalbuminuria, diabetic …

Creating Restful Environments: Applying Evidenced-Based Interventions To Increase The Patients Perceptions Of Room Quietness At Night, Timothy Marks

West Chester University Doctoral Projects

Florence Nightingale first described the detrimental effects of noise on patients as an element nurses could control. Hospitalized patients who sleep in the hospital are at risk for poor periods of rest from unwanted noise in the care environment. This Doctor of Nursing Practice Project will assess interventions aimed at increasing the patient’s perception of quietness around the care environment at night for a pilot population. Swanson’s Theory of Caring will be utilized as a framework for the project. Outcomes of nursing interventions were reviewed for the improved patient perception of the care environment at night and resultant health outcomes. …

Just Culture: It's More Than Policy, Linda Ann Paradiso, Nancy Sweeney

Publications and Research

Any healthcare organization’s top priority is effective and safe care. Despite this, medical error is the third-leading cause of death in the US. Hospitals are imperfect systems where nurses have competing demands and are forced to improvise and develop workarounds. Errors rarely occur in a vacuum, rather they’re a sequence of events with multiple opportunities for correction. Clinical nurses can have a significant impact on reducing errors due to their proximity to patients. When errors are identified, the events and impact on safe care need to be shared. Just culture is a safe haven that supports reporting. In a just …

Implementing A Discharge Navigator Reducing 30-Day Readmissions For Heart Failure And Sepsis Populations, Karen Weeks

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

A national focus for healthcare reform is preventing hospital readmissions. Thirty-day unplanned hospital readmissions impact patient outcomes and are costly to the healthcare system. This project explored the impact between the discharge navigator and 30-day unplanned readmissions for heart failure and sepsis populations in a 238-bed community hospital located in central Virginia. The primary aim of this discharge navigator project was to reduce 30-day readmissions for the heart failure and sepsis populations to meet the goals of the top quartile for like hospitals and the evaluation of cost avoidance for these readmissions. Heart failure and sepsis populations are high risks …

Evaluation Of The Effect Of Milner-Fenwick Video-Based Education And Teach-Back On Knowledge Acquisition In Atrial Fibrillation Patients, Melissa Czarapata

DNP Projects

PURPOSE: The purpose of this study was to evaluate if video education impacts knowledge acquisition and health literacy in patients with atrial fibrillation. METHODS: This study employed a descriptive, pretest-posttest single site comparative design. Baseline health literacy was assessed before video education was completed using the Atrial Fibrillation Knowledge scale. Health literacy regarding atrial fibrillation was again assessed for the same participants immediately after video education was completed and again in 7 to 10 days through the use of the Atrial Fibrillation Knowledge scale and teach-back questions. RESULTS: There was no statistical significance found when comparing scores before and after …

Pain Management: A Flowsheet For Providers, Lisa Swezey

Doctoral Dissertations and Projects

Many different factors led to the trend of providers prescribing opioids for chronic pain. However, the misuse of and many deaths related to opioid prescriptions have caused the trend to reverse its direction. National organizations call for providers to stay clear of opioid medication and increase the use of nonpharmacological pain management, but also to treat pain adequately. There are still many barriers to decreasing the use of opioids and increasing the use of nonpharmacological methods. This scholarly project hoped to use an educational flowsheet to assist providers in meeting the demands from national organizations to decrease the use of …

Increasing Hcahps Scores By Scripting Of Hourly Rounding, Katherine Rivera

Doctoral Dissertations and Projects

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a standardized national report on patient perceptions of care and is now linked to hospital reimbursement by both government and now some independent insurance companies. Healthcare systems are therefore very interested in ways to increase patient satisfaction within their facilities. This evidence-based practice pilot project was based on the Iowa Model of Evidence and used a quasi-experimental process to ascertain if adding scripting to the hourly rounding process was able to increase patient satisfaction scores on the HCAHPS. The increase in patient satisfaction, in the area of perceived responsiveness …

Nurses Role In Health Home Mixed Methods Study, Jacqueline S. Prokop

Nursing Theses and Dissertations

Managing individuals with chronic health conditions in the primary care setting continues to be a significant challenge in the U.S. health care system. This issue is further compounded for low-income individuals with both mental health and physical health chronic conditions. With the enactment of the Affordable Care Act (ACA), new chronic disease health home opportunities have emerged to address the existing structural and process gaps found in primary healthcare. The nurse’s role is integral to health homes as they empower nurses to play a greater role in improving patient experiences, population health, and lowering healthcare costs. Three research manuscripts presented …

What’S In A Name: Performance Improvement, Evidence-Based Practice, And Research?, Andrea Prentiss, Eve Butler

Nursing & Health Sciences Research Journal

No abstract provided.

Pots: Educating School Nurses, Stephanie Sherwood

Doctoral Dissertations and Scholarly Projects

The project used educational modules as a means for providing knowledge about postural orthostatic tachycardia (POTS) to school nurses. It evaluated knowledge of symptoms and the referral process. A pre and post-test were used immediately prior to and following an educational module to determine gained knowledge about POTS. Participants completed a survey evaluating their perceived knowledge and comfort level to evaluate POTS symptoms and refer patients for further evaluation. One hundred percent of participants demonstrated improvement in their post-test score confirming knowledge gained in all participants. All participants reported that the modules helped them about POTS, and they felt confident …

Strategies To Improve Control Of Blood A1c In Diabetics, Jennifer Aronson, Leanne Bellino, Elizabeth Eisenhardt, Diane Bryant, Haley Pelletier, Internal Medicine Team, Adult Outpatient Clinic

Maine Medical Center

A1c monitoring is an important aspect of controlling the health of a diabetic patient. An adult internal medicine clinic noted that the percentage of their diabetic patients who had an A1c higher than 9 or no reading within the past year exceeded the national average. As a result, operational excellence methods were implemented with the overall goal to reduce their percentage to 18% or less.

A root cause analysis identified several deficiencies to includelack of essential equipment, variations in

staff education and the absence of daily reminders.

Post KPI implementations, an overall decrease in the percentage of patients with poorly …

I’M A Big Kid Now: Enhancing Transition Rn Residents’ Confidence During Pediatric Patient Care, Emily W. Lam

Master's Projects and Capstones

The title of the clinical nurse leader project is “I’m a Big Kid Now: Enhancing Transition RN Residents’ Confidence During Pediatric Patient Care”. The project aims to improve the support components for Transition RN residents during their Transition RN Residency at Children’s Hospital Los Angeles. The clinical leadership theme that correlates to this project is communication. The clinical nurse leader’s role is to act as an educator and a facilitator throughout this project. In examining the clinical nurse leader competencies, competencies “use performance measures to assess and improve the delivery of evidence-based practices and promote outcomes that demonstrate delivery of …

Provider Based Interventions To Mitigate Risk For Opioid Pain Medication Abuse Among Adult Patients In A Primary Care Setting, Sheree Lamara Conley-Donaldson

Doctoral Projects

Mental and substance use disorders are predicted to exceed all physical disease processes causing major disability by 2020. Misuse and overdose of opioid pain medications is a significant public health concern in the United States. Approximately 1 in 4 patients receiving prescription opioids in primary care settings struggle with misuse. Half of all opioid prescriptions are written by primary care providers, including nurse practitioners. The purpose of this DNP project was to determine if nurse practitioner providers are implementing evidence-based practice guidelines including screening, brief intervention, and referral to treatment (SBIRT) to mitigate risk of prescription opioid pain medication misuse …

Evaluation Of A Nurse Navigator Program On The 30-Day Readmission Rate In Heart Failure Patients, Katie A. Winiger

DNP Projects

PURPOSE: The purpose of this study was to evaluate the impact of a registered Nurse Navigator (NN) on hospital 30-day readmissions for patients with heart failure at Norton Healthcare (NHC) in Louisville, Kentucky.

METHODS: This study involved two phases. Phase I was a retrospective descriptive design utilizing a medical record review of 159 patient charts. Group 1, 54 charts, included patients with heart failure who were discharged from NHC for heart failure related illnesses and were seen in a primary care clinic that utilized a NN after discharge from the hospital. Group 2, 105 charts, included patients with heart failure …

Personal Protective Equipment Use For Patients With Clostridium Difficile, Mallory L. Compton

Scholars Week

In researching the literature on correct PPE by healthcare staff when a patient has C. diff. I have found that the policy on PPE for patients with C. diff at Baptist Health Paducah is compliant. The theoretical framework used for this research is that of Imogene King. Their policy is evidence based and is also cost effective when it comes to preventing the spread of infection from patient to patient. There is no need for change to this policy at this time because it is supported by evidence in the literature.

Nursing Spirit, Volume 1 (Spring 2016), Neal Chambler, Dean, Mary Bennett, Director, Susan Megahee, Editor, Creative

School of Nursing Publications

No abstract provided.

Management Of Hypertension In Student Patients In A University Student Clinic, Kathleen E. Solter

DNP Projects

Purpose: To evaluate provider adherence to a clinical guideline for management of hypertension, and to assess improvement in quality of management of student patients with hypertension in a university student clinic.

Methods: A retrospective chart review was conducted to identify student patients with hypertension. Data collected included the demographics of the sample patients, blood pressures, LDL results, weights, and evidence of provider compliance with guidelines.

Results: Of the 13 patient charts audited, providers recommended exercise to 46.15% of patients, weight loss or maintenance to 53.85% of patients, no-added salt diets to 53.85% of patients, low fat to 23.08% of patients, …

Retention Of Cardiopulmonary Resuscitation Knowledge And Psychomotor Skill Among Undergraduate Nursing Students: An Integrative Review Of Literature, Fernanda Tirado

Honors Undergraduate Theses

Purpose: The purpose of this integrative literature review is to explore the effectiveness of different training modalities on the acquisition and retention of CPR knowledge and psychomotor skill among undergraduate nursing students. Background: It is well known that standard CPR-training is ineffective at preparing nurses for the rigors of a cardiac arrest event. Survival rates for in-hospital cardiac arrests remain low and the proportion of neurobehavioral sequelae among survivors is very high. Methods: A review of relevant literature published between 2006 and 2016 was conducted using the CINAHL and MEDLINE databases. The following key terms were used in the search: …

Diabetic Prevention The Hard Way: Modified Diet And Increased Exercise, Torrie Reese St.Julien

Doctor of Nursing Practice Final Manuscripts

Background and Purpose: In the United States, 79 million people are pre-diabetic: most have no symptoms. If left untreated, 37% will develop diabetes within 4 years. Fourteen percent of United States health care expenditures are related to diabetic complications. This Evidenced Based Project (EBP) involved a behavioral lifestyle change with the purpose of 7% weight loss and a minimum of 150 minutes of physical activity a week. It was also designed to reduce risk factors and glycated hemoglobin A1c (HgA1c) levels.

Methods: The interventional approach was modeled after the Diabetes Prevention Program (DPP) and Group Lifestyle Balance Program. Participants were …

Attitudes Towards An Evidence-Based Clinical Decision Support Tool To Reduce Exposure To Ionizing Radiation, Raymond Zakhari

Faculty Publications and Presentations

Patients who suffer minor brain injuries experience unnecessary ionizing radiation in the form of a non-contrast head CT scan despite the dearth of evidence supporting standard CT scans for all brain injuries. Exposure to ionizing radiation increases the incidence of certain types of cancer. This evidence-based practice change project assesses the attitude of clinicians towards evidence-based clinical decision support tools, specifically the Canadian CT head rule. The use of highly sensitive clinical decision support tools is supported in the literature to help healthcare providers mitigate the risk associated with unnecessary use of CT scan imaging studies. The project was conducted …

Perceived Patient Satisfaction With Hospital Services And Interventions, Marietta Abernathy

Nursing Theses and Capstone Projects

The patient and family voice should be heard in the healthcare setting. Gaining knowledge and insight from a parent of a pediatric patient will allow hospital staff and administrators to see the hospital experience from the vantage point of a patient and family member (Uhl, Fisher, Docherty, & Brandon, 2013). It is important to continually review feedback and suggestions from families of pediatric patients to improve the care of future patients. Ultimately, this will improve patient satisfaction scores, but most importantly, it will improve the experience of pediatric patients (Creating patient and family advisory councils, 2010). The investigator interviewed ten …

Improving Depression Care For Older Home Health Patients, Sarah R. Schirmer

DNP Projects

Rates of depression in older home healthcare (HH) patients are highly prevalent. Although depression in this population is associated with increased rates of re-hospitalization, falls, and suicides, it is frequently under diagnosed and under treated. This Capstone Report examined this problem through three interrelated manuscripts. The first manuscript explored the problem through a review of the literature. This review determined that while there are many barriers to adequate depression care, programs that train clinicians to screen for depression and connect patients to depression care encourage adequate evaluation and treatment and can result in clinically significant changes in depression scores. This …

Comparison Of Housed And Homeless Patients With An Orthopedic Diagnosis, Susan M. Williams

Electronic Thesis and Dissertation Repository

Studies on homelessness have shown that people who are homeless are admitted to hospital more frequently, for longer periods of time, and at a younger age than people who are housed. Once admitted to hospital, discharge planning is difficult and resource intensive, often leading to discharge back to the streets or a shelter. This puts this population at risk for complications and readmission. Although people who are homeless are prone to orthopedic injuries, there is no research on the outcomes of patients who are homeless with orthopedic injuries. This retrospective, case control study, based on the social determinants of health, …