Nursing Administration Commons^™

State Actions And Shortages Of Personal Protective Equipment And Staff In U.S. Nursing Homes, Diane M. Gibson, Jessica Greene

Publications and Research

BACKGROUND: It is crucial that nursing homes have adequate personal protective equipment (PPE) and staff to protect residents and staff from COVID-19. Some states have taken actions to mitigate shortages of PPE and staffing in nursing homes, including creating dedicated long-term care (LTC) teams and supporting staffing capacity.

OBJECTIVE: To examine whether state actions and nursing home characteristics are associated with shortages of PPE and staffing.

DESIGN AND SETTING: Facility-level data, released July 31, 2020, from the Nursing Home COVID-19 Public File, were combined with data from other sources. Our sample was the 13,445 facilities with information about PPE and …

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 …

Pressure Injury Documentation And Reporting: A Quality Gap, Mary Ann Laslo

Master's Projects and Capstones

Abstract

Problem: Inaccurate and incomplete pressure injury (PrI) assessment and documentation leads to inaccurate reporting of PrI quality reporting measures to the Centers for Medicare and Medicaid Services. Inaccurate, incomplete documentation of pressure injuries and wounds adversely affects the quality of care, financial reimbursement, and hospital reputation as well as increasing the risk of litigation to medical providers. Barriers to accurate and complete documentation by the nurses were inaccuracy in identification of PrIs Stage 1 or greater and knowing what and where to document the information in the electronic medical record.

Context: This quality improvement project attempted to improve nurse …

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 …

Implementation Of Post Falls Huddles In Skilled Nursing Facility, Princess Lomax

Evidence-Based Practice Project Reports

The purpose of this paper is to discuss the quality improvement project, implementation of the post fall huddle in a long-term care facility. Falls are the most common problem in adults 65 years and older. Falls in this population can have devastating effects, often leading to significant changes in morbidity or death. Adults in long term care settings have an increased risk of falling and having a subsequent fall due to an acute illness, weakness, or confusion (CDC, 2015). At the skilled facility, there has been a significant increase in hospitalizations due to injuries sustained from falls. To address this …

Oral Care And Ventilator Associated Pneumonia Prevention, Rachel Baber

MSN Capstone Projects

With rising healthcare costs and increasing demands placed on healthcare workers, it is no wonder that decreasing hospital length of stay for patients is high priority for hospitals today. Hospital acquired infections are one of the culprits keeping so many patients hospitalized. Specifically, in intensive care units (ICU) and intermediate care (IMC) units that care for mechanically ventilated patients, ventilator associated pneumonia secondary to intubation is a complication and cost that is being sought to be avoided. Hospitals have been pro-active to prevent ventilator associated pneumonia from occurring by placing oral care bundles or protocols in place to care for …

Barriers To Patient-Centered Care For Dementia Clients In The Long-Term Living Setting, Shaina Gaba

Nursing | Senior Theses

When caring for people with severe dementia, the concept of the person being central is increasingly advocated in clinical practice. Person-centered care acknowledges autonomy in all facets of care. Recent studies examine behavioral changes in individuals with dementia and how health care teams address these alterations. Health care providers are vital for effective holistic management. Therefore, this review focuses on the current knowledge regarding care goals, practices, and perceptions of the client battling with cognitive decline. A literature review ascertains that clients with dementia respond to interventions and have decreased negative health outcomes, when providers ensure values and needs are …

Utilization Of Patient Toolkit And Discharge Algorithm For Providers To Reduce Readmission Due To Repeat Ground Level Fall, Sara Karl

Doctoral Projects

Introduction. Falls are the leading cause of injury and injury death in adults over the age of 65. A retrospective examination at Level 1 trauma center in the Midwest found that 19.4% (118/605) of older adults admitted with a ground level fall were readmitted with a subsequent fall and injury. The aim of this quality improvement initiative is to determine if the implementation of an evidenced based patient toolkit and a discharge algorithm for providers will reduce outpatient falls. The objective was to reduce hospital readmission due to repeat fall.

Methods: The design of this project was mixed methods, observational, …

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 …

Patient Perception Of Fall Risk And High Fall Risk Screening Scores, Nicole D. Pena

Dissertations

Purpose: The purpose of the study was to describe the relationship between patient

perception of fall risk and high fall risk screening scores.

Background: Despite mandated government regulations and multiple hospital

interventions, falls are the most prevalent adverse event among hospitalized patients and

are the leading driver of health care costs, amounting to over $30 billion each year with

projections to double by 2030. Recently, perception was identified as a major component

in preventing falls. A dearth of research examines the relationship between a patient’s

perceived risk for falls and standardized fall screening scores.

Methods: A descriptive correlational design with …

Healthy Aging In The Community Initiative, Didem Kadriye Unver

Master's Projects and Capstones

In 2016 the Sequoia Health Care partnering with Peninsula Family Services developed a non-profit and free program called 70 Strong. It is a personal resource guide for the 60 and above client base for activities and services from Redwood City to Foster City to encourage independence amongst the older population. It includes a wide array of categories, such as fitness and social activities, volunteer opportunities, transportation, enrichment, and support groups. This is not an acute healthcare provider; however, it is a primary prevention effort by Sequoia Healthcare District to increase wellness among the older population in the county. The purpose …

Implementation Of Safe Patient Toileting To Decrease Patient Falls On Medical-Surgical Unit, Kimberly A. Goldsborough

DNP Scholarly Projects

BACKGROUND: Patient falls are a serious safety concern in the hospital setting throughout the country. Falls are one of the most challenging patient safety events to prevent, as there are many contributing factors with toileting activities producing the highest incidence. Fall prevention bundles are used to minimize and reduce these such events although multifaceted. The project was conducted with an academic medical center on an acute inpatient medical-surgical unit primarily housing burn wound patients. Nursing leaders and front-line nursing staff participated.

METHODS: Literature review to determine the gap in knowledge of interventions to prevent acute inpatient falls was completed. Concepts …

Change In Falls And Sitter Cost Post Implementation Of Remote Centralized Video Monitoring In Hospitalized Adult Patients, April Nicole Dougherty

DNP Projects

PURPOSE: Falls are the leading cause of injury in hospitalized patients. Patient sitter programs are proven to be an effective way to reduce falls in hospitalized patients. Innovative technologies have been examined that provide a safe and cost-effective way to reduce sitter costs and prevent falls. An innovative technology option is a remote centralized video monitoring system containing one video monitoring technician watching and verbally redirecting multiple patients at one time using mobile cameras. The purpose of this project is to evaluate the implementation of a remote centralized video monitoring system for adult patients in the acute care hospital setting. …

Defying The Gravity Of Falls On Msu, Alvin Joseph Abad

Master's Projects and Capstones

Falls are a leading cause of injury and death for adult males in the United States and have been an ongoing problem on the Medical Surgical Unit (MSU). Therefore, the aim of this project is to increase fall prevention education and communication on MSU in order to ultimately improve fall rates. Although there are currently fall prevention processes already in place, these may not be sufficient as demonstrated by recent fall metrics. Many RNs on MSU are fairly new nurses; and their enthusiasm and adaptability may be an advantage for this evidence-based project. Furthermore, the management team seems to be …

Improving The Staff Responsiveness By Bundling Care, Practicing Proactive Authentic Hourly Visits, And Using The Four P’S, Robert Vega

Master's Projects and Capstones

Abstract

Problem

Staff responsiveness is an important Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Star Rating composite tool that hospitals monitor because it is consumer-driven information. The intent is that the HCAHPS composite promotes patient satisfaction, contributes to the prevention of harm, and can save millions of dollars (Danaf et al., 2017). On admission, the patient is orientated to their room, provided a nurse call light button to use, and told not to get out of bed alone and to wait for their nurse (Mitchell et al., 2014). On Three North, a gap exists in the delay it …

Identification Of Perioperative Barriers To Enhanced Recovery After Surgery In Colorectal Surgical Populations, Leah Marshall

Master's Projects and Capstones

Enhanced recovery after surgery (ERAS) has evolved over the past 30 years through evidence-based interventions. Enhanced recovery after surgery uses a multidisciplinary and multimodal evidence-based approach to maximize patient recovery. Perianesthesia nurses are critical to its success and have an obligation to understand and participate in the process to optimize patient outcomes. Despite proving to decrease complications and duration of stay in colorectal surgery patients without following colorectal surgery, the implementation of ERAS in colorectal pathways have been met with barriers (Alawadi et al., 2015). Subramaniam & Horgan (2016) describe ERAS pathways as evidence-based interventions that eliminate dated practices based …

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

Nursing and Health Professions Faculty Research and Publications

Abstract

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

Standardizing The Palliative Care Referral Process, Ronaviv M. Garcia

Master's Projects and Capstones

Standardizing the Palliative Care Referral Process

Problem: Heart failure (HF) is one of the most common causes of hospital admissions and emergency department visits in the United States. HF patients are at high risk for hospital readmission: 25% of HF patients discharged from the hospital are readmitted within 30 days of discharge, and 50% are readmitted within 6 months (Vedel & Khanossov, 2015).

Context: Palliative Care (PC) has been shown to be an effective way of managing distressing HF symptoms and thus of reducing hospital readmissions, yet patients are infrequently referred to PC services during their transition from hospital to …

Identification Of Risk Factors Associated With Falls In The Long Term Care Setting, Jacqueline L. Patel, Dnp, Ms, Anp-Bc

Doctor of Nursing Practice Projects

Background: Falls threaten the safety of older adults in long term care (LTC).

Objectives: To assess environmental, clinical and pharmacological causes of falls as well as compare Fall Risk Assessment Score, Brief Interview of Mental Status (BIMS) score, Activities of Daily Living (ADL) scores, age and gender of residents with one fall, recurrent falls, and no falls.

Methods: Using a descriptive-comparative design, we included a convenience sample of 290 adults ≥50 years old at our LTC facility. Fall and recurrent fall groups were matched to those with no falls. We assessed environmental, clinical and pharmacological variables, Fall Risk Assessment Scores, …

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

Nursing & Health Sciences Research Journal

No abstract provided.

A Program To Prepare Frontline Nurse Leaders For Peer Review, Suzanne K. Murdock

DNP Scholarly Projects

Introduction: The purpose of nursing peer review is to assess the quality of nursing care against established standards, identify strengths and weaknesses in practice, and identify knowledge gaps. Studies of nurse peer review predominantly focuse on staff nurse attitudes and knowledge after an educational intervention and barriers to implementation. Frontline nurse leaders (FLNL) can influence adoption of new practices such as peer review.

Purpose: The purpose of this project was to engage frontline nurse leaders in a role specific peer review program, preparing them to support their staff in the implementation of peer review in the future and providing an …

Fall Prevention In The Ed, Ninojoseph Lacap

Master's Projects and Capstones

This project focuses on the prevention of patient falls in the emergency department (ED). Kaiser Santa Clara Hospital is an academic medical facility in the heart of Silicon Valley. The facility has a 46 bed ED with an average daily census of 220, specializing in stroke, pediatrics, heart, and left-ventricular assist device (LVAD) patients. For the calendar year of 2016 there were thirty-reported patient falls in the ED. The global aim is to reduce the patient fall rate by 35% for the 2017 calendar year. The project’s objective is to continue the road to patient safety and to have less …

Perceived Knowledge And Perceptions Of Palliative Care Among Advanced Practice Cardiac Providers, Jordan Vance

Doctoral Dissertations and Projects

Providers of healthcare have continued to focus on addressing patients’ chronic health outcomes. When understanding how to manage chronic disease, there remains many opportunities in facilitation of better management. With such a wide range of individuals who suffer with a chronic condition, better management to address this population is essential. Palliative care aids in accomplishing this task. It was seen that there was a lack of education in relation to palliative care, with perceptions that continued to be a barrier to the utilization of the service. Due to the lack in education, the strongest barrier to palliative care service utilization …

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

MaineHealth 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 …

Patient Fall Prevention, R9 West Cardiovascular, Cathy Palleschi, Suneela Nayak, Ruth Hanselman, Stephen Tyzik

MaineHealth Maine Medical Center

PATIENT FALL PREVENTION STRATEGIES IN AN ACUTE HOSPITAL

Every year in the United States, hundreds of thousands of patients fall resulting in injury. Injured patients often require prolonged hospital stays and a resultant increase in medical costs.

The purpose of this study was to identify the current state of fall prevention strategies on a hospital inpatient acute care cardiac unit. Through a root cause analysis, some deficiencies were identified and a process improvement plan was implemented.

Several positive outcomes were attained as a result of the countermeasures initiated. Patient falls per month and total waste in dollars saw a decline …

Physician Orders For Life-Sustaining Treatment (Polst) Utilization In A Skilled Nursing Facility: An Educational Quality Initiative, Ryan Hazley Bsn, Rn, Dnp Student, Karl Steinberg Md, Cmd, Joseph Burkard Dnsc, Crna

Doctor of Nursing Practice Final Manuscripts

According to expert reports and recent research, frequent clinician-patient conversations about individual end-of-life preferences are necessary to avoid unwanted treatment and to ensure that desired treatments are received. The ongoing diffusion of Physician Orders for Life-Sustaining Treatment (POLST) educational initiatives in skilled nursing facilities (SNFs) are vital to success of California’s POLST program, which is now recognized as only 1 of 3 mature POLST programs in the country. The purpose of this evidence-based practice project was to answer the question: Among staff in a skilled nursing facility, does implementing a formal POLST education program compared to current practice improve staff …

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 …

Communicative Behaviors Elicited By Leisure Activities In Memory Care Units, Tarynn Clune

Honors Projects

A wide variety of leisure activities used in reminiscence care have been studied for their merits in terms of preventing cognitive decline, and increasing quality of life; however, little is known about what different types have to offer in terms of communicative opportunities. Communication with peers is imperative for quality of life, and is crucial for maintenance of relationships between the person with dementia (PWD) and their loved ones. As a result of this importance, an exploration of communication elicited by different activities facilitated in a unit was conducted. The communication explored in this study was solely vocal, and included …

Adult Qdts, Chinese, Marianne E. Weiss, Binghua Wang

Quality of Discharge Teaching Scale

The Readiness for Hospital Discharge Scale, Quality of Discharge Teaching Scale, and Post-Discharge Coping Difficulty Scale were developed by Dr. Marianne Weiss to measure nurse-sensitive discharge care processes and patient outcomes. Three versions of the scales were developed concurrently for different patient populations – Adult medical-surgical patients, Parents of hospitalized children, and Postpartum Patient mothers (see Weiss & Piacentine, 2006, Weiss et al., 2007, and Bobay et al., 2018 for description of the development and initial testing). Additional scales and information about translation rights are located at Marquette Nursing.

PERMISSION TO USE

The Readiness for Discharge Scale, Quality of Discharge …