Nursing Administration Commons^™

Impact Of Ante- And Postnatal Depression Screening In Women With Hiv: A Scoping Review, Kimberly M. Grider Bsn, Rn, Pmh-Bc, Bao Chau Le Bsn, Rn, Blessing Okon Bsn, Rn, Diana Dedmon Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background Maternal depression has been identified as a strong predictor of poor prenatal care. Among pregnant women living with Human Immunodeficiency Virus (HIV), mental health-related factors such as depression could potentially undermine effective antiretroviral therapy (ART) adherence, increase mortality, and cause poor HIV viral suppression consequently impacting vertical transmission of HIV. This scoping review aims to identify existing knowledge regarding the impact of ante- and postnatal depression screening in women with HIV and to adduce the necessity for effective screening.

Methods A literature search was performed for studies with primary outcomes of depression screening within the context of ante- or …

Implementation Of Daily Nhppd Calculator In The Acute Care Setting, Spencer Y. Cho

Student Scholarly Projects

Practice Problem: In the United States, it is estimated that hospitalized patients experience an adverse event that require a rapid response and/or code blue event in 3% to 18% of hospitalizations.

PICOT: In the adult medical-surgical inpatient (P), does the implementation of a daily NHPPD calculator (DNC) (I) compared to an annual staffing methodology for calculating NHPPD (C) reduce rapid response calls, code blue episodes, and unplanned admission to critical care (O) over 8 weeks (T).

Evidence: Seven studies provided evidence that implementation of staffing methodology, nursing surveillance, and nurse staffing that supports meeting targeted nursing hours per patient …

Retention Of Physician Assistants Within A Specialty After Completion Of A Postgraduate Training Program, John Ansiaux Pa-C, Carly Farrell Pa-C, Kathryn Hess Pa-C, Aubrey White Pa-C, Charlotte Peeters Pa-C, Jill Schulten Pa-C, Ryan Krasnosky Mpas, Pa-C, Dfaapa, Drph

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Background: The advantages of a specialized training program have led to over 84 postgraduate training programs for Physician Assistants (PAs) covering over 25 specialties. Employee lateral mobility is more prevalent within the PA profession, which allows PA providers to switch between medical specialties. The versatility of PAs promotes higher turnover rates compared to physician counterparts. These high turnover rates can result in increased institutional burden. Postgraduate PA programs provide pre-employment exposure to more in-depth medical training, enabling a well-rounded knowledge base of the PA’s roles and responsibilities, minimizing turnover rates.

Purpose: The goal of this survey study is to identify …

Barriers Identified By Nursing Leaders In Supporting Nursing Research, Marietta Sperry

Articles, Abstracts, and Reports

Background/Intro:

Nursing leaders at acute care hospitals often lack knowledge of how best to support nurses who wish to engage in nursing research and evidence-based practice. Inclusion of the nurses who have direct bedside contact with patients is integral in improving patient outcomes.

Problem Description-Patient facing nurses have cited a lack of leadership support in conducting research. A lack of research knowledge by nursing leaders has also previously been identified. I determined to learn other barriers nursing leaders would identify and if a brief module on basics of nursing research might mitigate these barriers.

Purpose/aims:

To determine what …

Communicating Comfort In Crisis: A Literature Review On Overcoming The Emergency Room Environment To Foster The Nurse-Patient Relationship, Faith G. Davenport

Senior Honors Theses

The average emergency room patient is not receiving the compassionate nurse-patient communication that patients experience on other hospital floors. Fewer positive nurse-patient interactions prompt patients to state that they feel uncomforted and dissatisfied on hospital exit surveys, inciting hospital management to investigate how to reverse this trend to retain their federal funding. Emergency room nurses cite multiple barriers inherent in their work environment that prevent them from building rapport with their patients, including a layout not conducive to private conversations, strict time constraints, and a fluctuating workload. Working for a prolonged period under these conditions is driving many nurses to …

Oral Care Bundle Impact On Staff Assisted Oral Care, Sabrina Oliver

Student Scholarly Projects

Practice Problem: Non-ventilator hospital acquired pneumonia (NV-HAP) is more common than ventilator acquired pneumonia. Oral care is the only modifiable risk factor for all patient populations.

PICOT: The PICOT question that guided this project was: In non-ventilated patients in a tertiary care setting (P), how does implementing an oral care bundle (I) compared to the current practice of individual tasks without a bundle (C) affect adherence to facility oral care standard of patients receiving oral care at least once a day (O) over six weeks (T)?

Evidence: Lack of an oral bundle that has been proven to decrease …

Survey Analysis Of Overall Job Satisfaction Of Physician Assistants, Clare Lookian Pa-C, Claire Keaton Pa-C, Kasey Keane Pa-C, Erin Schulte Pa-C, Abby Atchley Pa-C, Edwin Welsh Pa-C, Devon Gersh Pa-C, Jack Carter Pa-C, Ryan Krasnosky Mpas, Pa-C, Dfaapa, Drph

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Background: Over the last three decades, the physician assistant (PA) profession has seen an increase in the number of women in the profession, a decline in the age of new PA graduates, a movement toward specialty practice, and an exponential growth in the workforce as a whole. Historically, surveys reveal the majority of PAs are satisfied with their career choice and current job. Although a majority of PAs report high job satisfaction, career burnout is still significant within the profession. Career burnout among health care providers continues to rise due to the strains of the US healthcare system, growing patient …

Utilization And Workforce Integration Of Physician Assistants, Tara Harkins Pa-C, Jason Thomas Pa-C, Brian Fontenot Pa-C, Joseph Day Pa-C, Marielle Faraone Pa-C, Alexandra Borden Pa-C, Megan Lomax Pa-C, Darius Dranginis Pa-C, Ryan Krasnosky Mpas, Pa-C, Dfaapa, Drph, Angelo P. Giardino Md, Phd

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Background: The healthcare field is experiencing rapid growth in the number of advanced practice providers (APPs) with projections that demonstrate that this trend will only continue. Even though the number of APPs is growing, the development of facility-specific APP management infrastructure often grows at a slower pace. Specific policies and procedures on APP utilization and clinical efficiency metrics are lacking. This can lead to deficiencies in the understanding of the education and practice boundaries of APPs.

Objective: Our study aimed to analyze the growth and utilization of physician assistants (PAs) in several hospitals located within Texas Medical Center (TMC) …

Reducing Pulmonary Function Testing Procedure Times In Pediatric Patients, Kathleen Richards Rrt, Shontae Hill Rrt, Kaylynn Bernardo-Stagg Rrt, Heather Miller Rrt, Daniel Barker Rrt, Kailee Perkins Rrt, Michael Richards Mba, Mha

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Problem. The Pulmonary Function Test Time Project (PFT Project) is a quality improvement (QI) initiative designed to decrease PFT testing time and PFT total time in pediatric patients and improve the overall process for both providers and patients. Patients scheduled to see a pulmonary provider were also scheduled for a PFT prior to the provider’s visit. Data showed that the length of time to perform a pulmonary function test (PFT) was causing: (1) a delay in the pulmonary provider seeing patients at the intended appointment time, (2) a disruption to clinic workflow, resulting in scheduling difficulties, and (3) a decreased …

Incorporation Of Surgical Cadaver Lab Training In A Physician Assistant Fellowship Program, Jacqueline Guarino, Jordan Rodriguez, Ming Zhang Phd, Ryan Krasnosky, Kristina Marsack

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Physician Assistants (PAs) are licensed medical professionals who provide health care under the supervision of and in collaboration with physicians. PAs can specialize in any field of medicine or surgery with additional on-the-job training while some PAs participate in a postgraduate training program in order to increase their knowledge in a certain subspecialty area. This paper describes the incorporation of a cadaver lab curriculum into a postgraduate PA surgical training program. The description of the development, implementation, and evaluation of the cadaver lab experience can assist other programs to implement this hands-on educational experience for a variety of medical providers, …

Developing An Evaluation Process For Telehealth In A Copd Clinic, Jodi H. Biller

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Telehealth was broadly implemented as a care modality in response to a worldwide pandemic in 2020. Before the COVID-19 pandemic, while telehealth was not new, it was not widely utilized at the project site location, and a uniform method of evaluating its effectiveness was needed. This quality assurance project developed and piloted a uniform process to evaluate telehealth in a Chronic Obstructive Pulmonary Disease (COPD) clinic, then evaluated stakeholder perceptions about the process used in developing the evaluation tool.

Methods: The telehealth evaluation tool was developed using the National Quality Forum (NQF) framework and Global Obstructive Lung Disease (GOLD) …

Measuring The Quality Of Postgraduate Physician Assistant Fellowship/Residency Programs With A Surgical Focus, Lesley Davies, Jacqueline Guarino, Caitlin Justus, Cassandra Mueller Pa-C, Ryan Krasnosky, Jordan Rodriguez, Angelo P. Giardino

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Introduction

Postgraduate programs for PAs provide formal postgraduate training for clinical specialty areas. These programs are intended to provide intense specialty training in various fields, as well as to standardize education beyond the entry level. The purpose of this descriptive study was to determine if there are consistent trends or clear differences in program length, approach to training, validation of learning, and accreditation through the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) for postgraduate programs with a surgical focus in the United States.

Methods

This study is a non-experimental and descriptive research design. Program directors were mailed …

Manager Onboarding To Improve Knowledge And Confidence To Lead, Christine (Tina) K. Asiimwe

Doctor of Nursing Practice (DNP) Projects

Background: Primary care (PC) is increasingly the setting for affordable, coordinated, end-to-end patient care, with PC managers in charge of organizational performance. While PC managers are central to high-functioning teams, they often receive inadequate onboarding.

Local Problem: Primary care onboarding competes with other operational priorities and faces time constraints, lack of mentorship, and cost.

Context: At an integrated healthcare system, a need was identified to develop structured, role-specific onboarding for newly hired PC managers to improve knowledge and confidence to lead.

Interventions: Bauer’s Four Cs framework for onboarding guided the development of a manager onboarding program for 12 new PC …

Creating A Pipeline To Increase Diversity In Executive Leadership Positions, Trarina Harris

Doctor of Nursing Practice (DNP) Projects

Background: Minority nurse leader presence at the executive leadership level is suboptimal, with insufficient pathways to increase representation. The lack of diversity in executive leadership threatens efforts to improve patient care and reduce disparities (Jerome Harris, 2021).

Local Problem: Practices to increase the diversity of executive nurse leaders at a pediatric medical center have had very little to no impact. Frontline nurses and nurse executives are not racially or ethnically representative of the increasingly minority patient populations served.

Context: As a commitment to increasing workforce diversity, the medical center developed an executive-level Racial Equity Taskforce, which aligned with the …

Enhanced Recovery After Surgery: Necessity Of Real Time Tracking In Quality Measures And Outcomes, Emily Owens

Master's Projects and Capstones

Abstract

A High Reliability Organization (HRO), such as this Northern California Medical Center, holds itself to high standards of performance in the areas of recognition, ranking, and accreditation. The commonality between these high-scored and valuable acknowledgements is the pillars of Quality Outcomes. As benchmarking and reporting allow this facility to measure outcomes against self and other plans, it greatly strengthens the internal focus for continual improvement and goal setting in direct patient care and outcomes. A deeper layer of the Quality Department includes the bundle “ERAS – Enhanced Recovery After Surgery”, which is compiled of principles aiming to minimize opioid …

Development And Implementation Of An Evidence-Based Practice Mentor Fellowship, Stacy L. Alves

Doctor of Nursing Practice (DNP) Projects

Background: The Institute of Medicine (2008) set a goal that 90% of healthcare decisions would be based on the best evidence possible by 2020, yet many challenges remain. Common barriers include clinicians’ beliefs about the value of evidence-based practices, their competency to implement it, and systems issues such as time, resources, and organizational value and preparedness (Melnyk et al., 2017).

Local Problem: A hospital within an integrated health care system sought to increase the use of EBP for clinical decision making. A gap analysis revealed a lack of sufficient EBP mentors to lead efforts to promote system-wide EBP implementation.

Context: …

Impact Of Central Line Bundle Care On Reduction Of Central Line Associated-Infections: A Scoping Review, Alisha James-Scott Msn, Fnp-C, Rachel Savoy Msn, Fnp-Bc, Donna Lynch-Smith Dnp, Acnp-Bc, Apn, Ne-Bc, Cnl, Tracy Mcclinton Dnp, Ag-Acnp-Bc, Apn

Doctor of Nursing Practice Projects

Purpose/Background Central venous catheters (CVC) are typical for critically ill patients in the intensive care unit (ICU). Due to the invasiveness of this procedure, there is a high risk for central line-associated bloodstream infection (CLABSI). These infections have been known to increase mortality and morbidity, medical costs, and reduce hospital reimbursements. Evidenced-based interventions were grouped to assemble a central line bundle to decrease the number of CLABSIs and improve patient outcomes. This scoping review will evaluate the literature and examine the association between reduced CLABSI rates and central line bundle care implementation or current use.

Methods A literature review was …

Leadership Rounding To Improve Patient Satisfaction In Pediatric Ambulatory Care, Tara J. Haskell

Student Scholarly Projects

Practice Problem: Low patient satisfaction has been linked to poor treatment compliance, patients leaving the practice, staff decreased job satisfaction, and high staff turnover (Haskard Zolnierek & DiMatteo, 2009; Prakash, 2010). Magnet reporting has identified wide discrepancies in ambulatory clinics, with some clinics reporting below benchmark patient satisfaction ratings.

PICOT: In pediatric ambulatory and primary care services, how will the implementation of leader-led customer service rounding, compared to current practice, increase family and/or patient satisfaction over 4 weeks?

Evidence: Key findings are that the rounding needs to be population-specific, intentional, and swiftly followed up when problems are identified. The body …

Medicated-Assisted Treatment And 12-Step Programs: Evaluating The Referral Process, Candace S. Brown, Chudney Williams, Ryan E. Stephens, Jacqueline Sharp, Bobby Bellflower, Martinus T. Zeeman

Doctor of Nursing Practice Projects

Purpose/Background Overdose deaths in the U.S. from opioids have dramatically increased since the COVID-19 pandemic. Although medicated-assisted treatment (MAT) programs are widely available for sufferers of opiate addiction, many drop out of treatment prematurely. Twelve-step programs are considered a valuable part of treatment, but few studies have examined the effect of combining these approaches. We aimed to compare abstinence rates among patients receiving MAT who were referred to 12-step programs to those only receiving MAT.

Methods In this prospective study, a cohort of participants from a MAT clinic agreeing to attend a 12-step program was compared to 15 controls selected …

"More Accessible And Easier To Deal With": A Qualitative Inquiry Of Leaders' Perceptions Of The Evolving Roles And Responsibilities Of Advanced Practice Providers At Texas Medical Center, Athena Krasnosky Msn, Aprn, Cpnp, Jessie Marcet-Gonzalez Msn, Aprn, Cpnp, Jordan Rodriguez Bs, Natalie Cormier Smith Msn, Aprn, Np-C, Brenda Chesley Msn, Aprn, Cpnp-Ac/Pc, Linda Brock Msn, Aprn, Cpnp, Heena Narsi Prasla Msn, Aprn, Cpnp, Geran Barton

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Background. With over 10 million patient encounters a year at Texas Medical Center (TMC), Advanced Practice Providers (APPs) are being incorporated into health care delivery models. Moving beyond the narrow “scope of practice” debates that frequently surface when talking about APPs, this inquiry instead seeks to broaden the discussion and take a more comprehensive view of how APPs are being incorporated into health care delivery models that span across several TMC institutions.

Methods. This study uses a thematic analysis study design to analyze structured interviews collected from a small convenience sample of Advance Practice Provider Program Directors at Texas Medical …

Outcomes Of A Positive Patient Id Campaign At A Pediatric Quaternary Care Center, Taylor Kim Md, Arjun M. Dangre Bds Mph, Andrea L. Davis Mph Cic, Betty J. Reeves Mha, Mt (Ascp), Omobola T. Durojaiye Msn, Rn-Bc

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Introduction. Positive patient identification (PPID) is critical to safe and accurate labeling of patient lab specimens. Accurate PPID is also an important priority of The Joint Commission’s National Safety Goals. Inadequate PPID compromises may lead to waste of time and resources, and in the worst-case scenario can lead to significant patient morbidity and mortality. With a focus on PPID, this initiative examined the occurrence of mislabeled and unlabeled lab specimens as well as compliance with wearing ID bands in a cohort of hematology/oncology and bone marrow transplant inpatients at a large pediatric quaternary care center.

Methods. Using the Plan-Do-Study-Act Model, …

Spiritual Care Competency Of Critical Care Nurses: A Literature Review, Julia O. Rohm

Bachelors of Science in Nursing

While caring for their patients, nurses often encounter spiritual needs. In a study with 241 hospice, palliative care, and holistic nurses, “all respondents (100%) indicated they had encountered a patient with spiritual needs throughout their nursing clinical practice” (Lukovsky et al., 2021, p. 32). Despite the prevalence of spiritual needs, many nurses feel unable to confront spiritual issues among their patients. According to a survey conducted among 4054 nurses from the UK, “almost 93% of the nurses surveyed believed spiritual care should be addressed, yet only 5.3% felt always able to meet the spiritual need of patients on a regular …

The Use Of Isbared/Ishaped And Elimination Of Reviewing Patients’ Chart Before Handoff To Decrease Incremental Overtime, Sheila Bucao

Master's Projects and Capstones

Problem: Incremental overtime was found to majorly impact the financial well-being of a stroke unit. From an allocated budget of 22 hours per pay period, the unit’s incremental overtime averaged 40 hours. The stroke unit had skilled-mix competencies, further complicating handoffs. The absence of a standard reporting method means that reviewing patients’ charts takes approximately 10 to 15 minutes, extending what should be a quick, but thorough nurse knowledge exchange.

Context: The body of evidence reviewed indicated that pertinent information to patient care is not left out or missed when a standardized tool is used during handoff. Based on Lean …

Pre-Admission Patient Education For A Prostatectomy Enhanced Recovery After Surgery Pathway, Vanessa C. Cotton

Doctor of Nursing Practice

Background. In the United States, prostate cancer is the most common cancer diagnosed in men and a common treatment choice is a radical prostatectomy. The Enhanced Recovery After Surgery® Society developed evidence-based guidelines to optimize treatment and improve outcomes in prostatectomy patients, yet not all hospitals are utilizing these guidelines or employing all of the elements, including pre-admission education. Purpose and Objectives. The purpose of this quality improvement project was to develop, implement, and evaluate a pre-admission patient education component for a prostate surgery pathway based on the Enhanced Recovery After Surgery guidelines. Objectives included assessing the nurse’s intention to …

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 …

Improving Emergency Department Throughput: Using A Pull Method Of Patient Flow, Jeffrey Collins

Student Scholarly Projects

Practice Problem: Overcrowding in the emergency department (ED) has been shown to increase the length of hospital stay, adversely impact patient outcomes, and reduce patient satisfaction. Problems with overcrowding and throughput are often thought of as an ED-specific inefficiency; however, the issue is indicative of hospital-wide inefficiencies.

PICOT: The PICOT question that guided this project was “For ED patients admitted to the medical-surgical unit at an acute medical center, will the implementation of a pull model for patient flow, when compared to the current push model, reduce admission delay and length of stay (LOS) within six weeks of implementation?

Evidence: …

Pediatric Wound Care: Establishing A Consensus Group To Develop Clinical Practice Guidelines, Ryan Krasnosky, Geran Barton, Linda Highfield, Sheila Martinez, Stephen Linder, Edward Buchanan, Angelo P. Giardino

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Introduction. Wound care practices for neonatal and pediatric patients have created a lack of standardized evidence-based guidelines for treatments in clinical practices. Unfortunately, published clinical guidelines for the evaluation and management of wounds in pediatric populations is limited. Consensus groups are used to develop clinical guidelines which define key aspects of the quality of health care, particularly appropriate indications for interventions. The aim of this initiative was to conduct the first two steps of the guideline development process, and to report on the findings from the expert consensus group for pediatric wound care.

Methods. The goal was to recruit a …

A Systematic Review Of Acuity-Based Staffing In Acute Healthcare Environments, Demitria Idella Stafford

Electronic Theses and Dissertations

Nursing leadership is responsible for considering the equity of patient care assignments when providing nursing care. Nursing leadership is responsible for assuring the delivery of patient care assignments with the intent to offer nurses an unbiased, evenly distributed patient load. Effective distribution of patient care assignments ensures patients receive the safest, most efficient, and highest quality of care. The purpose of this project was to provide nursing leadership with an executive summary of a systematic review of evidence-based research on the structure and process of making patient care assignments, and it provided evidence on how those patient care assignments affect …

Changing The Culture Of Nurse Practitioners: Incorporating Medical Billing And Coding To Prevent Fraud, Waste And Abuse, Tralissa Morrow

DNP Research Projects

Medical coding and billing errors are avoidable problems that have afflicted practitioners for decades. Correct coding and billing are required for reimbursement of healthcare services. Fraud, waste and abuse increase healthcare costs, reduce the quality of care provided and directly impact costs to patients. This pilot study was intended to evaluate the impact of an educational webinar on medical billing and coding, fraud, waste and abuse on nurse practitioner (NP) knowledge using a pretest posttest design. Mean scores increased from 58.4% to 76.4%. Test reliability was low at 0.477 (pretest) and 0.142 (posttest) with two questions that were unable to …