Nursing Administration Commons^™

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 …

Developing Resilience Training For The Healthcare Employee In A Rural Medical Center, Sandra E. Gothard

Electronic Theses and Dissertations

In the clinical setting and in their personal lives, health professionals are confronted with many stressors that impact their time and the clarity of their role. Stressors are emotional, moral, or spiritual in nature as a result of exposure to suffering and death. There are often occupational stressors, such as reduced social support, excessive workload, or a prolonged misalignment among personal needs, individual values, and the work role. As a result of these challenges, health care employees need to create coping skills when stressors and demands become hindrances to personal well-being and their professional ability to care for others. Developing …

Use Of Best Practice Alerts To Improve Adherence To Evidence-Based Screening In Pediatric Diabetes Care, Daniel Desalvo, Sara K. Bartz, Blair Mockler, Rona Y. Sonabend

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Background: Youth with type 1 diabetes (T1D) are at increased risk for comorbid autoimmune conditions and long-term complications. To help with early identification of these complications, the American Diabetes Association (ADA) has published evidence-based screening guidelines. The aim of our quality improvement intervention was to improve and sustain adherence to the ADA recommended screening guidelines to >90% for youth with T1D in the Texas Children’s Hospital (TCH) Diabetes Center by utilizing best practice alerts (BPA) within the electronic medical record (EMR).

Methods: In accordance with the ADA Standards of Care screening guidelines for youth with T1D, we analyzed the database …

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 …

Patient’S Utilization Of Health Information Technologies For Disease Self-Management, Mahmoud Hamzeh Altawalbih

Dissertations

Background: The rapid growth of Health Information Technologies (HITs) provides

patients with greater opportunity to take control over their health. HITs utilization has

been proven to be a critical component of disease self-management and can result in

positive outcomes. Its widespread adoption and utilization is still relatively low among

patients with chronic disease. It is important to understand the factors that may impact

HITs utilization, such as the perceived Task-Technology Fit (TTF). A very limited

number of studies have examined the relationship between HITs utilization and the

perceived fit between task and technology in the context of TTF theory.

Aims/ …

Beyond The Transcript: A Narrative Analysis Of Students' Experiences With Academic Dismissal In A Baccalaureate Nursing Program, Angela Edwards Capello

LSU Doctoral Dissertations

ABSTRACT

Re-defining different is the first step in addressing inequity in nursing education and the disparities that result in a high incidence of academic dismissal in baccalaureate nursing programs. What are the students' differences that contribute to one student’s ease of progression through a baccalaureate nursing program and those who struggle from the first semester?

This study provides a private look into the experiences of nine baccalaureate nursing students who were academically dismissed from their nursing program. Each story chronological from the time they decided to pursue nursing to their experiences during nursing school and to their lives after dismissal. …

Implementation Of Change Of Shift Huddles In An Urban Medical Center, Benson Kahiu

Seton Hall University DNP Final Projects

Since 1999 when the Institute of Medicine (IOM) highlighted medical errors in hospitals, healthcare leaders continue to pursue relevant and sustainable patient safety initiatives. Some of these initiatives include projects that increase accountability while encouraging enhanced teamwork and communication between team members. The lack of consistent communication results in decreased patient outcomes and patient dissatisfaction. Decreased camaraderie in organizations, results in fiscal waste associated with employee tardiness and call-outs. This paper reviews the process and impact of implementing change of shift huddles in an urban medical center. Literature reviews concluded that positive outcomes were associated with implementation of huddles during …

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 …

Peripheral Intravenous Infiltrates: Engaging Staff To Increase Reporting, Emily Weber, Kimberly Castrillon, Joyce Ramsey-Coleman

Journal of Nursing & Interprofessional Leadership in Quality & Safety

A large free standing children’s academic hospital aimed to improve patient safety and outcomes by decreasing the overall severity of peripheral intravenous infiltration and extravasations (PIVIEs). A care bundle was developed by creating a PIVIE measurement tool within the electronic medical record (EMR) and integrating the tool into standardized daily practice for nurses. The care bundle included creating a team of clinical leaders consisting of empowered bedside nurses acting as mobilized resources embedded into each unit. The initiative resulted in a large scale increase in reported PIVIEs system-wide within 1 month of education dissemination to bedside RN staff. The QI …

Improving Nurse Anesthetist Intraoperative Handoff Process By Developing And Implementing An Evidence-Based, Facility-Specific Cognitive Aid, Jason Silva, Myron Arnaud

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Miscommunication or non-transfer of pertinent patient information during intraoperative handoffs between anesthesia providers creates patient safety risks. An evidence-based facility-specific cognitive aid was developed and introduced to nurse anesthetists in an anesthesiology department of a large academic hospital with the aim of improving the intraoperative patient handoff process. The program used a handoff cognitive aid that addressed five pertinent patient information points. A secondary measure was evaluation of provider satisfaction. Twenty-four nurse anesthetists utilized the handoff cognitive aid during handoffs in the course of a 4-week pilot program. Eighty-eight nurse anesthetist handoffs were observed (23 with and 65 without the …

Emergency Nurse Perceptions Of Disaster Preparedness After The Implementation Of A Department Emergency Operations Plan, Angela R. Gentry

Theses and Dissertations from 2019

Emergency departments (ED) are the entryway into the healthcare system during a disaster event and patients often arrive in the first thirty minutes after an event has occurred. This creates unique challenges for ED nurses. The purpose of the Quality Improvement (QI) project was to measure the impact of a Department Emergency Operations Plan (DEOP) on the ED nurse’s perception of disaster preparedness. This study included a convenience sample of 126 full time and part time registered nurses working in the ED at a Level 1 Trauma hospital. Institutional Review Board (IRB) approval was obtained by both Arkansas Tech University …

St. Cloud Hospital Nursing Director Orientation And Mentorship Program, Deb Eisenstadt, Tiffany Omann-Bidinger, Diane Pelant

Nursing Posters

Develop and implement an evidence-based orientation and mentorship program for nursing directors using AONE’s Nursing Executive Competencies along with a structure curriculum.

Nursing Leaders’ Ethical Decision-Making About Professional Boundaries And Nurse-Patient Relationships: A Mixed Methods Explanatory Sequential Design, Pamela Scott

Theses & Dissertations

The purpose of this mixed methods explanatory sequential design study was to ascertain nursing leaders’ knowledge and skill in ethical decision-making when evaluating and managing professional nurse-patient relationship boundaries. It was also the purpose of this study to better understand nursing leaders’ perception of moral, cognitive, and organizational factors influencing their ethical decision-making in evaluating and managing professional nurse-patient relationships, with the intent of generating a theory grounded in the views of the participants as a final outcome of the study. The two theories, virtue ethics and self-efficacy comprise the ethicality construct of the conceptual framework explaining the nurse leaders’ …

Attitudes Of New Graduate Rns Regarding Their Readiness For Practice Before And After Hospital Orientation, Diane Young

Dissertations

The acuity level of patients continues to increase making it more vital than ever that new graduate Registered Nurses (RNs) be prepared to give safe, quality care when leaving their hospital’s orientation program (Spector et al., 2015). Today, new graduate RNs need orientation programs that will ensure a smooth transition into nursing practice. This involves the ability to apply higher-level knowledge and skills in everyday practice situations, thereby, maintaining quality care (Henderson, Ossenberg, & Tyler, 2015).

The purpose of this study was to identify differences between new graduate RNs’ opinions on readiness for practice, as measured by the Casey-Fink Readiness …

Improving Hbpc Utilization, Janet Freeman

The Eleanor Mann School of Nursing DNP Capstone Projects

Home Based Primary Care (HBPC) services in the Central Arkansas Veterans Healthcare System (CAVHS) are underutilized among high-needs, high-risk (HNHR) patients based on baseline assessment of provider capacity. It is important to evaluate this problem as these patients have the highest need for frequent care yet face the most difficult challenges in accessing care. The purpose of this project was to analyze the factors that contribute to the under-utilization of HBPC services in the CAVHS and make recommendations for improvement. An assessment of the CAVHS HBPC service was completed using the Dartmouth Institute Microsystem Academy Outpatient Specialty Care Workbook. Microsystem …

A Framework For Learning During An Honors Internship: Embold Health Inc., Haley Haldeman

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Embold Health Inc. is a health care analytics start-up company that identifies top performing providers using large data sets and clinically nuanced measurement. A comprehensive assessment of quality, appropriateness, and cost is what Embold Health delivers. Embold allows payers more control in choosing providers within their region. Being able to identify top provider behaviors through rigorous data driven measurement is significant both clinically and commercially; it provides the opportunity to increase value of care, decrease waste, and drive down cost.

Over the past year as an intern, I’ve had a first-hand look into the complexity that surrounds data driven health …

Patient Perception Of Telephone Follow-Up After Resection For Colorectal Cancer: Is It Time For An Alternative To The Out-Patient Clinic?, Marcus Gilmartin, Nicholas Leaver, George Hall, Helena Fawdry, Seung Lee, James Nicholson, Ramya Kalaiselvan, Raj Rajaganeshan

Patient Experience Journal

The economic reality of modern healthcare provides a timely reminder to clinicians of their duty to provide outstanding and cost-effective care. Although multiple guidelines outline investigation, management and surveillance of colorectal cancer, none advocate a particular delivery method. Nurse-led telephone follow-up in multiple specialties has demonstrated equivalent clinical outcomes and patient satisfaction when compared to traditional outpatient department follow-up. This paper aims to compare nurse-led telephone and outpatient follow-up, following surgical resection of colorectal cancer (CRC), focusing on patient perceptions. This cross-sectional study distributed adapted patient satisfaction questionnaire (PS-Q 18) to patients undergoing surveillance following CRC resection via either nurse-led …

Sustainability In Quality Improvement And Patient Safety Initiatives, Angelo P. Giardino, Eileen R. Giardino

Journal of Nursing & Interprofessional Leadership in Quality & Safety

The question often asked of a quality improvement initiative is whether the improvement process has been sustained within the organization. Rarely is the question answered satisfactorily. The sustainability of an improvement process is important as it justifies the investment of human and financial capital. The term 'evaporation of improvements' addresses the dilemma that between 33% to 70% of all innovations are reportedly not sustained (Fleiszer, Semenic, Ritchie, Richer, & Denis, 2015) . This evaporation of improvement captures the frustrating inability of many institutions to maintain the achieved improvement after the newness of the initial effort wears off (Buchanan, Fitzgerald, & …

Going For Gold With The Perioperative Olympics, Hope L. Johnson Msn, Rn, Cnor

Patient Care Services / Nursing

No abstract provided.

Use Of Workplace Incentive Programs To Increase Health Behaviors In Nurses, Sydney Harris, Barbara Mcclaskey

Posters

As the frontline and most visual health promoters in a hospital setting, nurses are to be at the top of their game in terms of their health behaviors. Unfortunately, several studies show that nurses tend to follow the trend of the general population in poor eating habits, physical inactivity, sleep habits, and smoking and alcohol consump­tion. The purpose of this study is to unveil the benefits of Workplace Health Incentive Programs in an effort to increase the overall health of those who are to be considered role models for a healthy lifestyle, the nurses who hold the seat for the …

Improving Nursing Staffing Methodology And Nursing Sensitive Outcomes With The Addition Of A Patient Centered Acuity Measure, Douglas C. Howard Rn, Ms, Ne-Bc

Doctor of Nursing Practice Projects

Background: Assigning the correct nursing resources to hospitalized patients positively impacts patient outcomes. The current process for matching nurses to patients is highly variable and involves a combination of simple ratios, historical workload data, and expert opinion but lacks objective measurement of the patient’s condition.

Objectives: This project evaluated change in selected quality indicators and the daily unit-level management of nursing resources after implementing the Troubled Outcome Risk (TOR) into existing nursing staffing methodology in a Department of Veterans Affairs hospital.

Methods: TOR provides objective measurement of individual patient allostatic load. Daily calculation of TOR scores for each patient on …

Nurse Managers: An Association Between Empowerment And Burnout, Sonja Lynn Avery

Doctoral Projects

The purpose of the study is to ascertain the presence of an inverse relationship between nurse managers’ feelings of structural empowerment and self-perception of burnout. Although research is available studying the effects of staff nurse empowerment and burnout, literature is sparse relative to evaluation of nurse manager empowerment and burnout. Of the studies available, there is supportive evidence pertaining to the negative implications associated with nurse manager burnout such as reduced staff nurse retention and morale, decrease in quality of patient care, and financial impact on organizational success. With such negative implications associated with a lack of empowerment and burnout, …

Improving Patient Handover From The Pediatric Emergency Department To The Pediatric Intensive Care Unit, Kathryn Devinney

Doctoral Projects

Patient safety can be at risk during registered nurse handover, particularly when transitioning between high risk areas. According to The Joint Commission (2017), a standardized transition process should be implemented during patient handover. The purpose of this paper was to evaluate the effect of a standardized process with a cognitive aid on handover between a pediatric emergency department and an intensive care unit. Objectives of the project were to decrease conversion time in the emergency department, increase standardized process utilization, and improve patient outcomes, registered nurse perception and satisfaction, and patient proxy satisfaction. This evidence-based quality improvement project took place …

Interprofessional Collaboration To Improve Discharge Planning, Erica L. Spalding

Doctoral Projects

Historically, health care professionals collaborated solely with other professionals within the same discipline. However, evidence shows collaboration between all disciplines involved in patient care leads to improved patient outcomes. Interprofessional collaboration can reduce costs and improve patient care, yet is used inconsistently in health care systems. Interprofessional collaboration was not fully used on two medical-surgical units in a large health system in the Midwest, particularly during the discharge planning process. This project aimed to standardize rounds on two units as part of a larger initiative to standardize rounds across all units within the system. The clinical question to be answered …

Development Of A Process For Adoption And Attainment Of Pcmh Recognition Requirements For An Urban Primary Care Clinic, Jamie L. Hendricks

Doctoral Projects

The Centers for Disease Control and Prevention (2017) reported that in 2016, healthcare expenditures in the United States totaled 17.9% of the gross domestic product. Unfortunately, care quality is not reflective of the high costs of care. Models of care delivery like the patient centered medical home (PCMH) have shown promise in addressing these concerns.

This project focused on program development for PCMH adoption at an urban clinic in an effort to improve financial stability and remain competitive. The purpose was to propose a plan for adoption and attainment of PCMH recognition requirements for an urban primary care office.

The …

Factors Affecting Nurses’ Job Satisfaction In Rural And Urban Acute Care Settings: A Prisma Systematic Review, Yasin Yasin, Mickey Kerr, Carol A Wong, Charles H. Bélanger

Western Research Forum

This review aims to systemically describe the findings of primary studies in order to identify the intrinsic and extrinsic factors that affect nurses’ job satisfaction using PRISMA guidelines. It also aims to analyze the finding according to the two-factor theory; and compare studies based on rural and urban settings.

Two reviewers completed study selection, screening, and quality assessment. After data extraction, content analysis was used to categorize identified factors into themes.

Thirty-eight studies were selected for this review. Extrinsic factors reported in the findings were: work conditions (n=17), monetary benefits (n=5), hospital policies (n=6), supervision (n=7), interpersonal relationships (n=8), organization …

Nurses’ Cyberloafing And Its Relationship To Procrastination And Conscientiousness In Damanhour National Medical Institute, Yaldez Zeineldin Prof, Fatma Baddar Prof

Nursing

Cyber-loafing involves an unproductive use of time in the workplace and distracts employees from their responsibilities and duties. This study was conducted because there is a risk posed on patient's safety if nurses are cyberloafing and if this behavior has a direct relation with procrastination and lack of conscientiousness. Aim of the study: to determine the relationship between cyberloafing, procrastination and conscientiousness among staff nurses working in Damanhour National Medical Institute. Research Design: A cross-sectional descriptive correlational design with a self-reporting questionnaire was used to obtain data. Setting: The study was conducted in all inpatients units except Intensive Care Units …

Improving Nurse-To-Nurse Handoff Communication At The Bedside Through Simulation-Based, Lisa Thornsberry Mrs.

Doctor of Nursing Practice Projects

Communication among nursing staff is crucial to the outcome of patient care. Poor handoff and communication among professionals can have a negative impact on the safety of patients. The systemic nature of the problem with miscommunication among healthcare clinicians supports the necessity of standardization of communication among nursing as a handoff of care.

Change of shift report, or nurse-to-nurse report ensures the transfer of critical information to promote patient safety and best practices. Transferring and communicating pertinent information from one shift to the next is one factor in providing continuity of care. Bedside Shift Report (BSR) is an opportunity to …

Nurse Manager Leadership Styles, Tristy Morrison

Nursing Theses and Capstone Projects

Strong leadership skills are crucial to establish, grow, and sustain a healthy work environment in healthcare. Transformational leadership behaviors drive nursing teams to achieve higher levels of engagement, increased nursing satisfaction, increased retention rates, and higher commitment levels to the organization. The purpose of this research was to assess the transformational leadership characteristics among assistant nurse managers, managers, and directors, in a southeastern hospital in the United States. The Multifactor Leadership Questionnaire (MLQ-5X) was administered to evaluate the leadership characteristics. A convenience sample of 14 nurse leaders rated themselves as more transformational than the norm with an average score of …

Mobile Video Monitoring To Reduce Falls And Sitter Usage, Jennifer L. Forman

Doctor of Nursing Practice Projects

In the United States between 700,000 to 1,000,000 people fall in hospitals each year. Reducing patient falls in the inpatient setting remains a challenge for many acute care hospitals. Inpatient falls can lead to serious injuries such as fractures and internal bleeding. Fall-related complications can lead to increased hospital stay, prolonged rehabilitation, and increased healthcare costs. Inpatient falls are considered preventable. One intervention commonly used to prevent falls and keep patients safe is the use of an in-person sitter or a patient safety companion (PSC). However, sitters are very costly and considered a variable staffing resource. The need for a …