Nursing Administration Commons^™

Application Of Transformational Leadership In Nursing-An Integrative Review, Sudha R, Dhanalakshmi R

Manipal Journal of Nursing and Health Sciences

Nurses play a crucial role as leaders in healthcare and have the ability to turn their vision into reality. The different styles of leadership directly or indirectly affect both nursing and patient outcomes. Among these styles, Transformational Leadership (TFL) is the most preferred. Transformational leaders empower individuals to believe in themselves and have been found to have numerous benefits in nursing and other fields. As a result, this study aims to gather evidence for its application in nursing. The study employed an integrative review approach and searched literature from online databases such as PubMed and Google Scholar. Additionally, articles were …

Advanced Practice Clinician Outcomes: Pre/Post Implementation Of An Advanced Practice Clinician Council, Jeannine M. Moss

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Improving access to quality, affordable, and timely healthcare is a national priority. Health systems across the United States are utilizing Advanced Practice Clinicians (APCs) to fill the void in healthcare delivery. As provider shortages continue and the demand for APCs increases, organizations must develop robust structures to support APC engagement, retention, job satisfaction, and professional growth. Currently, 44% of the provider workforce within a large urban health system are APCs, yet despite substantial APC provider labor pool representation, the organization had little infrastructure to support APC professional growth and no mechanism for organizational involvement. This quality improvement (QI) project aimed …

Implementation Of A Daily Engagement System Board (Desb) To Improve Hospital Staff Communication, Catherine Villanueva

Master's Projects and Capstones

Implementation of a Quality Improvement (QI) project to help improve staff communication between shifts at an Inpatient Acute Psychiatric Unit was determined to be of immense need. This unit is part of a large acute medical hospital. Currently, the end of shift report consists of a verbal report along with a robust printed end of shift report consisting of shift related information. This printed end of shift report can have as many as seven to nine pages thus causing information overload and decreases prioritized patient information. Furthermore, missed information or too much information can be provided in the verbal shift …

Practicing Responses To Acute Clinical Troubles: Initiative Through Clinical Education (P.R.A.C.T.I.C.E.) To Improve Medical Emergency Response Increasing Nurse Confidence And Preparedness Through Low-Stakes Clinical Education, Lauren Castelblanco Rn, Viviana Lopez Rn, Nosa Odiase Rn, Everly Pompa Rn

Master's Projects and Capstones

A newly established pediatric outpatient infusion center in Los Angeles does not have immediate access to a Code Blue Team or a Rapid Response Team, and instead relies on the Staff Assist protocol to manage medical emergencies. Via direct interviews, registered nurses at the infusion center report feeling underprepared and lacking confidence to respond to medical emergencies that must be escalated to code blue. Microsystem assessment tools determined the root cause to be limited clinical exposure and limited opportunities for skills development. To address the nurses' concerns, Practicing Responses to Acute Clinical Troubles: Initiative through Clinical Education (P.R.A.C.T.I.C.E.) was implemented …

Implementing Donna Wright’S Competency Model For Enhancing Nursing Professional Development In Pediatric Perioperative Units, Justin C. Chu

Master's Projects and Capstones

Background Hundreds of thousands of deaths occur in hospitals annually due to preventable adverse events. As literature shows nurse competency is positively associated with improved patient outcomes, it is the mission of any healthcare organization to continually improve staff competency. Bay Area Children’s Hospital X is looking to adopt the Donna Wright Competency Model (DWCM) to change the way they approach this process, transitioning from traditional methods of manager-selected competencies to a collaborative, shared governance approach. Objectives Utilizing the DWCM, the project goal is to enhance competencies among 90 nurses in pediatric perioperative units. The ultimate goal is to create …

Impact Of Training For Nursing Staff In The Prevention Of Hapis, Onyinye E. Ohia, Colleen A. Anthony

Master's Projects

Abstract

Background: The incidence of Hospital acquired pressure injuries (HAPIs) have remained a problem in healthcare despite concerted efforts by hospitals and other governmental agencies to eliminate the problem via policy and emphasis on safety. There is support in literature for the training of healthcare professionals as an important tool in the prevention and management of HAPIs. Despite the existence of studies that link training of nurses to a reduction in rates of HAPIs, evidence in support of that is still piecemeal; with poorly defined outcomes.

Aims and objectives: The aim of this integrative review is to identify …

Academic Nurse Leaders’ Application Of Bolman And Deal’S Leadership Orientation Framework, Jasmine Bratton

Dissertations

While Academic Nurse Leaders (ANLs) are vital to the functioning and quality of nursing programs in academic settings, many enter their roles with limited or no prior academic leadership and management experience. The inadequate preparation and development of ANLs remains a critical concern. For this reason, ANLs positions can be challenging and hard to fill. Although ANLs can hold various titles and positions across different academic institutions, this study specifically focuses on Deans, Directors, and Department Chairs working in the New York State area. Bolman and Deal’s (2021) four-frame model of leadership offers a framework that can be used to …

Evaluating An Evidence-Based Quality Improvement Initiative For Food Insecurity Screening And Referral In Adults With Diabetes Initiating Continuous Glucose Monitor Therapy, Coni Dennis

Graduate Theses, Dissertations, and Capstones

Diabetes affects 37 million people annually in the United States, with direct medical costs exceeding $237 billion per year (American Diabetes Association, 2018; Xu et al., 2018). Complications account for up to 64% of diabetes-related expenses, emphasizing the importance of glycemic stability in preventing costly and debilitating outcomes (Dieleman et al., 2016). Diet and nutrition, essential for glycemic control, are often undermined by food insecurity—defined as inconsistent access to adequate, nutritious food—affecting 16% of adults with diabetes (Casagrande et al., 2022; Kirby et al., 2021). Food insecurity is linked to higher HbA1c levels, increased complications, and hospitalizations (Thomas et al., …

Disruptive Clinician Behavior: A Qualitative Descriptive Study Of Non-Native English-Speaking Nurses, Seyoung Baik

Dissertations

Background: Disruptive clinician behaviors among healthcare staff are an increasing concern, negatively affecting patient safety. In 2015, 16% of nurses in the U.S. were foreign-born (Shaffer et al., 2022), and 25% of New York and California nurses were immigrants (Shaffer et al., 2021). Nurses' migration to the U.S. has been exploding. Non-native English-speaking nurses experience complications, problems, and discord in their workplace with coworkers.

Aim: The purpose of this qualitative descriptive study was to explore and understand non-native English-speaking nurses’ experiences with disruptive clinician behaviors in the U.S.

Specific aims were to 1) create a comprehensive description of the experiences …

Identifying The Risk Of Violence In The Inpatient Setting, Megan Julian

Student Scholarly Projects

Practice Problem: Workplace violence directly contributes to the development of psychological conditions in nurses and reduces nurses’ level of job satisfaction as well as organizational commitment (ANA, 2018). Additionally, the occurrence of workplace violence events impacts patient and organizational outcomes.

PICOT: The PICOT question that guided this project was, in acute-care medical-surgical nurses (P), does the use of a structured risk of violence screening tool (I), compared to current practice (C), improve the nurses’ perceived ability to identify patients who are at risk for becoming violent (O) over eight weeks (T)? Evidence: Evidence that was reviewed supported the implementation of …

Examining Mentoring As A Catalyst For Nurse Work Engagement And Professional Development, Cherryl A Rainey

Dissertations

Abstract

Research literature has identified mentoring as a strategic intervention for employee professional development. The Business and Psychology disciplines have used mentoring widely for employee development, but it has not been used extensively in nursing.

Nursing has unique challenges and is constantly changing with a need to meet some of those needs by advancing the development of nurses to serve as leaders and fill positions due to nurse shortages and high turnover rates. Mentoring has also been identified as a vehicle to promote work engagement.

The purpose of this study was to examine mentoring as a catalyst for nurses’ professional …

Their Stories, Our Testimony: A Narrative Inquiry Into The Remote Teaching Experiences Of Community College Clinical Nurse Educators During The Covid-19 Pandemic, Catherine E. Fenner

Doctor of Education Program Dissertations

This narrative inquiry explored the lived experiences of clinical nurse educators who taught at community colleges during the COVID-19 global pandemic, contributing to the growing body of literature about what nurses endured during the pandemic. The pandemic and the ensuing havoc it caused occurred when the profession faced significant staffing shortages. In the early months of 2020, when the virus was spreading rapidly, many states issued stay-at-home orders requiring nursing programs to pivot to remote learning platforms. Teaching hands-on skills, communication techniques, and time management strategies through virtual and remote pedagogy was a time of confusion for nurse educators, who …

Clinical Learning Obstacles Of Nursing Students At The University Of Mosul: A Qualitative Study, Karam Yaseen Fathi, Younes K. Attia, Atheer Abd Ahmed, Ahmed K. Mohamed Taher

BioMed Visions Journal

Background: Clinical learning is a crucial component of nursing education, as it provides students with the opportunity to apply their theoretical knowledge in real-life healthcare settings. However, nursing students often face obstacles during their clinical experiences that can hinder their learning and professional development. The study aim to explore the obstacles that nursing students confront during clinical training.

Materials and Methods: A qualitative phenomenological study design was used to reach the study's aim. The study was conducted in Mosul city and included 20 nursing students who were selected purposefully. A semi-structured interview with open-ended questions was used to collect …

Measures Of Success: Making The Case For Advanced Practice-Sensitive Quality Indicators, Ruth Kleinpell, April Kapu, Cynthia Borum

HCA Healthcare Journal of Medicine

Advanced practice registered nurses (APRNs) are key health care providers in a variety of settings. Often APRNs are grouped in a collective category, along with physician assistants, and referred to collectively as advanced practice providers. As APRNs assume an increasing role in patient care management in hospital, outpatient, and community settings, such as clinics and rural practices, measuring the impact of their care on patient outcomes and quality of care becomes a necessary component of performance evaluation. APRN-sensitive outcome indicators are an important way to identify the impact of the role. While a number of studies have been conducted that …

Development Of A Facility-Level Second Victim Syndrome Peer-Mentor Program: Program Design And Future Directions, Jacqueline Trammell, Noah Zanville, Caryn Alper

HCA Healthcare Journal of Medicine

Background

Despite efforts to prevent errors, studies show that iatrogenic, or health care-related, errors continue to occur. Understandably, these errors, which can range in severity from near-misses to serious harm, can be devastating for the health care professionals involved, creating a potential second set of victims, in addition to the patient(s) that were harmed directly. Studies show that individuals struggling with second-victim syndrome (SVS) can be at increased risk for depression, burnout, and poor work performance. However, programs designed to develop peer mentors to support individuals struggling with SVS are poorly described.

Methods

Following a review of the literature, our …

Effectively Addressing Hospital-Acquired Pressure Injuries With A Multidisciplinary Approach, Nicki Roderman, Shandlie Wilcox, Andrew Beal

HCA Healthcare Journal of Medicine

Background

Hospital-acquired pressure injuries (HAPIs) result in patient harm, discomfort, and even death, with an estimated 2.5 million HAPIs occurring annually in the United States. These pressure injuries from prolonged pressure on the skin and deeper tissues cause reduced blood flow and the breakdown of skin and tissues, resulting in wounds. Additionally, these injuries contribute to longer hospital stays and increased health care costs. Hospitals have programs aimed at reducing HAPIs as well as ongoing surveillance to identify new trends early on. This ongoing monitoring revealed a trend early at our institution that HAPIs were 66% higher than the national …

Central Line-Associated Bloodstream Infection Reduction In Hemodialysis Patients Across 9 Hospitals And 3 States, Nicki Roderman, Kasadi Moore, Shandlie Wilcox, Jennifer Jellerson, Zoey Bridges

HCA Healthcare Journal of Medicine

Background

This quality improvement project was initiated to reduce hospital-acquired catheter-associated bloodstream infections (CLABSI) in hospitalized patients receiving dialysis. A team dedicated to reducing hospital-acquired infections led the implementation of evidence-based interventions across all the included hospitals. This innovative approach demonstrated substantial enhancements in outcomes for patients on hemodialysis.

Methods

To enhance patient safety in patients receiving hemodialysis, new strategies were implemented, including (1) transitioning from a vendor model to an internal model, enabling dialysis program standardization, (2) empowering intensive care nurses with increased autonomy and ownership, (3) transitioning to a standardized dialysis machine, and (4) introducing chlorhexidine gluconate (CHG) …

Assessing The Effectiveness Of A Non-Punitive Fall Prevention Program, Nicki Roderman, Shandlie Wilcox, Cynthia Lang

HCA Healthcare Journal of Medicine

Background

Our single-center, quality improvement project evaluated the impact of a fall reduction plan while using a Just Culture Algorithm that included weekly fall reviews involving front line staff using a non-punitive structure. The project has shown successful results.

Methods

Prior to starting the program, data at this institution indicated falls were higher than the national fall rate of 3-5 per 1000 patient days. To achieve the goal of reducing the fall rate to below 3.1, an interdisciplinary fall committee was formed, consisting of nurses, nursing leaders, patient care technicians, pharmacists, and physical therapists. The committee operated in a non-punitive …

The Future Of Nurse-Led Research: The Road Ahead, Sammie Mosier

HCA Healthcare Journal of Medicine

Nursing as a profession is full of innovation. From nurse-led research and new technology to emerging models of care, nurses continue to blaze trails and take steps to improve patient care. As one of the largest employers of nurses in the United States, HCA Healthcare has an obligation to produce research and evidence-based practices to pave the way for the future of nursing practice and potentially change how care is delivered. In this editorial, HCA Healthcare’s chief nurse officer describes her vision for the future of nurse-led research and examines how education, partnerships, and technology facilitate the road ahead for …

Reducing Patient Falls In A Behavioral Health Unit: Improvement Through Audit Implementation, Kristin Gardner

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Fall-related events are a significant source of harm, with more than 700,000 patients falling every year in U.S. hospitals. The project was implemented in a 41-bed acute inpatient adult behavioral health unit (BHU). Over the last eight quarters, the BHU experienced an average of 3.16 falls per 1,000 days, exceeding the benchmark's median of 2.53 total falls.

Aim of the Project: The primary aim of this project was to decrease overall falls in an acute inpatient behavioral health unit.

Review of the Evidence: A comprehensive literature review identified intervention prevention bundles, compliance auditing, and staff education as effective ways …

Trauma-Informed Care: A Therapeutic Approach In Communication, Nicole A. Leonce

DNP Qualifying Manuscripts

As medical providers, it is crucial to use therapeutic communication when building relationships with patients. Bias, stigma, and judgment often manifest through a provider’s body language and choice of words, exacerbating patient trauma and leading to health disparities. Trauma-informed care (TIC) addresses these issues by emphasizing respect, compassion, and empathy. TIC has been extensively studied in high-income regions such as Australia, Europe and the United States, but its application in low- and middle-income countries (LMIC) such as Kenya, is less understood. The aim of this study was to assess the knowledge, attitudes, and skills of nurses working in a rural …

Health Literacy Among Chronic Kidney Disease Patients: Disparities In Information Seeking, Educational Needs, And The Role Of Healthcare Professionals, Fitri Mailani, Rahmi Muthia, Emil Huriani, Rika Sarfika

The Qualitative Report

Chronic kidney disease (CKD) is a complex disease that poses various challenges to patients. Health Literacy (HL) is considered essential for the effective management of CKD. This phenomenological study explored health literacy in 12 patients with chronic kidney disease undergoing hemodialysis in Padang, Indonesia. Semi-structured individual interviews were conducted, and the data were analysed and interpreted using the hermeneutical phenomenological approach of Diekelmann. We found six themes: sources of information and knowledge, differences in patient attitudes and behaviors as health information seekers, learning needs for successful treatment and care, effective learning and education methods, experiences with alternative treatments, and positive …

Enhancing Teamwork With Cliftonstrengths, Lauren A. Lelaidier

Master's Projects and Capstones

Abstract

Problem: Poor teamwork has a negative impact on patient safety, patient outcomes, patient satisfaction, healthcare work environments, and staff satisfaction. Effective teamwork is therefore critical but can be challenging.

Context: At a large, non-profit, academic healthcare system in San Francisco, all staff members working in the clinical research services (CRS) department identified teamwork as an area of concern. Teamwork survey results also indicated that teamwork could be improved.

Interventions: A literature review provided evidence that many types of team training are effective in multiple settings. Team training for all CRS staff included three interventions: a CliftonStrengths assessment, a one-on-one …

Increasing Resiliency In Front-Line Nurse Managers, Adrianne N. Bunyard-Fallquist

Master's Projects and Capstones

Problem

According to Membrive-Jimenez et al. (2020), 29% of nursing managers experience emotional exhaustion due to work overload, conflict mediation, and a lack of support from senior leadership. In a central California hospital, front-line nurse managers struggle to meet organizational goals and support their teams, with 64% indicating dissatisfaction in their roles in fall 2023. This highlights the need to improve job satisfaction and retention.

Context

A large healthcare system in Northern California has implemented Caring Science (Foss et al., 2015) and HeartMath® (HeartMath, 2023) techniques in a rural hospital to improve nurse manager retention and job satisfaction. The project …

Decreasing Incivility Through Improved Communication And Teamwork, Marvin Ernest Tamayo

Master's Projects and Capstones

Problem: Workplace incivility (WI), lateral violence (LV), and bullying in healthcare settings are pervasive issues negatively impacting staff morale, turnover rates, and patient care outcomes. High turnover and low employee satisfaction scores from a September 2023 culture of safety survey signaled a toxic work environment characterized by ineffective communication and unprofessional behavior. Context: A 24-bed telemetry-stroke unit at a 172-bed acute care facility in the North Bay area of San Francisco.

Interventions: The Transtheoretical Model (TTM) of behavior change and the Crucial Conversation frameworks were used to improve staff communication and reduce incivility.

Measures: September 2023 and March …

Preventing Hospitalization-Associated Disability, Elizabeth M. White

Master's Projects and Capstones

Problem: Hospital-associated disability (HAD) affects one-third of hospitalized adults, diminishing post-discharge independence and contributing to high mortality rates. Identifying at-risk patients through early assessment of nutritional and functional status upon admission is critical to personalizing care and improving discharge outcomes.

Context: A 24-bed adult medical-surgical unit in a 173-bed suburban hospital in Northern California is part of a large not-for-profit healthcare organization. Interventions: Nursing staff received education on the Enhanced Recovery Medicine (ERM) pathway designed to prevent HAD. A visual display board, maintained and updated by unit champions, gave staff performance feedback. Nursing leadership reviewed admission assessments and addressed barriers …

Decreasing Incivility And Bullying Through The Development Of A Healthy, Respectful Work Culture, Bridgette Wilson

Master's Projects and Capstones

Abstract

Problem: Incidents of bullying and incivility, including verbal aggression and exclusionary practices within the Telemetry department.

Context: This quality improvement project addresses workplace incivility, bullying, and harassment. The project aims to develop and implement a Compact Agreement of Unit Norms to foster a healthier work environment.

Interventions: Interventions included leadership education on bullying and conflict resolution, team awareness was heightened through workshops defining bullying and incivility, and a collaborative Compact Agreement of Unit Norms was developed and implemented.

Measures: An analysis of reported incidents for the first quarter of 2024 through the Electronic Reposting System (ERRF) on the Telemetry …

Reducing Hapi On A Medical Surgical Telemetry Unit, Emily Nicole Johansen

Master's Projects and Capstones

Abstract

Problem: Hospital-acquired pressure injuries (HAPI) are a global issue that harms patients, prolongs lengths of stay, and increases hospital costs and financial burdens. Because HAPIs are preventable, hospital organizations worldwide are implementing prevention strategies to improve the quality of care and quality of life and decrease costs associated with them.

Context: The 24-bed medical-surgical telemetry unit is one of five adult inpatient units within a Northern California hospital. The patient population includes an increased number of patients who are at risk of HAPI. The unit struggles with HAPI prevention, and the staff is challenged with implementing proper HAPI prevention …

Unlocking Icu Barriers: Investigating The Challenges Of Early Progressive Mobility, Leslie S. Bigler

Doctoral Projects

Approximately 800,000 patients in the United States annually are admitted to the Intensive Care Unit (ICU) due to critical illnesses and prolonged immobility contributes to poor patient outcomes. While existing data demonstrates early and progressive mobility helps improve outcomes, adherence remains inconsistent for a variety of reasons such as safety concerns, staffing, and lack of knowledge and confidence of mobilization techniques. This quality improvement project, conducted in a 20-bed Medical Intensive Care Unit, asked staff to identify barriers to adherence to mobility protocols. Nurse managers and clinical educators play a crucial role in addressing these issues using strategies such as …

Moral Disengagement And The Tendency To Engage In Academic Dishonesty In Prelicensure Nursing Students, Sarah Guimaraes

Electronic Theses and Dissertations

Despite decades of research, academic dishonesty remains a significant concern in nursing education. The connection of academic dishonesty to dishonest clinical practice presents a moral imperative for nurse researchers to find new facets of understanding these phenomena. Literature regarding moral disengagement in health care is minimal and is even less prevalent in the context of nursing education. The purpose of this study was to determine the effects of moral disengagement on prelicensure nursing students’ tendencies to engage in academic dishonesty in their last or next to last semester of a nursing program. A correlational design via survey method was used. …