Other Nursing Commons^™

Pursuing Equity In Diabetes Population, Aisha Rawlinson

Master's Projects and Capstones

Abstract

Background

Poor glycemic control (HbA1c >8) overtime leads to microvascular and macrovascular complications after the first and third years respectively, ultimately resulting in death after five years (Karter, 2016). Current Kaiser Permanente (KP) data stratified by race, ethnicity, age, and gender shows a significant disparity gap between Hispanics/Latino and Caucasian populations. The Pursuing IHI initiative is over a 2-year period completed at a microsystem that is focusing on health equity practices to reduce disparity gaps.

Project aim

KP Riverside, microsystem selected has a large population of Hispanic/Latino KP members, with focus on health equity. The project aim is to …

Cnl As Educator In The Emergency Department: Improving Hand Hygiene Outcomes, Michelle Batz

Master's Projects and Capstones

Prevention of hospital acquired infections (HAI) is a National Patient Safety Goal. Proper and frequent hand hygiene (HH) prevents HAI and various cross-infections in any setting. Audits of visual adherence for HH generates low compliance scores. During a yearlong improvement project, low monthly compliance scores of 52% in the Emergency Department (ED) of a community hospital, were reported by hospital auditors and found to be inaccurate by ED staff due to lack of visibility of HH actions because they occurred behind curtains or closed doors. Low scores and challenges were associated with behavioral change among ED team members, requiring multiple …

Improving Communication And Satisfaction Through Hourly Rounds, Karen E. Sondeno

Master's Projects and Capstones

The focus of this CNL project is quality improvement using high quality hourly rounds to achieve improved patient satisfaction and communication with nurses. It was determined by reviewing survey results that patient satisfaction and nurse communication is below National levels. Data shows that rounds are not being done well on a medical unit before the improvement project. It is proven that patients receive and perceive higher quality care and communication with increased nurse presence at the bedside. The population of the medical unit has high numbers of confused/dementia, and dual-diagnosis patients. It was determined that the unit would benefit from …

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 …

Hospital Acquired Clostridium Difficile Infection Prevention, Sandy Maalouf

Master's Projects and Capstones

Abstract

The aim of my CNL Internship Project is to decrease the incidence of healthcare acquired C diff infections at the acute care unit 1800 to zero for the next quarter. This will be accomplished by developing an action plan to address the issue by collecting data from audits and developing evidence based practice interventions. The process begins with patient’s admission to the medical surgical unit and ends with patient’s discharge from the medical surgical unit.

By working on the process, the Hospital Acquired Infection (HAI) team expects to improve infection control among all units, increase patient safety, reduce unnecessary …

Perception And Behavior For Underreporting Workplace Violence, Marissa L. Payne

Master's Projects and Capstones

The project is focused in a medical centers’ emergency department that serves a diverse population, varying in age, health, socio-economic status, and mentation; and at a given 24-hour period, the department will care for about 150 to 200 patients. The focus is on the Clinical Nurse Leader (CNL) essential to advocate a change in the culture of acceptance of workplace violence and the perception of the value of reporting violent behavior. To identify the factors that hindered reporting of workplace violence, a root and cause analysis was performed. The analysis revealed that the most common reason behind underreporting is the …

Implementation Of Patient Mobility Assessment Tool: A Clinical Nurse Leader Initiative Towards Improved Patient And Nurse Health Outcomes, Janet Lopez

Master's Projects and Capstones

Abstract

Early ambulation during hospitalization has been recognized as a fundamental and logical intervention to reduce patients functional decline and muscle weakness. Recently, our healthcare system is encouraging nurses to become more actively involved in assessing patient’s mobility status and managing their mobilization. However, since the high nursing workload affects the time that a nurse can assign per task, more often than not they have little time to accurately assess patient’s mobility status; Presenting a safety concern for nurses and patients. In an effort to ease this challenge, the Patient Mobility Assessment Tool (PMAT) is introduced as an efficient nurse-driven …

Implementation Of Sbar Reporting In The Ed, William Russel Carpenter

Master's Projects and Capstones

Implementation of SBAR reporting in the ED

Abstract

In our emergency department, reports given to the accepting floor nurse, transfer of care between emergency department nurses and nurses reporting to physicians are given in many different formats with no continuity. It has been reported that 1,744 deaths and $1.7 billion in hospital costs related to miscommunications (CRICO Strategies, 2015). With the implementation of the SBAR reporting tool, we can begin to see a decrease in miscommunications, and improve patient and staff satisfaction. The SBAR framework not only enhances the clarity and efficiency of communication between team members but also assures …

Minimizing The Inappropriate Use Of Physical Restraint, Shiela Marie C. Telmo

Master's Projects and Capstones

The aim of this project is to be able to improve patient safety by minimizing the inappropriate use of physical restraints from 45% to about 20% in the acute respiratory unit which caters to patients with acute respiratory issues, such as exacerbation of chronic obstructive pulmonary disease (COPD), patients with new or old tracheostomy, needing bipap, rigorous nebulizer treatment, and other respiratory-related devices, not to mention the multiple comorbidities that oftentimes very difficult to stabilize which makes the hospital stay longer than usual. The Clinical Nurse Leader (CNL) as an educator and an outcome manager is an agent to empower …

Admission Handoff Between Emergency Department And Inpatient Units, Amanda A. Briones

Master's Projects and Capstones

When admitting a patient from the emergency department (ED) to an inpatient unit, a handoff report is conducted. There are many ways the ED nurse can go about delivering this report to the inpatient or floor nurse. Each ED nurse tends to this task in their own way, providing the information they deem important. Due to the absence of standardization, handoff reports have the ability to lack important information regarding the patient and can even lead to compromising the safety of the patient.

The purpose of this project was to gain a comprehensive understanding of the current handover process of …

Increasing Chlorhexidine (Chg) Daily Bathing Compliance, Jonathan Lee

Master's Projects and Capstones

Chlorhexidine gluconate (CHG) daily bathing in hospitalized patients in the intensive care setting is one of many interventions implemented by institutions to reduce and prevent central line associated bloodstream infections (CLABSIs) and catheter associated urinary tract infections (CAUTIs). These hospital-acquired infections (HAIs) plague and complicate treatments for critically ill patients in the acute care setting. CLABSIs and CAUTIs increase patient morbidity and mortality as well as place a financial burden with increased costs and hospital lengths of stay. The decrease of CHG compliance in our ICU unit can be associated with an elevated CLABSI rates. The focus of this CNL …

Nurse Shift Handoff Report At The Patient's Bedside: Improving Nurse-To-Nurse Communication, Francis R. Estrella

Master's Projects and Capstones

The purpose of the CNL project is to develop a standardized approach to communication during nurse shift handoffs through utilization of bedside shift reporting (BSR). Shift handoffs are integral to nursing practice; therefore, this process must be accurate, effective, and consistent in order to ensure the delivery of safe and quality care. The project focuses on the CNL curriculum element of Quality Improvement and Safety, under the role of an Outcomes Manager. Prior to BSR implementation, shift handoffs in the sub-acute unit were being conducted at the nurse’s station or by the medication carts. Nurse shift handoffs were often rushed, …

Standardization Of Body Imaging Huddle In Radiology, Margaret M. Browne Mcmanus

Master's Projects and Capstones

Mag Browne McManus

Clinical Nurse Leader Abstract

University of San Francisco

Abstract

Communication amongst healthcare providers is critical to reducing errors, and in procedural areas, the huddle can be used to standardized communication amongst the team before the beginning of interventional procedures (Goldenhar, Brady, Sutcliffe, Muething, & Anderson, 2013). Prior to the implementation of the revised huddle, a staff survey indicated none of the staff were satisfied with the current process. The objectives of the standardization of the body imaging huddle in the department of radiology were to increase staff satisfaction by 15% and reduce the time from patient arrival …

Approach To Safety Improvement: Focusing On Better Care (Fall Prevention In Medical Surgical/Intermediate Care Unit), Jose Fox Caballes Jr

Master's Projects and Capstones

Patient safety is one of the major concern of any healthcare provider during their patient’s hospital stay. This project addressed the steady trend of fall incidences compared to last fiscal years’ data of an average of 4 falls per month. This trend created urgency to envisioned a plan for solutions to prevent this circumstance from happening. This Clinical Nurse Leader led a project in creating a process in identifying all patients that are high risk to fall (HRTF) prior to their admittance or transfer to Medical Surgical/Intermediate Care Unit and throughout their hospital stay until they are discharged. In addition, …

Improving Preadmission Testing Nurses' Knowledge Of Aortic Stenosis And Transcatheter Aortic Valve Replacement, Alberta Lynn Canale

Master's Projects and Capstones

Abstract

The purpose of this Clinical Nurse Leader (CNL) project was to reduce gaps in nursing knowledge through staff education. Guided by the CNL theme of educator and information manager, the goals were to increase PreAdmission Testing (PAT) nurses’ knowledge of severe/critical aortic stenosis (AS), transcatheter aortic valve replacement (TAVR) procedure and patient selection, and satisfaction with knowledge by 10%. Rapid growth of the TAVR program has contributed to a gap in nursing knowledge leading to inconsistent patient care and education. An educational program was developed and spread through a series of Plan-Do-Study-Act cycles. Pre- and post- implementation surveys were …

Recovery-Oriented Care And Inpatient Psychiatric Nursing Practice, Julia M. Mclaughlin

Master's Projects and Capstones

For the past 15 years, major organizations such as the World Health Organization (WHO), Substance Abuse and Mental Health Services Administration (SAMHSA), and U.S. federal government have been committed to shifting mental health services from the medical model of care to the recovery-oriented model of care (Moller & McLoughlin, 2013). However, not all identified recovery-oriented practices have been fully implemented throughout mental health services, specifically in acute care settings. In 2015, San Mateo Medical Center’s acute psychiatric nursing staff completed McLoughlin’s (2005) Recovery Self-Assessment- Registered Nurse (RSA-RN). Data showed that 34% of nursing staff did not believe that the nurses …

Debriefing In The Emergency Department, Alyssa Johnson

Master's Projects and Capstones

Emergency Department (ED) staff are repeatedly exposed to high stress situations and as a result suffer from compassion fatigue, secondary traumatic stress, symptoms of post-traumatic stress disorder, burnout and high turnover rates. Staff turnover is costly to the health system in the form of training new staff and potential poor patient outcomes due to under staffing or inexperience of staff. Based on a survey about debriefing, Level 1 Adult and Pediatric Emergency Department staff reported 81% felt there was inadequate support for critically stressful events that occur. Debriefing was identified by 75% of the staff as an option for support. …

Improvement Of Outcome And Assessment Information Set (Oasis) Documentation In Home Care To Boost Medicare Star Rating, Jennifer Kernohan

Master's Projects and Capstones

The aim of this CNL Internship Project is to improve the admission and discharge assessments of a home care agency in order to boost agency’s star ratings. The project is being carried out within a home care agency in Northern California. The multidisciplinary team provides services in the patients’ place of residence, an ever-changing setting. The project follows a train-the trainer approach beginning with self-paced learning of the OASIS format. The trainee will conduct an admission, also known as start of care (SOC), assessment followed by trainer critique and advisement. Establishing a rapport early will aid the assessment process. Face-to-face …

Improving Unit Dynamics: Incorporating Lead Nurse Program On A Medical-Surgical Unit, Kara Mace

Master's Projects and Capstones

Clinical nursing leadership is now recognized as a key professional competency that will assure quality patient care and efficient work processes. The medical-surgical unit (MSU) at VA Mather has had high turnover rates and low staff satisfaction surveys for the past two years, which has led to a decline in staff morale. Lead nurses are in key positions to develop their unit staff, promote leadership development, and they are encouraged to act as role models in their practice. Change is difficult; therefore, the application of essential leadership skills is a necessary accompaniment to a change strategy in order to produce …

Issues In Patient Information Transmission: Standardizing Home Health Admission, Philippa Thomas

Master's Projects and Capstones

When 84 patients, current and former, complained about lack of information during the intake process within five months period, a uniform "Patient Screening Tool" (Appendix L) was developed to improve the admissions process to this home health agency. Intake staff is responsible for receiving accurate information from the referral sources, confirming qualifications to receive services, and initiating education about services to the patient. While the population served has a wide range in age, diagnoses, discharge settings and cultures, the majority are over 65, frail, homebound and are returning home after hospital, SNF or rehabilitation settings.

Data were collected through evidence …

Standardized Blood Transfusion Documentation, Kelly A. Hill

Master's Projects and Capstones

The aim of this project was to improve nurse satisfaction through the use of a standardized blood administration documentation template. The goal was to reduce the time that nurses spend charting by offering a structured documentation template and to ensure that the procedure is correctly recorded in the patient’s electronic record. The leadership theme that supported this project is Information Manager, as the clinical nurse leader (CNL) uses information systems and technology at the point of care to improve health care outcomes. The selected microsystem is a medical/surgical/telemetry unit, which has 38 beds with 38 registered nurses (RNs). When surveyed, …

Use Of The Patient Whiteboard To Improve Communication Of Pain Medication Schedule, Carmela Gonzalez-Shalaby Msn, Rn

Master's Projects and Capstones

Abstract

Despite advances in treatment, pain remains a significant problem in healthcare today. Sub-optimal pain management results in poor patient outcomes and patient satisfaction, culminating in decreased quality of life and financial loss for the health care facility. An important component of pain management is transparent and timely health care team/ patient communication. This project aims to improve patient satisfaction in pain management by incorporating pain medication last given and next available times on patient whiteboards. The targeted floor was a busy post-op medical floor in a medium sized community hospital. Staff were educated with short educational sessions, educational pamphlets, …

Implementing Change To Decrease The Re-Admission Rate For Clients Of A Care Transition Program, Aileen Tran

Master's Projects and Capstones

The clinical nurse leader (CNL) internship project’s purpose is to implement a change to decrease readmission for clients in a care transition program, thereby improving quality of life. This care transition program aids with the transition from hospital to home for adults. The microsystem is composed of public health nurses, volunteers, student interns, supervisors, and an administrative assistant. The aim statement for this change project is to improve patient safety by decreasing readmission rates by implementing an initial follow-up phone call within one day of discharge in 75% of the care transition clients by April 30, 2016. This project was …

Discharge Improvement Process, Medeina O'Neal

Master's Projects and Capstones

Abstract

The focal point of the project takes account of the CNL educational program component of the Care Environment. The purpose of the CNL role would reflect the Team Managers functionality. “Care Environment identifies clinical and cost outcomes that improve safety, effectiveness, timeliness, efficiency, quality, and the degree to which they are client-centered“ (AACN, 2013). The unit provides care to patients who require constant cardiac monitoring for reasons that may include sepsis, pneumonia, recent surgeries, advanced congestive heart failure, renal failure and COPD. Having a standardized discharge process could hopefully reduce the number of delays, so that the desired goals …

Implementing Ways To Reduce Catheter-Associated Urinary Infections (Cautis), Maryam Keyhani

Master's Projects and Capstones

Abstract

Center for Control and Disease Prevention (CDC), estimates that 40% of all Urinary Tract Infections (UTIs) are related to Hospital-acquired Infections (HAIs) (CDC, 2013). The Facility where the project was done consists of oncology, orthopedic, medical-surgical, telemetry, incentive care, and step-down units. This hospital with 242 licensed beds has approximately 51,571 ER visits and a total of 10,606 admissions per year.The prevalence of Cather-associated Urinary Tract Infections (CAUTIs) on the 4th floor, the medical-surgical unit with 42 beds was significantly higher than other units. The hospital goal is to increase patient safety and satisfaction as well as reduce and …

An Interdisciplinary Approach To Reducing Falls: Utilizing Team Huddles And Visual Aids To Increase Nursing Staff And Patient Knowledge On T.E.A.M. Fall Risk Interventions, Jennifer A. Viernes

Master's Projects and Capstones

One of the most important aspects of patient safety is the prevention of patient falls (PFs). PFs are a never event and are preventable. The project addresses the ongoing increase in PFs on a medical-surgical oncology unit in an inpatient hospital setting. The increase in PFs created urgency to provide solutions to these preventable circumstances. This Clinical Nurse Leader (CNL) led the project and conducted a comprehensive microsystem assessment of the potential causes of PFs calling for further investigation of the unit’s current fall policy. After conducting two surveys of both the nursing staff (NS) and patients’ knowledge of fall …

The Use Of Personalized Whiteboards In The Inpatient Acute Care Setting And Their Effect On Patient And Nurses Perception Of Communication, Cheryl Karn

Master's Projects and Capstones

A microsystem assessment of two inpatient medical-surgical wards in a medical facility determined a majority of nurses reported dissatisfaction with the amount and type of communication with the interdisciplinary team. This, along with a review of Press-Ganey scores from the inpatient wards, revealed patients reported decreased satisfaction when asked if “nurses kept me informed”, compared to previous quarterly reports as well as other VA facilities. Multiple studies have shown the benefit of personalized whiteboards (PWs) at the patient bedside in improving not only communication but also safety and patient outcomes. A PW was developed by the Clinical Nurse Leader …

Reducing The Incidence Of Hospital-Acquired Pressure Ulcers By Enhancing The Role Of Unit-Based Skin Champions, Anne V. Loewenthal

Master's Projects and Capstones

Reducing the Incidence of Hospital-Acquired Pressure Ulcers by Enhancing the Role of Unit-Based Skin Champions

Abstract

Hospital Acquired Pressure Ulcer continues to be an alarming issue in today’s healthcare systems. Often preventable, it is a significant nursing role and a frequently used benchmark for quality care. Studies have shown that hospital-acquired pressure ulcer (HAPU) complications have been associated with “up to 60,000 deaths each year in the United States” (AHRQ, 2014). A major health problem, it presents grave consequences on the patient’s well-being, significant treatment and recovery delays, increase length of inpatient stays, and have become a “never” event from …

Fall Reduction With Nursing Interventions, Sin Ting Chan

Master's Projects and Capstones

The aim of the project is to reduce the patient’s fall rate in the medical surgical unit at an acute care hospital through improving the fall precaution process. The unit consists of 37 bed with a population of stroke, medical, and surgical patients. The focus of the nursing staff education using handouts, brochures, and poster will be based on the results from pre and post intervention audits. The goal of this fall reduction project is to have the nursing staff learn, review, and apply fall prevention interventions for fall risk patients in order to help reduce fall rate by 50 …

Improved Satisfaction On Postpartum Unit By Implementing A Discharge Nurse Role, Nicole Ware Rn, Msn

Master's Projects and Capstones

A three-month time period was used to develop a postpartum education program change by designing a discharge nurse role on the postpartum unit at University of North Carolina Women’s Hospital. The goal of the education change is to increase patient satisfaction scores of discharged post-natal mothers on the postpartum unit by having HCAPS and Press Ganey to improve up to10% over the next 6 months.

An observational assessment revealed a fragmented and antiquated discharge process. This process was paper based and difficult to complete in light of the short stay and high volume patient population. Informal nurse feedback as well …