Other Nursing Commons^™

Can The Implementation Of Interprofessional Rounds Improve Hospital Throughput Efficiency?, Rebecca Howdyshell

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Abstract

Efficient throughput processes are a vital part of providing cost effective, safe, quality patient care. Research has shown interprofessional rounds can have success at improving throughput processes. A rural, not-for-profit, 255 bed hospital in a Mid-Atlantic State was experiencing issues with throughput/patient flow. The aims of this quality improvement project were 1). to implement Interprofessional Rounds on the Progressive Care Unit (PCU); 2). To design and build a working Interprofessional Rounds template into meditech to guide Interprofessional Rounds and streamline discharge documentation; 3). to increase the amount of discharge orders entered between 0700 and 1300 by ten percent; and …

Transitions Of Care: Implementing Early Follow-Up Appointment To Help Decrease Readmission Rate, Lualhati Espina Dursun

Master's Projects and Capstones

Abstract

Problem – The rate of readmission in the country is at a severe level. According to CMS, in 2017 the average national readmission rate was 18.4%(CMS, 2018). Hospitals are penalized for unnecessary readmissions (HRRP, 2018). In addition to the financial burden of readmissions, quality of life is decreased with readmission.

Context – Early or timely outpatient follow-up after hospitalization has been projected as a means of decreasing readmission rates.

Interventions – Integrating follow-up appointment to the current care transition - HUB process as a means in reducing readmission rates.

Measures & Results – Identified high-risk patients that need timely …

Healing Wounds Through Nutrition, Deanna Garza

Master's Projects and Capstones

Abstract

The role of nutrition in wound care is often overlooked. The main reasons why wounds fail to heal are malnutrition, infection, impaired organ function due to co-existing diseases such as diabetes, hypertension, renal disease, and peripheral vascular disease to name a few. These factors have contributed to poor patient outcomes and patient satisfaction, as well as an increase in hospital length of stay. To promote wound healing, fuel from macro and micronutrients are necessary to deliver oxygen and energy for cell regeneration. However, nurses must possess knowledge and understanding of these requirements and the effects of nutrition on wound …

Transforming Nursing Preceptors By Developing Emotional Intelligence, Michael Francis

Doctor of Nursing Practice (DNP) Projects

Changing the process of professionally developing nursing preceptors to meet the growing and changing needs of the nursing profession is critical. This evidence-based project leveraged an advanced preceptor education program for inclusion of basic emotional intelligence tenets and transitioning them into preceptor self-awareness, leadership recognition, and return on human capital investment. A large integrated healthcare system in Northern California identified a strategic need for preceptor development and within the system two acute care hospitals and one home health/hospice agency were selected to participate. The intervention included the development of a six-hour curriculum delivered through an interactive and innovative in-person learning …

Defying The Gravity Of Falls On Msu, Alvin Joseph Abad

Master's Projects and Capstones

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

Improving Nursing Communication Outcomes Through The Tell-Us Card, Brittney Pilker, Jillian Cule, Laura Le, Nina Park, Jeffrey Salao, Maricarmen Reyes

Master's Projects and Capstones

Nursing communication plays a pivotal role in patient-centered care. However, statistics have shown that failures in communication exist in more than 20% of all hospital settings (Sethi & Rani, 2017). Within the explored microsystem, a gap in patient communication was identified through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Reports revealed that the microsystem was performing at 69%, which is 11% below the national average for nursing communication (Centers for Medicare and Medicaid Services [CMS], 2018). After performing a microsystem assessment, there was a measurable communication opportunity between the patients and nurses. It was determined that …

Raising Oas Cahps Scores: Using Patient Education, Katrina Pangilinan

Master's Projects and Capstones

At the Golden Gate Endoscopy Center (GGEC), the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery (OAS CAHPS) survey results on patient satisfaction have been below the 50th percentile for the last three quarters of 2018. Patient satisfaction scores are a quality measure for the patient care experience and important for the success of the organization and its providers. Based on patient comments from previous surveys, patients feel that the center does not explain the possible side effects of the anesthesia in a way they can understand. Other patient comments and concerns included confusion regarding dietary restrictions …

Improving Nursing Communication Outcomes Through The Tell-Us Card, Jeffrey Salao, Nina Park, Laura Le, Brittney Pilker, Jillian Cule, Maricarmen Reyes

Master's Projects and Capstones

Abstract

Nursing communication plays a pivotal role in patient-centered care. However, statistics have shown that failures in communication exist in more than 20% of all hospital settings (Sethi & Rani, 2017). Within the explored microsystem, a gap in patient communication was identified through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Reports revealed that the microsystem was performing at 69%, which is 11% below the national average for nursing communication (Centers for Medicare and Medicaid Services [CMS], 2018). After performing a microsystem assessment, there was a measurable communication opportunity between the patients and nurses. It was determined …

Combining Patient-Centered-Care And Technology To Reduce Falls In A Medical/Telemetry Unit, Megan Mira

Master's Projects and Capstones

Abstract

PROBLEM: From October 2017 through June 2018 there were 25 patient falls recorded on the 5^th floor medical surgical telemetry unit. Top factors contributing to this high fall rate include: poor patient-centered-care planning, and inadequate set-up for use of technology.

CONTEXT: According to the Joint Commission, 2015, each fall with injury costs $14,000. This estimate doesn’t include the potential indirect costs that account for the long-term effects of injuries such as disability, dependence on others, lost time from work, household duties, and reduced quality of life.

INTERVENTIONS: Staff education was introduced and focused on using a new mindfulness …

An Innovative Discharge Intervention: A Quality Improvement Project, Yvonne Swain

Master's Projects and Capstones

Abstract

Problem: This project aims to decrease the discharge time of a patient from the hospital once the discharge order has been written. Current discharge times are averaging over 3 hours, leading to a breakdown in the patient throughput process. A patient survey was conducted to determine the reason for prolonged discharge times. The survey revealed that patients are not aware of their day of discharge, which may lead them to being discharged without transportation home. Many studies conclude that there are improvement opportunities around discharge planning and communication.

Context: This quality improvement initiative takes place in a 26-bed, medical-surgical/telemetry …

Catheter-Associated Urinary Tract Infection Reduction: A Quality Improvement Project, Wallace Kramm

Master's Projects and Capstones

Abstract

Problem: Hospital-acquired infections are preventable harm that occurs to patients while in the hospital. Catheter-associated urinary tract infection (CAUTI) is a preventable hospital-acquired infection that continues to plague hospitals nationwide. The Centers for Disease Control and Prevention estimates that there are more than 13,000 CAUTI related deaths in the United States annually (Scanlon, 2017). In addition to the harm caused to patients by CAUTIs, the estimated $500 million yearly cost for CAUTI treatment has created a fiscal burden on healthcare systems (Scanlon, 2017). Decreasing the rate of CAUTI by decreasing overall number of catheters is the goal of this …

"Improving Nursing Communication Outcomes Through The Tell-Us Card", Jillian Cule, Jeffrey Salao, Nina Park, Laura Le, Brittney Pilker, Maricarmen Reyes

Master's Projects and Capstones

Nursing communication plays a pivotal role in patient-centered care. However, statistics have shown that failures in communication exist in more than 20% of all hospital settings (Sethi & Rani, 2017). Within the explored microsystem, a gap in patient communication was identified through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Reports revealed that the microsystem was performing at 69%, which is 11% below the national average for nursing communication (Centers for Medicare and Medicaid Services [CMS], 2018). After performing a microsystem assessment, there was a measurable communication opportunity between the patients and nurses. It was determined that …

Post-Traumatic Stress Disorder Screening Project For Adult Males From The Middle East And Afghanistan, Ricky Norwood

Master's Projects and Capstones

Current research indicates a significant rise in PTSD signs and symptoms of adult males arriving from the Middle East and Afghanistan. In an effort to increase the awareness of Post-Traumatic Stress Disorder (PTSD) in clinical personnel and adult males from the Middle East and Afghanistan, the Sacramento Refugee Health Clinic implemented a PTSD Screening Project. This project was designed to ensure the maximum number of the adult males from the Middle East and Afghanistan would be appropriately screened for PTSD and provided additional opportunities to meet the mental and acute primary care needs of these patients in an adequate and …

Reducing Inpatient Readmissions Through Early Follow-Up Appointment Planning: A Quality Improvement Project, Isabella Cuenco

Master's Projects and Capstones

Problem: Inpatient readmissions have a highly negative impact on healthcare systems. Not only do these hospitalizations have a detrimental effect on patient outcomes they also are accompanied by a prohibitive financial burden to the hospitals.

Context: Follow-up appointment with a primary care provider after discharge has been demonstrated as a viable strategy to reduce the risk of readmissions.

Interventions: Create a volunteer program to schedule patient appointments with a primary care provider within seven days of discharge.

Measures and Results: Compare the number of patients that were discharged with a follow-up appointment after the intervention to before the intervention, and …

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

Master's Projects and Capstones

Abstract

Problem

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

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

Master's Projects and Capstones

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

Tools To Increase Compliance And Decrease Mortality Due To Sepsis, Cody F. Carr

Doctoral Projects

Severe sepsis is a leading cause of death in the United States and is the most common cause of death among critically ill patients in non-coronary intensive care units (Mayr, Yende, & Angus, 2014). The incidence of severe sepsis is estimated to be 300 cases per 100,000 population and cost an estimated $14 billion in the United States (Mayr et al., 2014). This Doctor of Nursing Practice (DNP) project focused on identifying an early-assessment tool to identify sepsis and increase compliance when using the tool. Identifying sepsis early is important in starting a treatment plan to prevent morbidity and mortality. …

Early Oral Feeding After Bowel Resection, Jennifer Strang

Theses & Dissertations

Research Focus: The primary purpose of this project was to determine if there was an association of factors with time to first solid meal in gastrointestinal (GI) surgery patients and the impact solid diet has on length of stay (LOS) in the hospital, GI symptoms, and incidence of post-operative ileus (POI). A secondary purpose was to observe and describe when an oral diet was started and the progression of diet after GI surgery.

Research Methods: This study was a cross-sectional, retrospective chart review of a convenience sample in a multi-centered hospital system conducted in 84 GI resection patients …

Nurse Expectations As Compared To Perceived Reality, Kathryn Mckelvy

Dissertations

Burnout and turnover in nursing have been well documented in nursing literature, but little is known about a nurse’s expectations of the profession compared to their perceived reality of the profession. Do these expectations meet the reality of the workplace, and does this cause the nurse to make a career change? What factors influence a nurse to leave the profession, job-hop, or return to school to further their education? The rate of nurse turnover is an ongoing issue with a lack of research regarding the foundation of nurse expectations compared to the realities of the profession.

The purpose of this …

Self-Care Vs. Self-Sacrifice In Medical-Surgical Nursing Culture: A Critical Ethnography, Elise Jordan Juergens

Dissertations

The critical ethnography research examines need prioritization culture among medical-surgical nurses. Grove, Burns, and Gray (2013) define the problem statement as an explicit identification of the research need. Literature search yields scarce ethnographic research on the nursing population as a culture-sharing group, and no qualitative research exists regarding medical-surgical nurses’ self-need prioritization. The purpose of this critical ethnography is to observe medical-surgical nursing culture, related to personal need prioritization, as reflected by behavior and dialogue.

Qualitative research methodology is appropriate where statistical data is not. Research motivation involves seeking insight and sociocultural understanding. Critical ethnography is the chosen qualitative research …