Fall Colloquium October 2023

Dr. Muriel Moyo

Aspen University

School of Nursing & Health Sciences

9:00 am PST

"Healthy Work Environment: Impact of Structured Nurse Leader Rounding 

in a Medical Intensive Care Unit"

Our Medical Intensive Care Unit (MICU) was the primary unit for COVID-19 patients requiring critical care during the height of the COVID-19 pandemic. Rapid changes in information and processes, high patient acuity, mortality rates, and use and shortages of personal protective equipment took a toll on staff, impacting staff and patient satisfaction in the MICU. The purpose of this quality improvement project was to determine if the implementation of structured nurse leader rounding would improve staff satisfaction related to communication, leadership, and recognition among staff and in turn improve patient satisfaction in the MICU. The Human-Centered Leadership theoretical framework guided this project. A pre-and-post design was used to measure staff and patient satisfaction after the implementation of structured nurse leader rounding. Structured nurse leader rounding included one-to-one conversations between the unit’s nurse leaders and staff and with patients and families asking the same strategic questions, collecting actionable insights, and addressing needs. Pre-and-post-intervention scores were in was measured using the AACN Healthy Work Environment Assessment. Post-intervention there was an increase in the aggregated mean score for all three standards targeted for this project namely, skilled communication 4.26 to 4.36, authentic leadership 4.27 to 4.64, and meaningful recognition 4.26 to 4.58. Patient satisfaction related to nurse communication improved during the intervention window, with two of the questions scoring above the benchmark. “Nurse courtesy and respect” remained at 100%; “Nurse explained things” improved from 66.7% to 87.5%; and “Nurse listened carefully” improved from 0% to 50%. This increase in staff satisfaction demonstrates the positive impact of structured nurse leader rounding related to communication, recognition, and leadership and in turn an improvement in patient satisfaction in the MICU.

Recording Link

Dr. Marell Hazel Garcia

Aspen University

School of Nursing & Health Sciences

9:00 am PST

"Impact of Process Improvement in Quality Check on Reduction of Errors 

in Surgical Instrumentation"

Ensuring that surgical instruments are clean and in proper working order is of importance to all healthcare organizations including the surgeons who perform surgery and the patient undergoing surgery. An audit by the project site determined that 43% of surgical instruments were flawed. This quality and process improvement project used the Association of periOperative Registered Nurses (AORN) standards related to guidelines for the care and cleaning of surgical instruments as an approach to reduce errors in surgical instrumentation at the project site facility. Nightingale’s Environmental Theory provided the theoretical foundation for this project. Using Lean methodology an analysis was completed, and a standard workflow was designed for quality checks for surgical instruments. Kotter’s Change Model guided the process change. The instrument data was collected at baseline for one month and post-implementation of the project for one month. The baseline timeframe had 1670 instruments checked with 667 errors (40%) noted. The month after implementation of the project there were 1915 instruments checked with 457 errors (24%) noted. Pearson’s chi-square was performed on the rates of errors to determine if the quality improvement had an impact. A significance level of .05 was used to determine statistical significance. A statistically significant difference in the rate of instrument errors was noted post-implementation [χ2 (N =3585) = 107.1, p = .000]. A clinically significant 16% decrease in the instrument errors was noted after implementing the project. Recommendations include continuation of the quality checks and disseminating of this practice to other organizations to reduce surgical instrumentation errors.

Recording Link

Dr. Heidi Roschinger

Aspen University

School of Nursing & Health Sciences

1:00 pm PST

"Binding the Brokenhearted: Early Recognition of Depression Improves 

Heart Failure Patient Outcomes"

Depression and heart failure are comorbid conditions in twenty percent of the heart failure population. These combined conditions are associated with poor patient outcomes, such as higher mortality risk, frequent hospitalizations, increased healthcare utilization, and diminished quality of life (Jha et al., 2019). An evidence-based quality improvement project was undertaken to implement depression screening in an ambulatory heart failure clinic to increase the recognition of comorbid depression in this population and assess the relationship between early recognition of depression and hospital readmissions. The Doctor of Nursing Practice quality improvement project used a correlational descriptive design to evaluate the relationship between early recognition of depression and hospital readmissions. The project found that depression was prevalent in the heart failure population, depression was positively associated with increased healthcare utilization as measured by emergency room visits, and no correlation was found between depression screening and hospital readmissions within thirty days. The project’s significance in practice is the implementation of evidence-based healthcare delivery with heart failure patients receiving screening for depression in the ambulatory setting and ultimately improving patient outcomes through early recognition of depression.

Recording Link

Dr. Liz Ubaldi

Aspen University

School of Nursing & Health Sciences

11:00 am PST

"Implementing an Alcohol Use Screening Protocol in Palliative Care"

While statistics have shown that up to 28% of palliative patients have alcohol use disorder (AUD), research has shown that up to 86% of these patients are undiagnosed at the time of palliative referral. This DNP quality improvement project is guided by the Humanistic Nursing Theory (HNT) and employs a validated alcohol use screening tool to improve alcohol use screening for palliative patients as part of an alcohol use screening protocol. The Knowledge-to-Action (KTA) framework was used to guide the project’s implementation. Participating staff were educated on the protocol during a face-to-face education session that was recorded and made available on the project site’s learning management system. Data from the pre-implementation and implementation phases were collected using a chart audit review. The results were analyzed using a chi-square test of homogeneity to determine if the proportion of patients screened for alcohol use was the same in each project phase. The results showed that there was a significant increase in the rate of screening for alcohol use on admission to the project site during the implementation period as compared to pre-implementation (p = .003). The results of this DNP project add to the limited body of knowledge about screening for and managing AUD in palliative care. 

Recording Link

Dr. Bev Naylor

Aspen University

School of Education 

1:00 pm PST

"Conquering the Challenge to Completion: A Phenomenological Study 

of Experiencing Negative Life Events During Doctoral Pursuit"

The doctoral dropout rate ranges from thirty to seventy percent. Research has identified reasons for doctoral attrition. Some doctoral students have experienced negative life events and persevered to doctoral completion. This qualitative hermeneutic phenomenological study was based on the problem statement; it was not known how some doctoral students pursuing their online doctoral program, overcame negative life events or setbacks to complete their doctoral program. The study examined doctoral completion from the angle of an added layer of complexity resulting from unexpected negative life events such as the deaths of family members, hospitalization of child, house fire, financial stress resulting from loss of income, and grave illness. Seven underlying research questions addressed the nature of unexpected negative life events, the processes and influences that facilitate doctoral completion, how resilience leads to doctoral completion and the resiliency factors characterizing the doctoral student, how salutogenesis, coherence, student integration, and student involvement contribute to doctoral completion, and whether the doctoral program facilitated recovery from negative life events. The sample comprised nine American graduates who completed their doctoral program between 2018 and 2022 and were recruited from Facebook doctoral groups. Data, collected through semi-structured interviews conducted via Zoom, were analyzed using Moustakas modified van Kaam method. Findings of this study indicate that strategies for doctoral completion under normal circumstances are effective for the doctoral pursuit under adverse conditions: A Student-Chair relationship, family support, research topic, desire for completion, self-care, time management, and positive thinking. Resilience was enhanced through goal setting, memories of coping with difficult past situations, and faith. 

Recording Link

Dr. Kristy France Smith

Aspen University

School of Nursing & Health Sciences

9:00 am PST

"Improving Geriatric Syndrome Treatment Recommendations"

In the United States as older adults continue to age, care becomes more complex and the likelihood of developing geriatric syndromes such as frailty, sarcopenia, malnutrition, and cognitive impairment increases. This quantitative, quality improvement project aimed to identify geriatric syndromes in older adults thereby maximizing function, health, and quality of life through the implementation of timely treatment interventions. The project collected data from a convenience sample of 75 patients ages 65 and older who receive care in the geriatric patient-aligned care team (GeriPACT) clinic at the Central Texas Veterans Health Care System (CTVHCS). The Rapid Geriatric Assessment (RGA), developed by the Saint Louis University School of Medicine, was administered to patients at the beginning of their scheduled GeriPACT clinic appointments to assess for geriatric syndromes. A pretest-posttest design was used to determine whether there was an improvement in the identification and treatment of geriatric syndromes as noted by the documentation of corresponding diagnosis codes being added to the participants' problem list. The project findings suggest completing the RGA improves the identification of geriatric syndromes. Of the 75 participants screened, 62 (83%) screened positive for either pre-frail or frail, 25 (33%) screened positive for sarcopenia, and 27 (36%) screened positive for risk for weight loss. Sixty-five participants were screened for cognitive impairment, 15 screened positive for mild cognitive impairment and 15 screened positive for dementia for a total of 30 (46%) positive cognitive impairment screens. Although, project findings noted no change in the documentation of frailty, sarcopenia, or risk for weight loss; data did reveal 27% of patients who had positive cognitive impairment screens received a corresponding diagnosis. 

Recording Link

Dr. Mary Dereshiwsky

Aspen University

School of Education

1:00 pm PST

"Teacher as Target: Recognizing and Minimizing 

Student Bullying of Faculty Online"

Student-to-student cyberbullying has been extensively researched. Comparatively less has been studied in the area of online student bullying of faculty. What causes such bullying? How does it manifest in student behavior? Finally, what are some proactive steps online faculty can take to reduce the likelihood of bullying by students to maximize the ideal of online safe learning spaces? Practical suggestions will be shared in this presentation.

Recording Link

Dr. Kimkyla Kritch

Aspen University

School of Nursing & Health Sciences

9:00 am PST

"Creating an Environment of Safety in the Emergency Department for Staff and 

Boarding Psychiatric Patients: A Quality Improvement Project"

Emergency Department (ED) overcrowding has become a problem for many organizations across the United States. The result of too few inpatient psychiatric beds and the increase in psychiatric patients presenting to the ED for emergent and chronic issues have created an environment of patient boarding. Based on literature recommendations, the Introduce, Check for Comfort, Assessment, Reorient, and Environment (ICARE) evidence-based purposeful rounding tool was implemented as a guide for nurses to preemptively interact with patients and address the increased safety events due to boarding of patients. This DNP project was guided by the following PICOT question: For psychiatric patients boarding in the ED, does the implementation of the ICARE rounding tool used by ED RNs, impact the number of safety events compared to current practice as measured over an eight-week period? The safety issues examined were assaults, self-harm, falls, elopements, and restraints. An eight-week implementation process guided by the IOWA model, which consisted of education, collection of pre-and post-data, and data analysis, was completed at Jersey Shore University Medical Center. Pearson’s chi-square was calculated, and the result was not significant [ꭓ2 (1) = 1.50 p =.221]. However, a clinically significant 13% decrease in safety events was measured after the implementation resulting in four fewer events. Recommendations are to sustain the practice with the ICARE rounding tool and disseminate the results.

Recording Link

Dr. Alanna Coleman

Aspen University

School of Nursing & Health Sciences 

11:00 am PST

"Reducing Falls Amongst Retirement Home Residents: An Evidence-Based Quality Improvement Project Using the Stop Elderly Accidents, Deaths, and Injuries (STEADI) Tool Kit"

Falls amongst community-dwelling older adults in Canada is a major public health due to high rates of morbidity and mortality and significant unnecessary health care expenditures. Despite this, health care providers who provide direct care to older adults do not routinely use fall prevention strategies to decrease fall risk. This DNP evidence-based quality improvement project supported the implementation of the Stop Elderly Accidents, Deaths, and Injuries (STEADI) tool kit into nurse practitioner clinical practice to facilitate a comprehensive fall risk assessment and implementation strategy to decrease the prevalence of falls and subsequent emergency department transfers amongst older adults in six retirement homes across the Greater Toronto Area. Additionally, this project enhanced the knowledge of registered practical nurses, personal support workers, and unregulated care providers in identifying fall risk to facilitate a reduction in fall rates. A mixed-method approach was used that incorporated Kurt Lewin's change management theory and Edward Wagner's chronic care model as a guide. This project reduced fall rates by 40.4% below the monthly average over four weeks with no falls requiring transfer to the emergency department, improved health care provider satisfaction by identifying fall risks using an evidence-based approach, and increased fall prevention strategies in the daily practice of registered practical nurses, personal support workers, and unregulated care providers by 20%.

Recording Link