Browsing Doctor of Nursing Practice (DNP) Projects by Subject "Nurse-Patient Relations"
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Daily Charge Nurse Leader Rounds on a Cardiac Surgery Progressive Care UnitProblem: Patient satisfaction is the measure of the success of a healthcare system in today’s competitive markets. However, achieving patient satisfaction relies on multiple internal and external factors. The Cardiac Surgery Progressive Care Unit (CSPCU) at an urban medical center in the mid-Atlantic United States was seeking to improve their patient satisfaction scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCHAPS) data. Purpose: The purpose of this quality improvement project (QI) was to implement and evaluate the effectiveness of daily charge nurse leader rounds on patients admitted to a CSPCU. It is anticipated that there will be an increase in the total number of times a nurse leader rounds on a patient that subsequently will result in in an increase in patient satisfaction as measured by HCAHPS nurse communication scores. Methods: The QI project was implemented over a 14- week period in a CSPCU at an urban Maryland academic Medical Center. Charge nurses were educated on the process change and then completed ‘charge nurse leader’ rounds. The project leader checked the rounding rates bi-weekly. Nurse communication scores were collected preand- post implementation using the scores from the HCAHPS surveys. Results: The number of patients rounded on daily over the course of the project was 64.7% and during the implementation period a total of 1140 rounds were completed. The HCAHPS scores increased in the category of ‘RN explanation’ and slightly decreased in the categories of ‘RN listening’ and “RN courtesy”. Patients’ perception of the nurse leader rounding increased from 79.64% to 87.23%. Conclusions: Charge nurses can be utilized as informal leaders to complete nurse leader rounds. Leader rounds are able to be incorporated into the daily routine of the charge nurse. Patient satisfaction scores are impacted by many different factors. The increase seen in one domain of HCAHPS indicates that further studies should be completed to better understand how nurse leader rounds impact patient satisfaction.
Implementation of De-Escalation Training to Medical-Surgical NursesProblem: The American Nurses Association reports only 20% of nurses’ feel safe in their area of practice with patient violence towards nurses happening more frequently on medical-surgical units (Cahill, 2008; OSHA, 2004). Purpose: To determine the effectiveness of de-escalation training on medical-surgical nurses’ confidence levels in handling agitated patients. Methods: This quality improvement project employs a non-experimental, single group, pre- and post-test design. Thackrey’s (1987) Confidence in Coping with Patient Aggression Instrument (CCPAI), a 10-item questionnaire, evaluates nursing confidence levels in dealing with agitated patients before and after implementing Richmond’s et al. (2012) Ten Domains of De-escalation. Outcomes: A one-sample t test comparing the pre- and post-test confidence scores showed the mean as significantly different from 55, a hypothetically neutral score. The post-test mean significantly increased (68.82, 95% CI [6.84 to 20.81]) from the pre-test, t(33) = 4.03, p = <.001 and showed a moderate to large effect size d = .72 (Pilot, 2010). A paired-sample two-tailed t test significantly increased from Time 1 pre-test (M = 49.82, SD = 10.11) to Time 2 post-test (M = 72.82, SD = 14.41), t(10) = 4.46, p < .001. The mean increase was 23.00 [95% CI, 11.51 – 34.49]; d = 1.84 indicating a large effect size (Pilot, 2010). A sensitivity analysis (Wilcoxon Signed Rank Test) showed a median difference amongst the matched pairs with a significant increase in confidence levels post-training, z =-2.847, p < .004. The median score increased from the pre-test (Md =51) to the post-test scores (Md = 71) (Pallant, 2013). Implications: This pilot project demonstrates improved medical-surgical nursing confidence in dealing with agitated patients. Further research using a larger sample size in several nursing units would add validity to the results.