Doctoral Papers
http://hdl.handle.net/10755/620763
2024-03-29T03:57:53ZInitiating a mobile wayfinding application at a verterans affairs medical center: A current state assessment & needs analysis
http://hdl.handle.net/10755/23760
<p><strong>Problem:</strong> Wayfinding within medical facilities is complex and challenging resulting in missed appointments, late appointment check-ins, and even procedural/surgical delays which further patients’ frustration, stress, and anxiety.</p>
<p><strong>Project Aim:</strong> This project aims to perform a current state of wayfinding assessment and a needs analysis of a potential mobile wayfinding application at a Department of Veterans Affairs (VA) Medical Center within the surgical service’s pre-anesthesia testing (PAT) check-in desk.</p>
<p><strong>Wayfinding:</strong> Wayfinding is simply defined as the process/activity of determining one’s current position then planning and following a specific route to a destination (Wayfinding, 2019).</p>
<p><strong>Theoretical Framework & Scope: </strong>This project will encompass a portion of the initiation stage within the overall System Development Life Cycle (SDLC) framework.</p>
<p><strong>Methods:</strong> A retrospective analysis of data queried from a convenience sample of 274 patient PAT check-in desk appointments was performed in February 2020. Prior to data collection, Institutional Review Board (IRB) approval was sought from the VA medical center. Data collected was examined qualitatively and quantitatively to determine the current state of wayfinding and to provide insight into a potential future state using a mobile wayfinding<br />application.</p>
<p><strong>Conclusion:</strong> The current VA wayfinding experience can be improved with the use of a mobile wayfinding application. It is anticipated that this project will create a foundation for which veterans and their family members become key stakeholders in their own care experience(s).</p>
On pills and needles: Students' and clinical nursing faculty's lived experience of a nursing students' first med pass in the clinical setting
http://hdl.handle.net/10755/23759
<p>Learning and teaching medication administration is a substantial component of prelicensure nursing education. The emphasis of the Quality and Safety Education for Nurses initiative is to prepare nursing students to provide safe, quality care. Medication administration, which falls under this initiative, is a challenge for nursing students to learn and for clinical nursing faculty to teach. Consequently, nursing students graduate feeling unprepared to administer medications in their practice. This issue is prevalent and long-standing within nursing education. Most of the research studies conducted, though, are from senior nursing students and nurses. There is little research from the beginner nursing student when first learning this skill and the faculty supervising them. Without an understanding of nursing students’ first experiences in medication administration and how faculty promote this clinical competency, strategies designed to prepare them for subsequent clinical and support them may be incongruent with their needs.</p>
<p>This study used a phenomenological design to illuminate the lived experience of beginner nursing students’ first medication administration in the clinical setting from the student and faculty perspectives. Six nurses were interviewed about their student experience, and six faculty were interviewed about their experience with teaching and supervising beginner nursing students. Both groups’ experiences of this phenomenon contrasted and converged, as evidenced through their compelling stories. Using van Manen’s phenomenological method and Merleau-Ponty’s intersubjectivity, five essential themes emerged: (a) A Transformative Experience, (b) Unprepared for Complexities in the Clinical Environment, (c) Overcoming Fear Through Self-Reassurance and Faculty Support, (d) The Rubber Meets the Road: Administering Medications in the Actual Clinical Setting, and (e) Reaping the Rewards. The findings from this study will contribute to nursing education’s body of knowledge and benefit nursing professors and clinical nursing faculty who prepare beginner nursing students and supervise them administering medications in the clinical setting.</p>
Impact of BrĂ˜set Violence Checklist on safety events in an adult mental health unit
http://hdl.handle.net/10755/23758
<p><strong>Background:</strong> Workplace violence (WPV) is an escalating issue in healthcare that needs to be addressed to improve patient outcomes and staff satisfaction. Inpatient mental health facilities are at higher risk for safety event occurrences.</p>
<p><strong>Problem:</strong> There is a practice gap in the assessment of possible violence at the practicum site with higher tolerance and acceptance that this is an acceptable event. The policies on deescalation are poorly implemented.</p>
<p><strong>Methods:</strong> A pre- and post-intervention design was used to investigate the impact of the BVC tool on safety events. Data analysis included outcome measures on BVC scores, safety events, and de-escalation intervention.</p>
<p><strong>Intervention:</strong> The BVC is a user-friendly simple assessment tool that scores patient behavior to indicate risk for violence as minimal, moderate, or high risk. Once identified, de-escalation intervention can be instituted to mitigate its occurrence.</p>
<p><strong>Results:</strong> A total of 126 patients were assessed from 3 shifts. The BVC tool did not decrease the number of violence-related incidents as there was a heightened staff awareness and recognition of reportable events. This also improved patient assessment, documentation, use of patientcentered interventions, and improved patient care.</p>
<p><strong>Conclusions:</strong> The BVC tool is recommended to be used consistently coupled with patientcentered mitigating interventions. This tool was instrumental for staff to improve their assessment skills, promote safety, and improve patient outcomes.</p>
Increasing the usage of MyChart bedside by nurses and patients in the acute care setting: An integrative review
http://hdl.handle.net/10755/23757
<p>Teach-back has been a proven model to teach patients about their disease process, medications, or dressing changes in a simple-to-understand language that often includes a return demonstration. Teach-Back isn’t just a tool to be used with patients, it can be used to help anyone understand something new. Based on the Technology Acceptance Model, people are less inclined to use new technology if they do not find it easy to use or useful in their day-to-day jobs. This integrative review aims to support the use of the Teach-Back method of instruction with staff, including return demonstration, to prove the ease of use and usefulness of patient portals integrated with the electronic medical record for hospitalized patients. Through extensive analysis of systematic reviews and qualitative studies, supporting evidence was found to prove that training focused on ease of use and usefulness of new technology will increase adoption by staff.</p>
Knowing the patient as a person: Social media listening and Gadamerian analysis of nurses' expressions shared during the COVID-19 Global Health Pandemic
http://hdl.handle.net/10755/23756
<p><strong>Background:</strong> COVID-19 has dramatically changed human-to-human interactions from in-person to the nonhuman domain of virtual space. In January 2021, every 28 seconds one person died of COVID-19 in the United States. An average of 3,100 Americans died each day during the deadliest month of the pandemic. As of January 2023, the number of COVID-19 deaths in the USA surpassed 1.000.000 people. In hospitals, human-to-human interactions were often limited to seeing one’s eyes behind the face shields, and respirator masks, and hearing a muffled voice, or sounds of the ventilators. In New York State 452 nurses died during the pandemic.</p>
<p><strong>Research Question:</strong> What does it mean to know the patient as a person during the COVID-19 pandemic?</p>
<p><strong>Method:</strong> A predefined search of posts was done with filters: Hashtags, Twitter handles, and keywords related to #NURSING “AND” #COVID-19 and #PATIENT “AND” #CARE and #PATIENT “AND” #PERSON. Talkwalker, a cloud-based social media data aggregator was used to search, in addition to social-media listening and manual data search. Qualitative Gadamerian content analysis was done to examine nurses’ textual and pictographic ways of self-expression.</p>
<p><strong>Results:</strong> A total of 15,300 posts on social media were identified between October 28, 2021, and November 28, 2022. This included a total of (n = 5,700) posts related to Nursing “AND” Covid-19 and (n = 9,600) posts to Patient “AND” Care during the COVID-19 pandemic. The themes identified in the study pointed to nurses: Health Concerns (79.4%), Burnout (78.6%), Care related issues (78.2%), (Work Stress (65.4%), Concern for patients’ safety (56.7%), (6) Crisis in healthcare (34.6%) and Life and family (27.5%). The data drill-down showed that the reference to the word “Person” was (94.2%) which was slightly higher than that to “Patient” (91.8%).</p>
<p><strong>Conclusions:</strong> Social media listening and Gadamerian content analysis provided insight into the nurses’ experience of <em>knowing the patient as a person</em> in the context of the COVID-19 Pandemic. Social media listening and content analysis can provide an innovative study design as opposed to the traditional literature review. Real-time social media data analysis can be used as a predictive tool for new and emerging health issues.</p>