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Breastfeeding and the Baby-Friendly Hospital Initiative: A quality improvement project
(2016-09-21)
The purpose of this DNP project was to provide support for nursing staff to feel empowered and motivated to provide new mothers with the support they needed to have a positive breastfeeding experience for their babies and themselves. Adult Learning Theory and the Rosswurm and Larrabee Model for Evidence-based Practice provided the framework for the project. A quasi-experimental study design was used to evaluate if the implementation of an educational intervention decreased barriers and improved nurses’ self-confidence in supporting mothers in the decision to breastfeed their infants. The project took place on the birthing center at a regional hospital in a Midwest state where approximately 120 infant deliveries occur monthly. The project director (PD) distributed an anonymous pre-intervention survey to all nursing staff in the birthing center by email using Qualtrics survey system to identify barriers that occurred when nurses tried to assist and educate a breastfeeding mother and to rate their self-confidence in assisting mothers. The PD recruited nursing staff for a breastfeeding taskforce through face-to-face communication and email separate from the survey. The breastfeeding taskforce, led by the PD, met to review survey data and brainstormed how to address identified breastfeeding education and support barriers. The taskforce developed two standardized staff education documents to address these barriers. Three months following the implementation of the newly written staff education, the PD distributed an anonymous post-intervention survey to all nursing staff by email that contained the same questions as in the pre- intervention survey. The PD analyzed the pre and post intervention survey data to determine if there was a decrease in barriers and increase of self-confidence in the nurses’ ability to assist patients with breastfeeding and support other nurses in the process. This information was shared with the taskforce to decide if any revisions in the written process were needed. No revisions were deemed necessary by the taskforce.
As a result of the findings of the breastfeeding taskforce and the PD, an algorithm titled. When Baby Does or Doesn’t Latch and a staff education sheet Nipple Shields 101 were created. When Baby Does or Doesn’t Latch was developed using Baby Friendly Hospital Initiative’s guidelines and the hospital’s hypoglycemia policy to provide nursing staff with a resource to use when babies are not breast or bottle feeding well. Nipple Shields 101 was created to give staff members a resource to use when assisting a patient that needs to use a nipple shield in order to help the baby to latch. Data gathered from the pre- and post- intervention surveys did show a statistically significant increase in the self-confidence the nursing staff felt when helping patients and each other with breastfeeding skills. Limitations on the study of outcomes for the project included time constraints, small survey sample, lack of ability to compare pre- and post-intervention survey results by person due to anonymity, and possible discrepancies in meaning of survey questions between PD and the survey participants....
Simulation to improve the clinical nursing instructor's teaching of ethics to students in the clinical setting
(2016-08-11)
Ethics knowledge and skill is crucial to the discipline of nursing and is considered foundational knowledge for nursing practice (American Nurses Association [ANA], 2001). Nurses who assume roles in clinical teaching may ...
The relationship between nursing skill mix, nurse sensitive patient outcomes and patient satisfaction
(2016-06-09)
Literature Review: Hospitals are the largest components of the United States healthcare system, and are encountering pressure to provide better quality care and reduce cost. The Patient Protection and Affordable Care Act ...
National institutes of health stroke scale certification improved assessment and care of veterans: A quality improvement project
(2016-12-13)
This pilot project sought to fill the gap in practice that included a lack of early recognition, assessment skills and practice guidelines for the care of stroke patients, improving patient care and hand off communication. ...
A quality improvement plan for safe medication administration for unlicensed personnel working in a Type "A" assisted living facility
(2016-11-30)
There is an increase in Assisted Living Facilities (ALF’s) throughout the United States that has been coupled with residents that have increasingly complex conditions leading to unanticipated problems related to poor ...
Instituting a quality improvement program at a community medical designed to reduce urinary catheter days and the incidence of catheter associated urinary tract infections
(2016-10-07)
Background: In the United States (US) it has been reported that approximately 40% of all healthcare-associated infections (HAIs) are indwelling urinary catheter associated. These infections give rise to increased morbidity, mortality, and result in increased healthcare costs (Nicolle, 2012). A northwest community hospital has identified a higher number of infections related to urinary catheter use and an excessive number of urinary catheter days as compared to the state average.Purpose: In an attempt to reduce the rate of catheter-associated urinary tract infections (CAUTIs) a quality improvement project involving the development of an evidence-based nurse-driven urinary catheter protocol (UCP) as well as ongoing educational efforts was instituted.
Method: Nursing staff reviewed catheter use daily and contacted physicians to discontinue urinary catheters based on the protocol. Education of nursing staff and patients in alternatives to catheter use and post catheter care were emphasized. All patients with urinary catheters were included in the quantitative analysis. Urinary tract infections were monitored by Infection Prevention through the review of all positive urine cultures and all physician diagnoses of urinary tract infection. Urinary catheter days were collected by nursing staff.
Results: Urinary catheter days were reduced from a three-month average of 2844 in the year before the intervention to 2361 in the three months after the intervention. The incidence of CAUTI was reduced by 67% with a resulting decrease in CAUTI rate from 3.79 to 1.30 infections/100 catheter days although the results were not statically significant (P=0.48).
Conclusion: The present study was limited due to time constraints and lacked statistical power but did appear to indicate that the use of a nurse-driven urinary catheter protocol may decrease the rate of hospital acquired CAUTI and warrants further ongoing study.
Keywords: Quality Improvement, Urinary Catheter Protocol, Catheter-Associated Urinary Tract Infection (CAUTI), Infection Prevention, Standard Infection Ratio (SIR), and Healthcare-Associated Infections (HAIs)...
Surgical site infections and prophylactic antibiotics
(2016-10-20)
Surgical site infections (SSIs) have negative clinical and financial outcomes for patients and healthcare organizations. Each surgical site infection increases cost, no longer to the patient, but to the organization. SSIs ...
The admission and discharge nurse role: A quality initiative to optimize unit utilization, patient satisfaction, and nurse perceptions of collaboration
(2016-06-15)
Registered nurses are at the frontline of the hospital admission and discharge process. Efficiency and collaboration during these processes are critical to the patient care experience and the promotion of safe, high quality ...
Multipronged approach to improve hand hygiene in acute care nurses
(2016-10-18)
Purpose: This article outlines a quality improvement project to implement a multipronged approach for improvement of hand hygiene (HH) adherence during bedside patient care in an inpatient acute care setting.
Design: A ...
A quality improvement project: Job satisfaction of nurses in home health care
(2016-10-18)
Purpose: The purpose of the quality improvement project was to explore if a formal preceptorship orientation program would minimize the low job satisfaction rate of registered nurses at a home health agency.
Design: The ...