Dissertations / Theses on the topic 'Medical / Nursing'

This paper evaluates nursing students’ perceptions and barriers as related to medical error reporting. This study was conducted as a mixed method based on the PS-ASK survey tool designed by Schnall et al (2008). Medical errors are a large problem in healthcare institutions. Understanding the underlying causes of why these events occur is needed in order to prevent repeat occurrences of the same error. However, in order to fully understand the underlying cause of the error, first and foremost, it must be reported. Evaluating nursing students’ perceptions and barriers to utilization of an error reporting system and addressing these issues is a crucial step towards decreasing medical error and improving patient safety. This study found that nursing students have an overall positive attitude toward error reporting. This survey validated the need for instituting a just culture within nursing education, in order to help encourage error reporting, rather than discourage it. Practice changes should be made in nursing education to provide transparency and role modeling with error reporting in order to encourage student accountability for reporting errors.

The occurrence of inflight medical incidents on commercial airlines is documented in medical and aviation journals to occur at a rate of approximately 1 in 11,000 – 50,000 passengers (Lyznicki, 2013; Prout, 2013; Johanson, 2013; and Peterson, 2013) but these numbers can vary. As there are no requirements to report medical incidents to any governing body worldwide (Ruskin, 2009), (Walters, 2008), (Liao, 2010) it is very difficult to obtain an accurate accounting of inflight incidents. The literature reveals that most of the inflight incidents are occurring among passengers with pre-existing conditions (Grounder, 2011) and that issues were not being properly addressed by their primary care providers. The purpose of this study was to show the depth of discrepancy between the currently reported rate of inflight medical incidents and the actual rate of inflight incidents and to gain a better understanding of the general public knowledge base regarding flying with medical conditions and practice of medical providers addressing their patient’s acute & chronic conditions as it pertains to flying on commercial airlines. This study surveyed the general public and revealed the majority of respondents had no knowledge of medical guidelines for passengers and a lack of discussion with their providers regarding safety of flying as it relates to their medical conditions. This study also conducted a survey of medical providers which revealed a lack of understanding of how aircraft cabin pressurization affects their patients with acute and chronic illness. These findings support the need for improvement in developing and implementing a unified method of calculating and reporting inflight medical incidents, along with patient and provider flight education.

Delirium in adults aged 65 and older is a common occurrence in the acute care setting and is often unrecognized by bedside nurses. Delirium can trigger a negative cascade of events resulting in an increase in morbidity and mortality, functional decline, longer length of stay, and high rates of post hospital institutionalization and has a significant socioeconomic impact. The purpose of this quality improvement project was to establish a solid foundation using scholarly literature to support the development of a delirium prevention, recognition, and treatment program in the medical-surgical acute care setting applying the program logic framework. The goal was accomplished by developing a structured program to enhance nurse education (phase 1) using a pretest/posttest design. Phase 2 will be implemented at a later date. The null hypothesis for the project was there is no difference between the pretest group knowledge of delirium scores and the posttest group scores following education. The results of the 36-paired pretests/posttests indicated a significant difference (p < 0.05) following the educational PowerPoint on delirium. Providing education and opportunities for bedside nurses to apply this new knowledge is an effective strategy to increase the identification of delirium, which can lead to improved patient outcomes, reduced socioeconomic burden associated with delirium, and increased positive social change. The economic impact of delirium is considerable with the average cost per day of delirium patients reaching nearly 3 times the cost of patients not having delirium. The elderly population is projected to continue to rise, which will have a profound impact on hospitals and health care as a whole.

The purpose of this thesis was to study different aspects of nursing content in patient records with special reference to nursing home care. The thesis focused on the content, comprehensiveness, accuracy and auditing of records, as well as the practice and perceptions of nurses in relation to recording. A national sample of nurses was asked to complete a questionnaire. The effects on recording and nurses' practice and perceptions in nursing homes following educational intervention were studied. Accuracy was examined through record reviews and interviews with nurses and patients. A literature review of record auditing methods was performed and findings from this search were applied in the assessment of a set of records.

The results indicate that the VIPS model, as a structure for nursing recording, is widespread and shows validity across various areas in Swedish health care. After the educational intervention program, documentation in nursing home care improved significantly in the study group concerning notes on nursing history, nursing status, nursing diagnoses, interventions and discharge notes. Systematic and comprehensive assessment grounded in research-based criteria were not used in the records. Accuracy varied considerably and was significantly better for some areas in the study group. After intervention, the nurses in the study group indicated that they recorded assessments of patients with greater frequency, showed greater satisfaction with their documentation and spent less time on oral reports. Procedures in auditing patient records were found to encompass four approaches: formal structure, process comprehensiveness, knowledge based and accuracy.

In conclusion, the evidence suggests that there are serious flaws in the nursing content of nursing home records though improvements can be achieved through educational means. Presently, there are serious limitations in using the patient record as the sole source of data for care delivery, quality assessment and evaluation of care.

Obesity has arisen as a major cause of morbidity and mortality in today' s society. The aim of this study was to assess potential barriers encountered by obese women seeking medical care. It was hypothesized that overweight or obese women will be likely to have a negative self-esteem and that a negative self-esteem associated with being overweight will decrease healthcare utilization. A convenience sample of 50 women over the age of 18 were surveyed upon entering a health care clinic. Self-report of height and weight was collected to calculate a body mass index (BMI) score. Furthermore, a self-report of healthcare utilization was obtained along with demographic data and a quantified self-esteem score. Results showed a significant Pearson's negative correlation between BMI and the self-esteem score (r = -0.395; p = 0.01) and a significant difference based on a t-test between self-esteem based on employment status ( p = 0.021). Other demographic variables (age, income, education, marital status, and race) had no significant impact on BMI, self-esteem or number of office visits. There was no significant difference between obese and non-obese women on the number or type of office visits, and no significant difference between average self-esteem score and number of medical office visits. Assessing self-esteem in those with higher BMIs may be a helpful tool in assisting providers to identify barriers of seeking healthcare in obese women.

Colorectal cancer is one of the most common cancers in the United States and confronting its challenges has remained a problem to the United States health sector, especially among outpatient clinics. Guided by health belief model, the purpose of this needs assessment was to identify patients age 50 and older in outpatient clinic located in a large metropolitan city in Texas who should receive information on the need for colorectal cancer screening based on their risk for developing colorectal cancer as outlined by American Cancer Society. A sample of 70 charts of patients age 50-75 years was randomly selected and audited using descriptive statistics. Among the patients aged 50-75 years attending the outpatient clinic, 25.7% were African Americans, 71.4% were Hispanic, and 2.9% were Caucasians; 42.9% were male and 57.1% were female. The rate of colorectal cancer screening was 12.9%, a rate that is lower than the rate for all Texans, which was 54.1% - 59.2%. CRC screening was ordered for 62.9% of all patients; 24.2% of clinic patients were identified as being at high risk for colorectal cancer. The low rate of screening may hamper early detection of colorectal cancer in outpatient clinics setting. It is recommended that the outpatient clinic develop intensive campaign to increase patient awareness about the need for and benefits of colorectal cancer screening, especially for those at high risk for developing colorectal cancer. The findings of this study may raise awareness on the chasm in quality of health care availability and provide insight on colorectal cancer and its prevention.

Effective communication is crucial in healthcare, as it plays a major role in patient outcomes. Medication errors, a common occurrence in hospitals, are harmful and costly. The use of effective communication to achieve adequate medication education for patients is key to preventing medication errors and related adverse events. Teach-back method is an excellent approach in verifying that the information has successfully reached the recipient. Using the teach-back approach makes the communication individualized. Individualized communication that addresses patient’s concerns and challenges promote trust in the healthcare provider and increase patient satisfaction.

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a standardized survey tool utilized by hospitals throughout the United States to measure patients’ perspectives on hospital care. The HCAHPS survey includes 21 patient perspectives on care relevant in nursing domains such as communication with nurses and communication about medications. The HCAHPS question addressed by this study was related to the nurses teaching patients of new medication and potential side effects.

Teach-back is an evidence-based strategy that has successfully been used to educate individuals of any age or culture. This methodology is suggested and supported by healthcare accrediting agencies to promote patient-centered care. Teach-back verifies the patient’s understanding by asking the patient for a return demonstration regarding the understanding of provided teaching.

This project focused on an acute care facility’s consistently low HCAHPS satisfaction scores on medication education. Despite patient medication education provided by nurses, this acute care facility's HCAHPS scores reflected low and erratic patient satisfaction. Guided by the logic model, this process improvement project aimed at improving the nurse to patient communication on a medical unit using the teach-back method.

Leadership implies followership, for without followers, there would be no true leaders. Followership has often been viewed in a negative fashion given the unidirectional nature of hierarchical power. Traditionally, a follower was assessed as unable to lead because of the assumption that a leader’s engagement is active and a follower’s engagement is passive. The word follower often advocates obedience and compliance in the minds of many and such a person may therefore be unfit for modern professional leadership discussions. However, assessing professional views of the term follower may provide insight for future leadership discussions, by understanding that followers get work done by working with other followers and leadership suggests the need for relational coordination with followers. This dissertation sought to advance the study of followership by examining the relational coordination of patient care through a study of hospital medicine. A hospitalist is generally thought of in terms of “service” (patient care), which is included in the literature on good followership. Hospitalists, as practicing physicians, are scientifically trained to possess the critical thinking skills that correspond to the Y-axis of Kelley’s Followership model. However, their training is to act independently without the intentional engagement (X-axis of Kelley’s model) of their interprofessional team members. This research detected a statistically significant relationship between relational coordination scores and followership types in the exemplary hospitalist followership type subscale of engagement with respect to other hospitalists and nurse managers. Additionally, there was a statistically significant relationship between relational coordination scores and followership types in the pragmatic hospitalist followership type subscale of critical thinking as related to case managers. Of the five followership types (exemplary, conformist, pragmatic, passive, and alienated), three types were eliminated from the analysis for the following reasons. For hospitalists, there were no conformist followers, there were no alienated follower hospitalists, and there was only one hospitalist who met the criteria for being a passive follower. As a result, it is more accurate to state that this research found a statistically significant relationship in relational coordination of hospitalists who are exemplary and pragmatic followers.

Background: One of the most pressing global issues in health care settings is patients’ safety. In an effort to decrease medical errors and improve the quality of patient care, many health care organizations have adopted an electronic medical record (EMR) system. The federal government supported this widespread EMR implementation with multi-billion dollar financial support. However, to date, the lived experience of the nurses transitioning to EMR is not clearly understood. Purpose: The purpose of this study was to explore the lived experience of nurses transitioning to EMR usage.

Philosophical Underpinnings: This qualitative study followed van Manen’s phenomenological perspectives under the naturalistic (constructivist) paradigm with the research question, “What is the experience of nurses transitioning to electronic medical records (EMRs) usage?”

Methods: A qualitative phenomenological methodology was used for this study. A purposive sample of 15 nurses who have experienced transitioning to the EMR usage was selected to explore the lived experience of nurses transitioning to electronic medical records (EMR) usage with the overarching question: What is the lived experience of nurses transitioning to EMR usage like? Data collection occurred with in-depth, semi-structured interviews using open-ended questions. Each individual interview was tape-recorded, transcribed verbatim, and member checked. Data analysis was guided by Max van Manen’s (1990) phenomenological method, which includes describing, interpreting, textual writing and rewriting. Data analysis resulted in a rich and thoughtful representation and increased understanding of what it is like for nurses transitioning to EMR usage.

Results: Four core themes Doubting, Struggling, Accomplishing, and Embracing emerged. Three subthemes emerged: Balancing time between computer and patients and Increasing workloads and responsibility, which are subthemes of Struggling, and Leaving human interaction behind, a subtheme of Accomplishing. These themes illuminated the lived experience of 15 nurses transitioning to EMR usage. Thomas Kuhn’s (1996) process of scientific inquiry provided a framework to gain a deeper understanding of this phenomenon.

Conclusions: This study explored the lived experience of nurses transitioning to EMR usage in hospital settings. The results of the inquiry highlighted the essence of participants’ experience by revealing their doubt about the EMR’s functionality, struggle with transitioning and using the new EMR system, accomplishment of successful transition to the EMR system, and finally acceptance of technology in their daily work practice. The findings of this study contributes to the debate about EMR usage in nursing practice to engage nurses to ponder how they provide quality, patient-centered care while using the EMR system to reach the common goal of provision of quality care.