No Pass Zone: A Quality Improvement Project

Introduction: Patient call-bell lights are a means for communication from a hospitalized patient\u27s room to staff members. This DNP project involves staff and patients on a 28-bed pediatric medical-surgical unit. The aim was to implement a No pass Zone for patient call bell lights. Additionally, this project served to aid in increasing staff responsiveness to answer patients\u27 questions and concerns. Methods: Staff completed a Cornerstone education on the No Pass Zone. Data was collected from pre/post-implementation staff surveys and pre/post-implementation Press Ganey scores. Weekly staff audits on direct observation of staff response to patients\u27 call-bell lights. Results: A total of 35 out of 61 medical-surgical unit staff completed the educational Cornerstone module. Press Ganey reports showed an increase in staff responsiveness to call bells from 71.43% in June 2021 to 78.57% in September 2021, 79.62% in October 2021, and 79.85% in November 2021. Post-project surveys showed 87.50% of staff who completed the measure agreed that implementing a call-bell management protocol resulted in quicker staff response times. Staff audits showed patient wait times decreased from 10-15-minutes to a 2-3-minutes. Conclusion: The No Pass Zone proved an adoptable protocol for patient call-bell light response that demonstrated benefit on one hospital unit. Staff voiced positive feedback to staff responsiveness. Lastly, with adequate staffing levels and the willingness of staff and supervisory roles, the No Pass Zone can effectively improve the current workflow

The Relationship Between Perceptions of Patient Safety Culture, Nurse Advocacy, and Nurse Sensitive Patient Outcomes

The purpose of the study was to understand relationships between and among patient safety culture, nurse reported attitude toward patient advocacy and key patient outcomes. Nurses play an integral role in patient safety, providing care through constant interaction with the patient and clinical team. Advocating for patients is part of that role; however little research existed that explored how advocacy was related to the safety culture or specific patient outcomes. A correlational cross-sectional design was chosen for this secondary data analysis. Correlation and regression models were applied to medical/surgical unit data from seven facilities within one hospital system. Sources of data included the patient safety culture survey from the Agency for Healthcare Research and Quality (AHRQ), the Nurses’ Attitudes Toward Patient Advocacy (APAS) Acting on Behalf of Patients (ABP) subscale, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, patient falls and hospital acquired pressure ulcers (HAPU). Significant findings included a weak to moderate correlation between patient safety culture and attitude toward advocacy, and a moderate negative correlation between safety culture, advocacy and years of experience as a nurse. No significant correlations were found between safety culture and patient outcomes or advocacy and patient outcomes. Perceptions of experienced medical / surgical nurses within the participant hospitals were overall less positive about the patient safety culture and advocacy than their less experienced peers. These results raised questions as to whether adequate leadership attention was being given to the practice concerns of experienced medical/surgical nurses related to patient safety and advocacy

Assessing the Impact of Electronic Health Record Systems Implementation on Hospital Patient Perceptions of Care

The delivery of health care services has been impacted by advances in Knowledge Management Information Systems (KMIS) and Information Technology (IT). The literature reveals that Electronic Health Records Systems (EHRs) are a comprehensive KMIS. There is a wide recognition in the body of knowledge that demonstrates the potential of EHRs to transform all aspects of health care services and, in consequence, the performance of Health Care Delivery Organizations (HCDO). Authors of published research also agree that there is a need for more empirical contributions that demonstrate the impact of EHRs upon HCDO. It is argued that in most cases, studies have been deployed with very limited data or in a specific health care setting. Small gains in performance and mixed results have made difficult to conclusively demonstrate a significant effect of EHRs on the quality of health care services. This study contributes to the knowledge base by empirically assessing the link between a hospital\u27s level of implementation of EHRs and patients\u27 perceptions of the quality of health care services through the analysis of 2,036 hospitals. Findings reveal that the level of implementation of EHRs has a positive impact, both on the percentage of patients who are willing to recommend the hospital to family and friends, and on the percentage of patients who give high ratings based on their last stay in the hospital

Patient satisfaction while enrolled in clinical trials: A literature review

Patient satisfaction surveys may not adequately reflect organizations that conduct research in patients who enroll in clinical trials. The purpose of this systematic literature review was to summarize the current state of knowledge of patient satisfaction while enrolled in clinical trials utilizing a widely used, validated patient satisfaction instrument. A comprehensive literature search was conducted using CINAHL, EMBASE, PsycInfo, PubMed and Web of Science. Studies were evaluated in terms of clinical trial participation; assessment conducted during or after participation; utilization of a validated instrument; a pharmacological intervention; and the paper was published in English. Only nine studies met this review’s inclusion criteria. Eight studies utilized investigator-developed patient satisfaction instruments and only one study used a widely-used, validated patient satisfaction instrument. Two studies evaluated patient satisfaction during the development of the instrument. Of the nine studies identified, only five patient satisfaction domains were common across the studies and only study evaluated the associations of patient satisfaction responses with clinical outcomes. Given the importance of patient satisfaction surveys, future studies need to focus on this subset of patients enrolled in clinical trials to evaluate a patient’s experience and its impact on protocol compliance and protocol outcomes. Future studies need to focus on domains associated with clinical trial participation and look beyond the current patients’ general expectations about healthcare accessibility, facilities, healthcare team clinical skills, and their ability to focus and listen to the patients’ concerns. Experience Framework This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

RELATIONSHIP BETWEEN NURSING SAFETY CULTURE AND PATIENT PERCEPTION OF SAFETY IN INPATIENT UNITS OF AN ACADEMIC SPECIALTY HOSPITAL

The objective of this research was to analyze the relationship between nursing safety work culture in inpatient nursing units of a specialty academic hospital and their patients’ perception of safety using quantitative and qualitative methods. The aim of the quantitative study was to quantitatively evaluate whether nursing safety culture, as measured on the Hospital Survey on Patient Safety Culture (HSOPS) safety questions of the institutional employee opinion survey, was associated with patients’ perception of safety during their inpatient care, as measured by responses on the inpatient Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The aim of the qualitative study was to explore patients’ and nurses’ perceptions of the experiences about safety through individual interviews. The setting of the study was 14 inpatient nursing units. The sample for the quantitative study was these 14 units. The selected HSOPS and HCAHPS question scores were used for selected domains for a regression analysis. For the qualitative study, 4 units were selected from these 14 units based on their HCAHPS score (top, lowest, and two average performers). A total of 14 nurses and 12 patients were interviewed from these selected units. The quantitative results indicated that there was no significant association between any of the domains of the nurses’ safety culture and the domains of patients’ perception of safety. A possible explanation was the limited vii statistical power, given the fixed sample size of 14 units. In the qualitative study, the nursing themes were the following: High workload and insufficient staff, nurses identified safety risks, and safety climate is favorable. The patient themes were the following: Patients identified safety risks, Communication and caring from nurses is appreciated, Patients noticed nurses work as a team, Insufficient staffing not an issue for patients. The conclusions from the study was that nurses are working in a favorable safety climate and teamwork is important because both nurses and patients recognized it as part of safety, patients perceived safe care and felt that nurses genuinely cared for them, and working and staffing are the highest safety priority for nurses

The Effectiveness of an APRN-led Pain Service on Patient Satisfaction Scores: A Retrospective Analysis

Abstract This quality improvement (QI) project examined if the implementation of an Advanced Practice Registered Nurse (APRN) led consult pain service, was able to improve patient satisfaction measured on the HCAHPS and Press Ganey pain satisfaction scores. A one-way ANOVA analysis was used to examine if mean outcome scores varied at a statistically significant level (p\u3c.05) by year (2018, 2019, 2020). Bonferroni Post Hoc tests reflecting How Often Staff Talk About Pain by year using the dependent variable Top Box Score, indicated that the mean score for year 2020 (M=74.10, SD=17.45) was significantly higher than year 2018 (M=63.22). The mean score for year 2019 (M=64.62, SD=22.80) did not differ significantly from the other two years. Bivariate analysis indicated that Press Ganey Scores reflecting Staff Talk About Pain Treatment did not vary significantly by year, F(2, 445) = .41, p=.66. Results from this QI project and the effectiveness of an APRN-led pain service on patient satisfaction scores are inconclusive, and further research is needed. Pain is complex, and a patient\u27s satisfaction with pain is never straightforward. The effectiveness of an APRN-led pain service on patient satisfaction remains under-researched and in need of more methodological evaluation. APRNs need to focus on multidimensional validated outcome measures, which can measure our effectiveness in the management of patients with pain. Keywords: Patient Satisfaction, Pain, HCAHPS, Advanced Practice Registered Nurse (APRN), Effectivenes

Womens Perception of Their Childbirth Expereinces: An Integrated Literature Review

Pregnancy and childbirth are a unique and sacred time in many womens\u27 lives and the process of giving birth often leaves women and families in a vulnerable position. This integrated literature review examined birthing experiences from the maternal perspective and focused on the short-term and long-term implications of negatively perceived maternal experiences. While there are several international studies, only a few have been published studies from the United States. The integrated review showed a significant impact of provider-client communication and shared decision making on a woman\u27s overall perception of her birthing experience. Reports of excess intervention, lack of informed consent, and a perceived disregard for embodied knowledge- all contribute to negative perception of the birthing women. Implications for nursing education, practice, policy, and research are discussed in depth with a focus on improving maternal perception of the birth experience

Pain Assessment in the Emergency Department

Aim: The aim of this integrative review was to synthesize studies that explore barriers to pain management in the Emergency Department. Background: Pain remains one of the main reasons a person seeks help from the Emergency Department. However, patient\u27s pain levels continue to be under-assessed and under-treated in Emergency Departments. Design: Integrative Review Data Sources: A systematic review of Medline, PubMed, CINAHL, and Google Scholar electronic databases was performed. The articles were searched using the keywords, and the inclusion/exclusion criteria. Eleven studies published between 2011 and 2021 were found. Review Methods: Studies were appraised using the John Hopkins Nursing Evidence-Based Practice evaluation tool. A thematic analysis was conducted to explore specific themes within the studies. Results: Three themes were identified as barriers to pain management in the Emergency Department, ‘nurse’s workload’, ‘nurse’s attitude’, and ‘lack of pain management education for the nurse’. Conclusion: Pain continues to be one of the main complaints’ patients present to the Emergency Department each year. The nurse can be a barrier or an enabler to effective pain management for the patient. For change to occur, improvement in pain management education for the nurse is required. Research regarding pain management in Emergency Departments based in the United States is limited. Research is needed to study the effectiveness of pain management and the possibility of nurse-initiated pain protocols in the United States

Workplace Bullying, Nurse Practice Environment, Patient Outcomes: A Descriptive Study

Better nursing practice environments are associated with improved patient safety, yet little is known about the nurse’s experiences of bullying or flourishing within the practice environment. This study described nurses’ experiences of workplace bullying and flourishing and identified associations with patient outcomes. The study used an exploratory cross-sectional survey design following Donabedian’s Quality Framework of structure-process-outcome and informed through critical feminist theory. The study took place at a large medical facility in the northeastern United States. A multi-instrument survey included four sections. The demographic section and the Practice Environment Scale of the Nurse Work Index (PES-NWI) were used to measure structure variables. The process variables were measured using the Negative Acts Questionnaire Revised for the United States (NAQR-US) to measure workplace bullying, and an investigator designed instrument was used to measure the workplace flourishing based on Chinn’s PEACE and Power model. Online survey results from 138 bedside nurses were correlated with outcome variables patient satisfaction from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, and unit based patient safety rates. Patient falls, 30-day readmissions, medication errors, pressure injuries, overall patient satisfaction, and whether patients would recommend the hospital were averaged by patient unit and assigned to each nurse based on unit association. Following descriptive analysis, multiple regression models were conducted for each patient outcome. The respondents were 76% female, 52 % had a bachelor’s degree or higher and the average time as an RN was 15 years. Nurse perception of the practice environment was inversely associated with patient falls (r=-0.21, pr=-0.26, p r=-0.26, p. Workplace flourishing had a moderate and significant positive association with the better practice environments (r=0.44, p This study contributes to a better understanding of the nurses practice environment by the associations found with bullying and flourishing. Implicit in the PES-NWI description of strong nursing practice environments is nursing control and autonomy of practice. More work is needed to explore the concept of flourishing and what keeps nurses working in adverse environments. As the practice environment is linked to patient safety, an understanding of nurse’s work that includes the practice environments, work satisfaction, the absence of bullying and intentional work flourishing will contribute to better patient outcomes. Further research is needed to understand the complex nature of the nurses’ work environment and the impact on nurses and patients

Daily Nurse Manager Rounding and the Impact on Patient Falls and Patient Satisfaction

Background and Purpose: Patients continue to fall despite multimodal multidisciplinary strategies. The purpose of this Doctor of Nursing Practice (DNP) project was to determine if a specified protocol for daily nurse manager rounding impacts patient falls and patient's perception of responsiveness to nursing care. The objective was to evaluate patient falls and satisfaction in the hospital setting before and after the nurse manager rounding intervention. Methods: A retrospective descriptive design was used with non-probability consecutive sampling; December 2014 through February 2015, and March through May 2015 were compared. Participants included adult patients 18 ≥ years on two 24-bed medical-surgical units in a community hospital in an urban setting. Data was collected via hospital incident reports for patient falls, and Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) for staff responsiveness. Chi-square test for independence was used to evaluate the distribution in staff responsiveness pre- and post-intervention, while risk ratios were calculated to determine significant change in the incidence of patient falls. Evaluation: For all statistical tests, the level of significance was set at p<0.05. There was no difference in staff responsiveness on either of the units, 6E and 6W (p=.73 and p=.52, respectively). Similarly, the incidence of patient falls on 6E and 6W did not differ significantly between pre- and post-intervention (p=.34 and p=.18, respectively). Clinical Implications and Summary: This study provided a clinically significant impact on reduction in falls and improved responsiveness of staff domain on one unit. Although the study did not demonstrate statistically significant differences in patient falls and staff responsiveness post-intervention, it provided a framework for the customization of a daily manager rounding protocol to address patient safety and patient needs proactively. Further qualitative and quantitative research is needed to evaluate this intervention that has potential for significant safety and quality of life implications.D.N.P., Nursing Practice -- Drexel University, 201