Nursing (Doctor of Nursing Practice)

Heart failure (HF) readmissions are incredibly burdensome to hospitals across the country. In 2020, approximately $563 million in penalties from the Center for Medicaid and Medicare Services (CMS) were assigned based on higher than average admission rates (Allen, 2019) with a significant portion related to HF. Our facility has consistently had readmission rates higher than the CMS national benchmark. This is both detrimental to our patients and the cause of assessed yearly CMS reimbursement penalties, which significantly impacts payment for care delivered. There has historically been a very incomplete and disjointed care transition post-discharge for our HF population.

In hospitalized patients, the transition from hospital to home can lead to adverse events, negative outcomes, ER visits, and hospital readmissions (Backman et al., 2021). A poor transition of care can also be reflected in low Care Transition scores in HCAHPS surveys. The Care Transition questions reflect how well the patient felt prepared to manage their own care at home.

This quality improvement initiative answered the following research question: “In hospitalized adult patients, how does collaborative care transition planning compared with traditional discharge planning affect Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores one month after implementation”?

The theoretical framework is Larrabee’s model of Evidence-Based Practice. Methods include comparing the Care Transitions scores the month prior to implementation to those from the month following implementation.

There was a decrease in scores the month during implementation, but then increased in the month after. While not a part of the initial data collection, there was also an improvement in patients’ average length of stay. It can be concluded that the increase in communication amongst the healthcare team during the huddle did play a part in the efficiency of managing patients’ plan of care.

The nursing implications include the need for increased communication. When the healthcare team works together, it improves the patients’ transition from hospital to home. Future research may focus on length of stay as an important variable. A limitation of this study was a lack of consistency in collaborative rounding. Additional research in this area is needed.

On average, humans spend one-third of their lives fulfilling basic sleep needs (Cirelli, 2019). Theories suggest that sleep improves immune responses, reduces energy, allows for the recuperation of cognitive functions, and removal of waste; however, the exact function is unknown (Zielinski, McKenna & McCarley, 2016). Research has revealed when sleep is chronically disrupted the individual experiences a reduction in their quality of life, an increased risk for mortality as well as cerebrovascular and cardiovascular events (Chattu, Sakhamuri, Kumar, Spence BaHammam & Pandi-Perumal, 2018). Ever changing variables that affect sleep in the hospital setting have created a need to ask the question, what happens when such disruptions occur in an environment like the hospital? Therefore, the primary purpose of this study was to identify adverse outcomes associated with insufficient sleep experienced by hospitalized non-critical older adults in literature.

A lack of support and understanding by healthcare professionals can contribute to cascading events in the quality of their patients, newborns, and communities’ lives from experiencing birth trauma. Women who experience a traumatic birthing experience without support can hinder their feelings of having more children, create relationship problems, negatively affect the bonding with their newborn, and they may avoid medical interventions that are like their birthing experience such as pap smears (Birth Trauma Association, 2018). This project aims to answer, “Does implementing trauma-informed care practices education to perinatal nurses increase their knowledge, attitudes, and practices of trauma-informed care after educational implementation?” Trauma-informed care (TIC) is a concept that is grounded in a set of four assumptions and six principles. A trauma-informed approach to nursing care is inclusive of trauma-specific interventions; whether it includes assessment, treatment, or recovery supports, it also incorporates key trauma principles into the targeted organizational culture. The results of the project noted a positive Pearson correlation from p= 0.1 to 0.6 in all areas of the nurse’s knowledge, attitude, and practices (KAP) from pre- to post-survey results. These results conclude that educating perinatal nurses does positively impact their KAP and is beneficial to implementation. This implementation impacts future perinatal nursing and maternal newborn dyads for generations. The ability to change cultural thinking from “What is wrong with you?” to “What happened to you”? This demonstrates an improvement in care and is the first step in healing for all past and future trauma survivors.

Homeless people with chronic disorders need routine follow up to control chronic diseases and prevent exacerbations. Returning to the clinic for appointments or other interdisciplinary collaboration without a reminder is challenging. An intervention that involves automatic text message reminders could increase the return to the clinic for follow-ups, minimize ‘no shows’, and improve the overall health of homeless people with chronic diseases.

Background: Alcohol use disorder (AUD) has among been reported in 10-32% of hospitalized patients. The evidence suggests the need for screening and early management of alcohol withdrawal syndrome (AWS). Methods: This project included 2 phases - retrospective and prospective chart reviews. Demographic variables (age, gender, race) and length of stay were examined. Statistical tests were conducted to compare data from the phases. The outcome variables examined were the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) and the Clinical Institute Withdrawal Assessment for Alcohol (CIWA) scale. Results: Of 61 patients in phase 1, most (72.5%) were males, had an average age of 47.1 years, and a length of stay of 8.1 days. Most (96.7%) of the patients were placed on CIWA at admission. In one patient, there was not a prompt initiation of the CIWA protocol and alcohol withdrawal treatment, which may have resulted in a reduced incidence of delirium and a shorter hospital stay. Of the 16 patients in phase 2, most (81.3%) were males, Caucasians (62.5%), with an average age of 49.3 years and a mean length of stay of 5.5 days. There were no significant differences at p<.05 between characteristics in the two phases of the study. In phase 2, 7 of 16 patients (43.8%) had a PAWSS score >=4, indicating that these patients were at high risk. 5 of these 7 patients experienced severe withdrawal symptoms making this a true positive PAWSS score. The PAWSS scores were not recorded for 9 patients in this study phase, and 7 of these patients had CIWA score >=16, indicating that the patients may experience severe withdrawal symptoms. Conclusion: As the problem of AUD continues to exist, more detailed information about the use of PAWSS and CIWA to assess alcohol withdrawal is needed. Improving strategies to evaluate the effect CIWA management may be warranted.