DNP Student Projects
A hallmark of the DNP-prepared nurse is the ability to utilize the concept of practice inquiry to translate meaningful health research into practice. Students learn this process through the completion of a final DNP project. Students investigate an area of nursing practice, the health care delivery system, or a health care policy issue to develop a project meaningful to the organization as well as one that meets the scope of doctoral level work. DNP projects may take the form of quality improvement initiatives, practice change programs, program evaluation or translating evidence into practice. See examples of DNP student projects below.
2021 Graduates
Teresa P. Abernathy, BSN, RN, CGRN, DNP-FNP Student Quality Improvement: Implementing a Screening, Brief Intervention, and Referral to Treatment Approach Among Patients on Chronic Opioid Therapy (PDF)
Vanessa R. Albert Recognizing Post Intensive Care Syndrome in Intensive Care Survivors in the Outpatient Setting: Policy Change (PDF)
Micah F. Anderson, RN, BSN, DNP-FNP Student Program Evaluation: Identifying Barriers for a Clinical Pathway for Heart Failure in the Emergency Department (PDF)
Alex Arnold, RN, BSN, DNP-FNP Student Program Evaluation: Assessing the Current STEMI Process from ED to Cath Lab (PDF)
Carly Beesley, RN, BSN, DNP-FNP Student A Quality Improvement Project: Improving Post-Pathogen Exposure Safety (PDF)
Rosemaria Blackstone, RN, BSN, DNP-FNP Student A Quality Improvement Project: Increasing Cultural Competency to Improve Medication Administration Documentation (PDF)
Samantha Anne Campbell, BSN, RN,DNP-FNP Student A Program Evaluation of Falls Prevention in a Medical/Renal Unit (PDF)
Ashley B. Dalgarno, RN, BSN, DNP-DNP Student A Quality Improvement Project: Improving Nurse Proficiency in Quantitative Blood Loss Measurement (PDF)
Cathleen M. Daly, BSN, RN, DNP-FNP Student Program Evaluation: Assessing the Effectiveness of Advance Directive Planning for Surgical Intensive Care Unit Patients (PDF)
Allison L. Davis, DNP-S, MSN, ARNP, FNP-BC A Quality Improvement Project: Implementation and Evaluation of a Preceptor Preparedness Program (PDF)
Sophia Dunton Assessment of EHR Implementation and Training Processes at a Pilot Site for a National Initiative: A Program Evaluation (PDF)
Ginnette Erb RN, BSN, CEN, DNP-FNP Student Program Evaluation: Improving Access to Healthcare in the Emergency Department to Identify, Monitor, and Create Solutions for Efficient Throughput of Patients (PDF)
Mandie R. Gardner, RN, BSN, DNP-FNP Student A Quality Improvement Project: Increasing Depression Screening and Intervention (PDF)
Andrew Given, RN, BSN, DNP-FNP Student Program Evaluation: Alprazolam and Medications for Opioid Use Disorder: One Washington Opioid Treatment Program’s Approach to Risk Management and Patient-Centered Care (PDF)
Allen J Gonzalez, RN, BSN, DNP-FNP Student Program Evaluation to Assess Process and Outcome Causes for Unsuccessful Colonoscopies (PDF)
Johannah Gregg, BSN, RN, DNP-FNP Student A Quality Improvement Project: Improving Value in Total Joint Replacement Care: The Effect of Perioperative Education on Patient Quality of Care (PDF)s
Grace Hiner, RN, BSN, FNP-FNP Student A Nurse Residency Program’s Impact on Nurse Retention and Turnover in a Rural Hospital: A Program Evaluation (PDF)
Sarah M. Howard Implementation of an Educational Teach-Back Program: A Quality Improvement Project in a Thrombectomy-Capable Stroke Center (PDF)
Joanne M. Iverson, MN, RN, DNP Student Program Evaluation: Evaluating a Social Emotional Learning Program for Youth Living Homeless (PDF)
Calperna C Lucas, RN, BSN, DNP-FNP Student A Quality Improvement Project: Strategies to Reduce Violence in an Inpatient Mental Health Setting (PDF)
Diane Marines, MSN, RN, DNP student Program Evaluation of Mammogram Screening: In the Rural and Underserved in a Coastal NW Clinic (PDF)
Chelsea Mellett, RN,BSN, DNP-FNP Student Program Evaluation: The Diabetic Prevention Program (PDF)
Amanda C. Moore, RN, DNP-FNP Student A Quality Improvement Project: Treating Procedural Needle Pain in Pediatric Patients Using Non-Pharmacologic Techniques (PDF)
Zach R. Nelson Using Group Cognitive Behavioral Teletherapy to Increase Student Access to Counseling Services: A Quality Improvement Project (PDF)
Maria Nikolao, RN, BSN, DNP-FNP Student Maternal Mental Health Capture: A Program Evaluation for Standardized Mental Health Screening (PDF)
Phoebe Ortman Improving Spinal Fusion Surgical Outcomes, Patient Expectations, and Patient Satisfaction: A Quality Improvement Project (PDF)
Kim L. Pederson, BSN, MSN, RN, DNP-Student Policy Proposal:Gender Affirming Care for PeaceHealth Systems
Ryan T. Pederson Improving Emergency Department Sepsis Bundle Compliance: A Quality Improvement Project (PDF)
Suzanne K. Puryear Improving Awareness and Knowledge of Post-ICU Syndrome in the Outpatient Setting: A Quality Improvement Project (PDF)
Nik Rademaker Evaluation of Fall rates on a Medical-Oncology Unit after the Implementation of Fall Prevention Education: A Program Evaluation (PDF)
Kimberly Riano, MSN, DNP Student, ARNP Innovations to Increase Access to IUD Training for Nurse Practitioners (PDF)
Catherine Shutty, BSN, RN, DNP-FNP Student Addressing Health Literacy through Staff Development in a Primary Care Setting: A Quality Improvement Project (PDF)
Oksana Solovyanchik, BSN, RN, DNP-FNP Student A Quality Improvement Project: Increasing Early Detection and Self-Management of Prediabetes in a Community Clinic (PDF)
S. Robert Spence, Jr., RN, BSN, DNP-FNP Student A Quality Improvement Project in a Culturally Diverse Community: Easing Access to Early Childhood Learning with Micronesian Islanders (PDF)
Mari C. Sullivan, DNP-S, MSN, ARNP, FNP-BC A Program Evaluation Project: Implementation of Health Promotion Activities Using the Teach-Back Method with Micronesian Islander Community Parent Leaders (PDF)
Caleb Tadesse, RN, DNP-FNP Student A Program Evaluation: Fall Prevention Program at a Long-Term Care Facility (PDF)
Misty Van Cleave, RN, BSN, DNP-FNP Student An Urban Emergency Department Quality Improvement Project: Improving Cultural Competency for Lesbian, Gay, Bisexual, Transgender and Queer Patients (PDF)
Jennifer L Venable, RN, BSN, DNP-FNP Student Quality Improvement: Initiating Protected Sleep Time to Improve Postpartum Patient Satisfaction and Reduce Postpartum Fatigue (PDF)
Benjamin Verbil Reducing Specimen Labeling Errors in a Large Metropolitan Emergency Department: A Quality Improvement Initiative (PDF)
Sara E. Welty Patient Navigation Program Based on Identified Social Determinants of Health in an Emergency Department in Spokane, Washington: A Quality Improvement Project (PDF)
- Understanding the Basics of a DNP Project
- How to Develop a DNP Project Using an Evidence-Based Approach
- Stages and Components of a DNP Project
- DNP Project Ideas
Sponsored School(s)
The Doctor of Nursing Practice DNP project represents the culmination of your doctoral studies and an opportunity for you to translate your acquired knowledge into practice. It is also the epitome of the practice-focused DNP and an essential part of the integrative practice experience. Preparing your DNP project is an exciting time, as it allows you to lay the groundwork for future scholarship while at the same time giving you a chance to make a potentially meaningful contribution to improving nursing practice and patient outcomes.
In a whitepaper published in August 2015 entitled The Doctor of Nursing Practice: Current Issues and Clarifying Recommendations , the AACN recommended that the DNP Project be referred to simply as the “DNP Project” as a way to distinguish it from final projects in other types of graduate programs. While the term DNP Project is still commonly used, it’s worth noting that schools and professional organizations are in the process of uniformly adopting the term “DNP Project.”
Here’s what you’ll want to know:
What is a DNP Project?
A DNP project is the umbrella term used to describe a scholarly project with the express purpose of translating evidence into practice. You may also hear it referred to as a final or research DNP project. Your DNP project will reflect your specialization/area of interest, allowing you to delve deep and create a project focused on clinical practice . You will use your DNP project to demonstrate mastery of your advanced nursing specialty.
Fortunately, given the wide breadth of clinical nursing practice, your choices for a DNP project are nearly limitless.
For example, your DNP project may be a practice portfolio that explores the impact or outcomes of nursing practice, or it may be a practice change initiative represented by a program evaluation. It may be a quality improvement project, a consulting project, or the evaluation of a new practice model. It may be a practice topic dissemination, a systemic review, or a manuscript submitted for publication—and that’s just to start.
Although DNP projects may take on various forms, depending on your college/university’s requirements and your area of advanced nursing practice, all DNP projects have three things in common: They all include planning, implementation, and evaluation components.
These components reflect the American Association of Colleges of Nursing’s (AACN) DNP Essentials, which states that a DNP project should be able to successfully integrate some or all of the following into practice:
- Focus on a change that impacts healthcare outcomes through either direct or indirect care
- Have a systems (micro-, meso-, or macro-level) or population/aggregate focus
- Implement the appropriate area of practice
- Include a plan for sustainability (e.g., financial, systems, or political realities)
- Include an evaluation of processes and/or outcomes
All projects should be designed so that processes/outcomes can be evaluated to guide practice and policy, and all should provide a foundation for future practice scholarship.
What is the Purpose of the DNP Project?
The goal of the DNP project is to inform the methods you will use to deliver care and educate others in your chosen population/community. You will use the DNP project to demonstrate your ability to lead and practice at the highest level of clinical nursing practice.
You will be asked to integrate a number of skills into your final project:
- Expertise in reflective practice
- Expertise in your area of interest
- Independent practice inquiry (identifying existing problems/needs in nursing practice and/or healthcare systems)
- The ability to evaluate, translate, and use research and evidence to improve health and quality of care outcomes
- Organizational and systems leadership skills (developing, implementing, and evaluating interventions to improve outcomes for diverse populations and/or communities)
- Knowledge of advanced healthcare policy, ethics, and law to develop a population-based program based on the best available and current evidence
Back to Top
This is your time to shine, so don’t let the task of choosing a DNP project stress you out.
Using your area of clinical expertise as a springboard, develop your project using an evidence-based process:
- Formulate a well-developed question: Describe an innovation or clinical inquiry; identify a problem/issue
- Review the literature to identify evidence-based resources that answer your question: Apply the best evidence from literature
- Assess the validity of your resources using evidence: Collect data using standard and acceptable methods/tools
- Apply that evidence: Define outcomes to be measured upon implementation
- Implement outcomes and/or analyze results: Re-evaluate the application and identify areas for improvement
An example of how one DNP student followed this 5-step evidence-based process to develop a change project with the goal of increasing vaccination among healthcare personnel working in a college:
Step 1. A change project was initiated to increase influenza vaccination among healthcare personnel at a college
Step 2. Barriers to vaccination as well as factors that would help facilitate vaccination were identified using a pre-intervention questionnaire survey
Step 3. Interventions were planned based on the findings of the pre-intervention questionnaire survey
Step 4. Interventions were implemented
Step 5. The effectiveness of the interventions was assessed through a post-intervention survey
An example of how one DNP student followed this 5-step evidence-based process to develop a quality improvement project with the goal of reducing delays in treatment for patients with hand trauma:
Step 1. A quality improvement project was initiated to avoid delays in care for patients with hand trauma
Step 2. Over 2,000 consultations and notes from emergency room and urgent care departments were reviewed to assess adherence to guidelines for treating hand trauma
Step 3. Factors associated with a lack of adherence to treatment guidelines were identified
Step 5. Outcomes were assessed
Questions to Ask
One of the best ways to ensure your DNP project accomplishes your objectives is to ask yourself questions to make sure the project meets the required standards:
- Does my project focus on individuals, communities, populations, and/or systems?
- What problems/issues will my project address?
- Is my DNP project grounded in clinical practice? Will it solve problems or directly inform my practice?
- Will my project demonstrate mastery of DNP competencies achieved through my doctoral education?
- Is my project supported by evidence provided through existing literature?
- Does my project address outcomes associated with patients and healthcare?
- Does my project provide a foundation for future scholarship in nursing?
- Executive summary of the project
- Introduction to the project
- Description of the problem, how it is defined, and the clinical setting/environment and target environment
- Data supporting the existence of the problem
- Description of the creative approach to resolving the problem
The steps required to complete a DNP project will also vary somewhat from one program to the next. Generally speaking, DNP projects include the following stages:
- Student identifies a focus area for the DNP project.
- A Capstone Chairperson is selected based on mutual agreement of the student and faculty member and the clinical/scholarly interests and area of expertise of the faculty member. Note: Careful selection of a capstone chairperson is important, as the student and chairperson will develop a plan of study and work closely throughout the process .
- Student selects a Capstone Committee (usually includes at least three faculty members, one of whom is the Capstone Chairperson).
- Student earns eligibility to defend the capstone proposal (the proposal must be formally approved by all Committee members).
- Student works with Capstone Chairperson to develop the proposal, using the Committee in an advisory capacity, as needed.
- Student prepares and distributes the proposal defense to the Committee members.
- Student arranges a meeting of the Committee to discuss the proposal and to rule on its acceptability (Committee members ensure the proposal’s feasibility, clinical relevance, and quality.).
- Upon acceptance of the proposal, the student begins the process of implementing the DNP project (must receive administrative approval for all steps of the project).
- Student schedules the final defense of the DNP project upon completing the written project and upon getting approval from the Capstone Chairperson.
- Student distributes the final copy to the Committee members and prepares for the oral defense of the DNP project.
- Committee members critique the project, identify any changes or additional work to be done, and determine the outcome of the DNP project defense.
- Smoking Cessation Program for Patients with Coronary Artery Disease
- Safe Foot Care in African American Type 2 Diabetes
- A Community Based Approach to Promoting Nutritional Awareness and Improving Dietary Habits
- Standardized Procedure for Assessment and Documentation of Pain in Long-Term Care
- Evidence-Based Practice Update for Nurse Practitioners in Urgent Care
- Strategies to Improve Patient Flow in an Urgent Care Facility
- Empowering Community Health: A Faith-Based Approach
- A Medication Safety Education Program to Reduce the Risk of Harm Caused by Medication Errors
- Integrated Model of Dementia Care in a Nursing Home
- An Evaluation of a School-Based Asthma Protocol
- A Strategy to Reduce Distress Among Isolated Blood and Marrow Transplant Patients Post-Transplantation
- An Evidence-Based Toolkit to Prevent Meningococcal Meningitis in College Students
- An Evidence-Based Ovarian Cancer Education Toolkit: A Pilot Study
- Consequences, Prevention, and Treatment of Childhood Overweight and Obesity
- Prevalence of Symptoms in Multiple Sclerosis Patients
- Obesity Prevention in Young Children
- Predictors of the First-Year Nursing Student at Risk for Early Departure
- The Predictive Value of Second Trimester Blood Pressures on the Development of Preeclampsia
- Nursing Informatics Certification and Competencies: A Report on the Current State and Recommendations for the Future
- Development of a Web-Based Health Information Database and Call Center
- Translation of Autism Screening Research into Practice
- Effectiveness of Chronic Disease Self-Management Programs for Mentally Ill Inmates with Diabetes
- Optimizing Inpatient Heart Failure Education to Support Self-Care After Discharge
- Strategic Plan for a Patient-Centered Medical Home Adaptation
- Development of a Virtual Nursing Learning Lounge to Bridge the Practice Gap
- Leadership, Advocacy, and Policy: Development of a Professional Organization for Doctors of Nursing Practice
- Media Influence on Nutritional Choices in School-Age Children
- Interdisciplinary Simulation Training for Evidence-Based Obstetric Crisis Management
- A Web-Based Group Intervention for Patients with Recurrent or Metastatic Pancreatic Cancer
- Evaluation of Pain Management Practices Among Laboring Women
- A Multi-Method Approach to Evaluating Online Distance Learning in Nursing Education
- Effects of Health Education on Nutrition and Physical Activity of School Children
- Clinical-Academic Partnership Education and Socialization into the Nursing Role
- Development of a Strategic Plan for a Dedicated Education Unit and Clinical Teaching Associate Role
- A Strategic Plan for Promoting Health in the Hispanic/Latino Population through Internet-Based Social Networks
- A Criterion-Based Job Description and Performance Assessment for the Advanced Practice Nurse
- A Strategic Plan for the Development of an Inpatient Hospice Program
- Deploying a Geriatric Nurse Practitioner in an Emergency Department to Improve Outcomes for Geriatric Patients
- Implementing Evidence-Based Practice in an Acute-Care Hospital
- A Strategic Plan for the Development of a Model of Care for HIV Co-Infected Diabetics in an Inner-City Clinic
- Implementation of Routine HIV Testing for the Hospitalized Patient
- Development of an Evidence-Based, In-Patient Alcohol Detoxification Guideline for Culturally Diverse Adults
- Conducting a Randomized Household Survey in an Underserved Urban Community
- Fall Prevention in the Medical Surgical Setting
- A Comprehensive Systematic Review of the Influence of Transformational Leadership Style on Nursing Staff in Acute Care Hospitals
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Home > ETDs > DNP Projects
Doctor of Nursing Practice (DNP) Projects
Dnp projects from 2023 2023.
Mindfulness Based Self Care Toolkit for Psychiatric Healthcare Staff , Harkirat K. Bajwa
Promoting Parent-Child Relationships Through Community-Based Family Wellness Programs to Improve Mental Health in Children , Maria Elena Falcon
School-Based Development and Implementation of Adolescent Mental Health Educational Toolkits , Chantel M. Kilford Ms
School-Based Development and Implementation of an Educational Toolkit , Chantel M. Kilford Ms
Depression Screening Tool for Hysterectomy Patients , Dede C. Mihedji
DNP Projects from 2022 2022
Save the Children Community Health Worker Program—Project Management , Lauren Loree Burchfield
Increasing vaccination rates in the Latin X communities through a public health initiative for increasing education and vaccination , Gabriela Carrico
Educating Providers Without Prescriptive Authority About Psychopharmacology Basics: Bridging the Interdisciplinary Work Among Psychotropic Prescribers and Psychologists , Olivia Ceja
Psychosocial Distress Screening for Patients with Cancer: A Value-Based Approach to the Integration and Delivery of Holistic Care , Candy Cheung
Engaging Rural Providers About the Potential of Low-Earth Orbit Internet Satellite Supported Rural Telehealth Programs , Joshua M. Cleary
Development and Implementation of a Standardized Protocol for Nurse Practitioners Working in an AUD Treatment Telehealth Program , CJ Dea
Oleoresin Capsicum Gel: Enhancing Safety for the Home Health Clinician , Lilly Dickens
Diabetes Prevention and Management Education for Punjabi-Sikh Older Adults , Mandeep K. Gill
Improving Home Health Nurses' Knowledge of Heart Failure Self-Care Management , Nenette Hoffman
Improving Colorectal Cancer Screening in Primary Care , Bushra iqbal
Improving Colorectal Cancer Screening in Primary Care , Bushra Iqbal
Community Health Worker Program - Substance Use Disorder in Pregnancy , Alicia Claire Kletter DNP
Improving Diabetes Self-Management (DSM) Among Patients with Uncontrolled Type 2 Diabetes Mellitus (T2DM): A Patient-Centered Education Model , Maria Hannah Tiangha Mandecote
Save the Children® Community Health Worker Program - Prenatal Care , Deirdre A. Martinez
MITIGATE Toolkit for Outpatient Antibiotic Stewardship: Enhancing Safe Antibiotic Prescribing Practices , Allyssa Marie Montemayor and Allyssa Marie Montemayor
Implementing a Diabetic Foot Care Program in a Virtual Primary Care Clinic , Zahra Naderi Asiabar
Decreasing Seclusion and Restraint Events Among Clients Within an Inpatient and Crisis Stabilization Behavioral Health Facility , Karen Lee Richards
Utilization of the Nurse Practitioner Skillset in Partnership with the Medical Device Industry , Daniel C. Rowland
Integrating Culturally Tailored Interventions to Increase Cervical Cancer Screening: A Quality Improvement Initiative in a Primary Care Clinic , Marife Centeno Solomon
Advancing Treatment for Opioid Use Disorder in a Rural Emergency Department , Jill M. Wabbel
DNP Projects from 2021 2021
Technology-Based Advance Care Planning Education for Primary Care Patients , Taryn Achong
Development and Implementation of an Evidence-Based Practice Mentor Fellowship , Stacy L. Alves
Promoting Antibiotic Stewardship in Primary Care Setting: An Evaluation Process of Treatment Practices for Uncomplicated Urinary Tract Infections in Premenopausal Non-Pregnant Women , Ira Amayun
Manager Onboarding to Improve Retention, Knowledge, and Confidence to Lead , Christine Asiimwe
Manager Onboarding to Improve Knowledge and Confidence to Lead , Christine (Tina) K. Asiimwe
Designing and Implementing a De-Escalation Toolkit to Improve Staff Education and Competency on De-Escalation within a Mental Health Outpatient Setting , Balraj Bajwa
Increasing Chlamydia Screening in the High-Risk Population using Electronic Notification and Targeted Education: A Primary Care Approach , Michael Barnett
Transcatheter Aortic Valve Replacement: Implementation of Shared Decision-Making , LIESEL BUCHNER
Mindfulness-based Cognitive Therapy Staff Training Program to Tackle Postpartum Depression , Helen XUMIN Chen
Implementation of an Acute Care for the Elderly (ACE) Unit in a Community Hospital , Kimberly A. Colonnelli
Bullying in the C-Suite: A Nurse Leader Perspective , Kimberly Ann Colonnelli
Educating Providers to Screen for Post-Traumatic Stress Disorder , Alyssa Fraino
Creating a Pipeline to Increase Diversity in Executive Leadership Positions , Trarina Harris
Developing a Culturally Relevant Mental Health Assessment for Persons of African Descent , Roberta Iyamu
A Peer Feedback Process to Improve Assistant Nurse Manager Job Satisfaction , Juanita A. Jularbal-Walton
Development of an eHealth Harm Reduction Resource to Address Opioid Use Among Youth in Rural Northern California , Carolyn Perrotti Lake
Implementation of a Mental Health Environmental Risk Assessment Tool , Alan Le
Purposeful Nurse Hourly Rounding: A Plan To Decrease Patient Falls During a Pandemic , Robbie Masangkay
Purposeful Nurse Hourly Rounding: Plan to Decrease Patient Falls During a Pandemic , ROBBIE MASANGKAY
Regulatory Orientation to Support Transition to Academic Leadership , Annmarie Munana
Preparing Nurses in Management Positions for Bedside Care During Times of Crisis , Trevor Murray
Utilizing Digital Technology to Address Loneliness and Isolation in Older Adults through a Community-Based Connection Model: Responding to a Pandemic , Melissa A. Nagel
The Nurse Will See You Now: Improving Nurse-Led Chemotherapy Teaching , Laura Oka
PROVIDING HYPERTENSION EDUCATION FOR AFRICAN IMMIGRANTS AT A SOUTHERN CALIFORNIA CONGREGATION DURING THE COVID-19 PANDEMIC , Esther Oshunluyi
PROVIDING HYPERTENSION EDUCATION TO AFRICAN IMMIGRANTS AT A SOUTHERN CALIFORNIA CONGREGATION DURING THE COVID-19 PANDEMIC , Esther Oshunluyi
Increasing Continuous Positive Airway Pressure Compliance with Various Telemedicine Interventions: An Integrated Literature Review , Tracy Partington
Telehealth Appointments to Increase Therapy Compliance in Patients with MOSA , Tracy J. Partington
Behavioral Health Patients and Agitation in the Emergency Department: A Synthesis of Literature , Adam Pelzl
Implementation of an Agitation Scale in Three Emergency Departments in an Urban Area of Northern California , Adam Pelzl
Targeting Pre-Operative Booking Processes to Decrease Risks of "Never Events" , Rebecca Lynn Poths and Rebecca Lynn Poths
Building Excellence through Shared Governance and Continuous Process Improvement , Deborah Reitter
Streamlining Care for Children with Autism Spectrum Disorder , Siavash Rostami Jafarabad
Nurse Practitioner-Led Care Pods: A Team Communication Enhancement Model , Miranda Saint-Louis and Miranda Saint Louis
Use of Simulation to Improve Nurse's Response to COVID-19 Code Blue: A Literature Review , Charity Shelton
Using Simulation to Improve COVID-19 Code Blue Outcomes , Charity Shelton
Utilizing Group Prenatal Care to Support Underserved Pregnant Women , Kathleen Shrader
Utilizing Tracer Methodology to Evaluate the Effectiveness of a Hospital Antimicrobial Stewardship Program , Christine Smyth
Patient Placement Matters: The Impact of Unnecessary Lateral Movement on Patients , Jacqueline Strinden
The Effects of Naloxone Education Among Adults in Alameda County , Patricia Ronnica Tinglin
Prevention of Abusive Head Trauma Using an Educational Program for Parents/Caregivers , camile williams
Utilizing a Stress and Coping Model into a Preventive Abusive Head Trauma Parent/Caregiver Educational Program , Camile Williams
Successfully Spreading Improvement Work Using a Proven Framework , Rachel Lynn Wyatt
DNP Projects from 2020 2020
Ultrasound-Guided Peripheral Intravenous Catheter Insertion for Nurse Practitioners , Alvin Joseph Abad
Preconception Screening for Family Planning , Nnenna Abaeze
Pre-conception Screening Tool , Nnenna Abaeze
Healthcare Provider Education: Adult Jamaicans with Type 2 Diabetes , PATRICIA ANDERSON
Bisphenol-A (BPA) and Breast Cancer: Utilizing Risk Assessment and Education to Improve Preventative Care , Ashley Catherine Babcock
Continuous Glucose Monitoring and Diabetes Management During Pregnancy , Nicole Beamish
Workplace Violence: An Urgent Call for Integrated Staff Education in Acute Care Hospitals , Nicole Bellisario
Valley Fever: Education for Primary Care Providers and Allied Health Care Professionals , Michelle Elizabeth Bergen
Improving Clinicians’ Access to Patient Education and VA Resource Information , Ella Bermudez
Reducing Frustration with Wait Times Utilizing Technology and Education: A Patient Satisfaction Improvement Model , Tiffany Brown
Identification of Victims of Human Trafficking: Leading Change through a Global Pandemic , Connie Clemmons-Brown
Earlier Palliative Care Referrals for Nephrology Patients , Jerold Cohen
Implementation and Evaluation of Whole Health Opioid Safety Shared Medical Appointments in a Veteran Population: A Quality Improvement Study , Sherry Cox
Chief Nurse Executive Work Engagement: System Leadership Through a Natural Disaster, Strike, and Pandemic , Ryan Fuller
Program Implementation for New Graduate Nurses to go from Moral Distress to Moral Courage and Beyond , Melinda Furrer
Wound and Stoma Care Education for Primary Care Providers , Deanna Garza
Transformational Leadership for Frontline Leaders , Marta L. Hudson
USP Compliance: A Hazardous Drug Safe Handling PPE Toolkit for Infusion Nurses , Cynthia Huff
USP Compliance: A Hazardous Drug Safe-Handling Quality Improvement Project for Ambulatory Care Infusion Nurses , Cynthia Huff
Preceptor as Frontline Leader Utilizing Emotional Intelligence , Dwanette Judkins
Technology-Based End-of-Life Planning for an Underserved Population , Haley Kirkpatrick
Increasing Access to Medicare Annual Wellness Visits in Primary Care; Utilizing Registered Nurses as part of an Interdisciplinary Team Based Approach , Iyo Kubota
An Online Self-Directed Learning Module for Regional Stroke Survey Success , Winchell Rodriguez Kuttner
Application of Sustainability Framework for Quality Improvement in an Integrated Health System , Cristine Lacerna
Using Simulation for Oncology Nursing Competency Evaluation in Hospitals , DANA N. LITTLEPAGE
Using Simulation for Oncology Nursing Competency Evaluation in Hospitals , DANA LITTLEPGE
Optimizing Screening Mammography: Educating Underserved Individuals with Limited English Proficiency , Yao Luo
Improving Clinical Communication and Collaboration Through Technology , Michelle Machon
Initiating PrEP in Primary Care: Addressing the Adolescent and Young Adult High Risk Populations , Igor G. Mocorro
Fall Reduction Project in a Skilled Nursing Facility , Jalpa Patel
Implementing Virtual Sitters to Reduce Falls and Sitter Costs , Asia QuoVadis Williams Plahar
Implementation of Artificial Intelligence Initiated Rapid Responses to Reduce In-Hospital Cardiac Arrest , Alicia Potolsky
A Performance Improvement Nursing Fellowship to Enhance Timely Access to Care , Cheryl Reinking
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- DNP Student Project Examples
Here are some examples of projects from former DNP students.
Addressing maternal outcomes in rural Indiana mothers through improved prenatal care utilization Yadira Santiago Banuelos, MSN, RN, FNP-BC, CLC | PowerPoint Presentation (PDF)
Examining Knowledge and Knowledge Retention in Nurse Practitioners after the Implementation of an Online Educational Module on Obstructive Sleep Apnea Jessica J. Pietras, BSN, BS, RN | Executive Summary
The impact of a resilience and self-care intervention on senior BSN students and their perception of readiness for practice during the COVID-19 pandemic Paula Morrow, MSN, RN, FNP-BC, FNP-C, CEN
Screening of Postpartum Depression and Stress Among Mothers of Infants in a Pediatric Cardiovascular Care Unit: A Pilot Study Alessi Miller , BSN, RN | Executive Summary
Care of the Obstetric Patient in the Intensive Care Unit: A Quality Improvement Study Caitlin Luebcke , MSN, APRN, AGACNP-BC, AGNP-C, CCRN | Executive Summary
Examining Factors That Influence Confidence and Competence Among Nurse Practitioners Kelsey Allbright
Best Shot: A Motivational Interviewing Approach to Address Vaccine Hesitancy in Pediatric Outpatient Settings Kristin Jamison, MSN, RN, FNP-C | Executive Summary
The Effect of Text Message Reminders on HPV Vaccination Rates in Adolescent Males Madison Plumer, BSN, RN | Executive Summary
Introduction of a Conversation Starter Tool to Improve Health Habits in Young Children Rachel Knafel, MSN, RN, FNP-BC | Executive Summary
The Association Between Use of Nurse Practitioners and Quality Measures in the Long-Term Care Setting Katie Begle, DNP, BSN, RN
Comparing Models of Nurse Practitioner Preceptorship Using a Simulation Approach Samantha Tielker, DNP, MSN, ACNP-BC | Executive Summary
Does Provider Education Increase Rates of Adolescent Sexual Health History Taking? Elizabeth Sigler, DNP
Identifying Sustainable Improvements to the Nurse-to-Nurse Patient Handoff Process: A Policy Capturing Study Taylor Vandervort, DNP | Executive Summary
Risk Perceptions and E-cigarette Use Among College Students: A Socioecological Model Approach Nachel Rhoades, DNP, BSN, RN | Executive Summary
Increasing Autism Spectrum Disorder Screening and Referrals in a Pediatric Clinic Amber Barney, DNP, RN, MSN, MBA, APRN, CPNP | Executive Summary
The Utilization of Sunscreen Prescriptions to Increase Patient Use: Examination of Healthcare Provider Perceptions James M. Roush, DNP, RN | Executive Summary
Testing a Pediatric Palliative Care Education Workplace Intervention Courtney James, DNP | Executive Summary
Anxiety and Coping Styles of First-Year Nursing Students During COVID Anne Campbell, DNP | Executive Summary
Utilization of Spanish Medical Interpreters for Diabetes Education in a Community Health Center Mariah Scheker, DNP, AGPCNP-BC, Summer 2021 | Executive Summary
Impact of Expedited Partner Therapy Implementation on STI Reinfection in an Urban Public Health Clinic Amy Evans, MSN, NP-C | Executive Summary | Manuscript
Early Prediction of Cardiac Arrest Using Machine Learning Laura Moffat, MSN, MSK, APRN, AGCNS-BC, CMSRN | Executive Summary
Indicators of Transport Nurses Safety Competency Donna York Clark, MS, RN, CMTE | Executive Summary
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Home > Theses and Dissertations > Doctor of Nursing Practice Final Manuscripts
Doctor of Nursing Practice Final Manuscripts
Dnp final manuscripts from 2023 2023.
3D-Wound Imaging: Precise, Consistent, and Efficient , Aubrey Halili
DNP Final Manuscripts from 2022 2022
Improved Monitoring of Depression and Suicidal Ideation in Low-Income Adolescents through Evidenced Based Provider Education , Sunday Adeyeye
Increasing Mental Health Literacy in the Black Church , Jonathan Allotey
Implementing Adverse Childhood Experience Screening in an Intensive Outpatient Mental Health Program , Bryan Amaro
Impact of Telephonic Follow Up in Patients Initiating Antineoplastic Treatment in the Ambulatory Setting , Lauren Belkin
Forestalling: Decreasing Super-Utilizers in the Emergency Department Using Case Management Strategies , Kelly Chambers, Megan Gilmartin, and Martha Narasimhan-Narayanan
eConsent Forms on Ancillary Applications with Electronic Medical Record Integration – Reducing Consent Error , Lilian Chan
Increasing COVID-19 Vaccine Awareness Among Hispanic Families: A Policy Perspective , Allison Chico, Iris Vazquez, Claudia Aguayo, and Jose Andres Rozo
Improving Completion Rate of Identifying Seniors At Risk (ISAR) Screening Tool in Emergency Department (ED) Setting , Ashley Clark
Improving Same Day Surgery Patient Outcomes Through a Nurse Practitioner Led Telephone Follow-up Call , Jessica Cooke and Kamila Zasowska
Does Comfort Care Make You Uncomfortable? Use of the CARES Tool for End-of-Life Symptom Assessment and Management , Christina Covington
Effects of Telephone Follow-up on Medication Adherence and Rapid Readmission Among Discharged Adults With Schizophrenia Spectrum Disorders (SSDs) , Romilynn Danko and Madalyn Cosensci
Implementation of the blunt tip cannula for dermal fillers to decrease adverse events intra and post treatment , Natalie Drone
Fall Risk Assessment and Intervention to Reduce Fall-Related Injuries and Hospitalization in Older Adults , Pittawat Emerson
Improving Discharge Outcomes: Telephone Follow Up for Heart Failure Patients , Ashley Fanjoy
Enriching the Perioperative Enhanced Recovery After Surgery (ERAS) Program for Patients Undergoing Whipple Procedure for Pancreatic Cancer , Natalie E. Fisher
Decreasing Falls on a Locked Inpatient Psychiatric Unit , Terri Fitzpatrick
Identifying Elderly Patients at High Risk for Post-Operative Cognitive Dysfunction: A Clinical Perspective , Kelly Glas
Effects of Diabetes Self-Management Education in the Primary Care Setting on Self-Efficacy and Glycosylated Hemoglobin Levels Among Adults With Type 2 Diabetes Mellitus , Colleen Harris
Physician Orders for Life-Sustaining Treatment (POLST) Forms in a Primary Care Setting , Elena Johns
Evaluating the Effectiveness of Education on the Misuse of Corticosteroids and Antibiotics for Treatment of Acute Pharyngitis , Samantha Kaikai
Screening for childbirth-related posttraumatic stress disorder using the City Birth Trauma Scale: A pilot project , Meredith Kazato
Improving Vaccination Rates Through Community Partnership , Marissa Marquez
Prediabetes education to prevent the progression to type 2 diabetes , Peggy Mata
The Power of Proactive Referrals: An Evidence-Based Practice Project to Improve Smoking Cessation Rates at a Community Health Clinic , Kristin McMahon
Screening for Suicide Risk in the Outpatient Electroconvulsive Therapy Population , Cerah Nagata
LIFESTYLE MODIFICATION INTERVENTIONS ON HEMOGLOBIN A1c LEVEL IN PATIENTS WITH TYPE II DIABETES MELLITUS IN AN UNDERSERVED COMMUNITY: A PILOT PROJECT , Anniesatu Newland
Implementation of Nola Pender’s “Clinical Assessment for Health Promotion Plan” to Increase Patient Self-Efficacy, Weight Loss and Health Promoting Behaviors Such as Improving Nutrition and Increased Physical Activity in Obese Women in a Weight Loss Clinic , Christine Ngwazini
Implementation of the Edinburgh Postpartum Depression Screening Tool to Screen Mothers for Postpartum Depression in the Pediatric Setting , Vera Nikolaychuk
Treatment Evaluation of Iron Deficiency Anemia in Women of an Underserved Community , Bukola Olusanya
Implementation of Surgical Education Video to Burn Patients Before the Informed Consent Process , Brian Piatkowski
Development of a Nurse Practitioner Driven Program for Cardiology Providers to Increase Knowledge and Awareness of Neurodevelopmental Assessment Needs in Children with Congenital Heart Defects , Michele Readman
Smiling Mind: A Mobile Based Application to Reduce Stress , Agnes Rodrigues
The Use of Telehealth to Improve Patient Outcomes Among Prediabetes and Diabetic Patients in a Rural Women's Health Clinic: An Evidence-Based Practice Project , Alejandra Villegas
National Early Warning Score (NEWS) for COVID-19 infected Patients: A Clinical Guidance Tool , Robert Villegas
Screening People Experiencing Homelessness for Adverse Childhood Events (ACEs) , Priya Vishwanath
DNP Final Manuscripts from 2021 2021
Identifying Adverse Childhood Experiences (ACEs) in a Federally Qualified Health Center using the Pediatric ACEs and Related Life Events Screener , Melody Albarran-Slovin, BSN, RN
Telehealth Breastfeeding: Best Practice Guideline , Laura Amabile
Obesity Prevention Toolkit to Combat Weight Gain Related to Sedentary Behavior and Dietary Habits in College Students: An Evidence-Based Project , Maria Amos and Martha Fuller
Motivational Interviewing and Frequent Follow-up in a Pediatric Primary Care Setting to Improve Diet and Activity in Adolescents , Celeste Armenta and Kathy James
Addressing Vaccine Hesitancy with Motivational Interviewing: A Pilot Study , Olivia Ball
A Guide to Vaccine Policy Change at a National Level , Janelle Bird
Sunscreen Use and Screening in College Athletes: An Evidence-Based Pilot Project , Nicole Brustkern BSN, RN, CPN and Sharon Boothe-Kepple PhD, MSN, FNP-C, PHN (Chickasaw)
Implementing EBP Guidelines to Optimize Human Donor Milk Usage in the Hospital Setting , Kimberly Carriker
Bridging the Gap: Utilization of Telehealth for Heart Failure Patients to Reduce Hospital Readmissions: Best Practice and Recommendations , Shalaine Corbilla
Self-Measured Blood Pressure Monitoring: A Patient Empowerment Project , Alison Cusmano
Preoperative Fasting Policy Updated for Healthy Patients , Janet Dewees
Improving Identification of Seniors at Risk Tool Adherence to Identify Emergency Department Readmissions in Older Adults , Joy Gao
Impact of Psychotropic Medications on Electrical Cardiac Conduction in the Emergency Department: A Best Practice Review , Juliann Hatt
Managing Pediatric Atopic Dermatitis in the Allergy Clinic: Use of an Eczema Action Plan to Improve Caregiver Understanding and Self-Efficacy, A Pilot Study , Danielle Hubacek
Achieving Advance Care Planning in Diverse Populations via Teleconferencing with Skilled Nursing Facility Residents , Tania Huezo
Utilizing Post Graduate Residency Program in New Graduate Nurse Practitioners to Improve Clinical Outcomes , LaShaunda Jethro
Establishment of Best Practice Skills for Advanced Practice Nurses , Leslie Kendrick; Tara Hughes; and Joseph Burkard DNSc, CRNA
Identifying Opportunities for Implementing Home Blood Pressure Monitoring in Newly Diagnosed or Worsening Hypertension at a Family Health Clinic , Catherine Liikala
Balancing Provider Stress and Resilience in the Time of COVID , Zachary Love
Health Disparities Associated with Pre-existing Cardiovascular Disease and Telemedicine Interventions during COVID-19 Pandemic: Best Practice Review with Recommendations , Barbara Mae Madriaga
Substance Use Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Pregnant Women Living with HIV , Whitney Markowitz
Identifying Gaps in Follow-up Care Among Adults in an Occupational Health Setting: A Retrospective EBP Pilot , Ginny Meyerhuber, MSN, RN
Implementation of the Center for Disease Control (CDC) Prediabetes Risk Test in the Medical Weight Loss Setting , Gabriela Miller, RN, BSN
Sun Protection Behaviors in Patients with Actinic Keratosis , Madison Molotky
Weight Reduction Motivation in Osteoarthritis Patients Through Nurse Practitioner Driven Education and Follow-Up: A Pilot Project , Caoilfhionn Mulvey and Martha Fuller PhD
Treatment Anxiety Education for Pediatric Cardiac Neurodevelopmental Patients, an Evidence Based Project , Mary Nagel
Pediatric Primary Care Depression Screening Using PHQ-9 Modified for Teens , Aksel Narvaez
Transitioning from Onsite to Online Psychotherapy Visits during the COVID-19 Crisis , Michael Angello Negron, DNP
Reducing Obesity Rates Among Adults in a Primary Care Setting: An Evidence-Based Practice Project , Raxita Neupane
Standardized Education on Physician Orders for Life Sustaining Treatment (POLST) Conversations , Venessa Oteniya
Screening for Resilience in Pediatric Primary Care , Kaitlin Phelan and Martha Grant Fuller
Management of Mild Abscesses in Adult Patients , LILIANA PITTMAN
Increasing Physical Activity in Children and Adolescents During the COVID-19 Pandemic , Alyssa Plisic
Removal of ANA Language to Increase Access to Vaccination Compliance , Steven G. Pochop Jr.
Introducing Trauma-and Resiliency-Informed Care in a Residential Treatment Setting , Connie Quach
Get America Talking: Implementing Advanced Care Planning in Primary Care , Sasha Recht
Improving Pediatric Provider Preparedness for Postpartum Depression Screening , Samantha Shafer and Martha G. Fuller
Efficacy of Telehealth Modalities in Medication Adherence for Older Adults , Mitchell Adrian C. Siy
Deprescribing in the Hospice Population, Who is Eligible and Who is Agreeable: A Quality Improvement Project , Ashlee Nicole Smith
Optimizing Best Telehealth Practices among Advanced Practice Registered Nurses , Karen Swafford
The Second Victim: Knowledge for the Healthcare Team , Charisse Lyn Tabotabo
Family Bereavement Implications for Military Personnel: A Policy Proposal , Dehussa Urbieta
Proper Utilization of the Canadian C-Spine Rule for Mild C-Spine Injury , Lizbeth Velazquez
Screening for Postmenopausal Osteoporosis in Women between Age 30-64 in Primary Care: A Policy Perspective with Recommendations , Shenwan Wang
DNP Final Manuscripts from 2020 2020
Improving Latent Tuberculosis Infection (LTBI) Screening and Treatment in a School-Based Setting , Andrea Bell
Exploring the Efficacy of a Perinatal Mental Health Community Based Organization’s Social Media Engagement , Johanna Bermudez Vera and Semira Semino-Asaro
Peer-led Education Expedites De-Prescribing Proton Pump Inhibitors for Appropriate Veterans , Mary H. Bowman
Mental Health Screening for Low Income Adolescents: An Evidence-Based Project , Allison Bryden
Utilizing Telehealth Technology to Reduce Social Isolation and Depression in Seniors , Bohan Farrell
Reducing the Rate of Falls in Hospice Patients: A Fall Prevention Pilot Program , Allison Floyd
Screening for Iron-Deficiency Anemia in the Pediatric Population (Ages 1-17) in Gonaïves, Haiti , Cara Rose Fratianni
Enhancing Chronic Pain Management: Motivational Interview Among Lower Back Patients –Phase II , Valerie Gates and Melissa Hines-Antico
Screening for Post-Menopausal Osteoporosis in Women ages 30-64 Review of a Pilot Program in Primary CareScreening for Post-Menopausal Osteoporosis in Women ages 30-64 Review of a Pilot Program in Primary Care , Elaine Henson
Bridging the Gap: Improving Hospital Discharge through Utilization of a Priority Care Clinic , Kristian Jamerson
Utilization of Peer-Led Education to Enhance Advance Care Planning and Advance Directive Completion , Jenna Juenger
It's More Than Just "Baby Blues" - Screening for Postpartum Depression in a Pediatric Setting , Breanna M. Lazar and Martha G. Fuller
Nurse Practitioner-Led Obstructive Sleep Apnea Screening in Patients with an Implantable Cardiac Monitor, and Confirmed or Suspected Atrial Fibrillation , Yarlenis Miranda, Lisa Alvarez, Mehran Moussavian, and Joseph Burkard
Recommended Syphilis and HIV Testing After Positive STI Testing , Katherine Cayce Monaghan RN, BSN
A Follow-Up Phone Call to Post-Operative Patients Using the Five A’s , Brittney Ochs
Transforming Clinical Care Through Sexual Wellness Education for Community College Students , Chelsea Ovanek
Empowering Newly Diagnosed Patients with Hypertension in Reducing Complications through Self-Managed Care , Ana Pacis
Assessing the Need for Standardized Pre-Chemotherapy Education: An Outpatient Oncology Clinic Initiative , Spana Patel
Effects of Standardized Self-Care Behavior Education on Self-Efficacy Outcomes in Type II Diabetes Mellitus , Nishita Patolia BSN, RN, DNP Student
Unplugging: An Evidence-Based Project to Reduce Screen Time and Improve Healthy Media Use in the Adolescent Population , Erica Persichetti
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Doctor of Nursing Practice (DNP) Final Projects
The Doctor of Nursing Practice Final Projects collection contains the completed works of students from the DNP Program at Arizona State University's College of Nursing and Health Innovation. These projects are the culminating product of the curricula and demonstrate clinical scholarship.
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All about the DNP project
Understanding the process helps ensure a successful project.
The final doctor of nursing practice (DNP) project provides students with the opportunity to systematically translate the best current evidence into practice. However, variability in how projects are implemented exists among programs. In response, the American Association of Critical Care Nurses (AACN) commissioned white papers from two internal task forces: the Implementation Task Force (ITF) and the Advanced Practice Registered Nurse Clinical Training Task Force. The ITF’s white paper, The Doctor of Nursing Practice: Current Issues and Clarifying Recommendations, describes and clarifies the characteristics of DNP graduate scholarship (including the DNP project), efficient resource use, program length, curriculum considerations, practice experiences, and collaborative partnership guidelines. The Advanced Practice Registered Nurse Clinical Task Force white paper, Re-envisioning the Clinical Education of Advanced Practice Registered Nurses , explores how APRN education can adapt to include more simulation opportunities, academic-practice partnerships, competency-based assessments, and nontraditional APRN clinical education models, such as technology or informatics. However, the AACN doesn’t make specific recommendations with regard to the final DNP project, pointing instead to the DNP Essentials to explain the project’s scope and depth.
This article discusses the issue of project variability, then explores DNP project fundamentals to help eliminate ambiguity and confusion and broaden students’ understanding of the project’s significance. Before initiating a DNP project, several key elements—mentoring, time management, organizational and academic support, potential institutional review board approval, and planning for dissemination—must be in place. (See 8 steps to completion.)
8 steps to completion
Students should take these eight steps to complete their doctor of nursing practice (DNP) projects.
- Identify and obtain approval for the area of interest.
- Write a proposal.
- Create a project timeline.
- Acquire institutional review board approval (if needed).
- Implement project.
- Write final report.
- Present an oral presentation.
- Disseminate the project.
Source: Anderson et al. 2015.
DNP project variability
With the increased volume of new programs and growing interest in the DNP degree, the profession must clarify the scope of the final project, including implementation, impact on system and practice outcomes, extent of collaborative efforts, dissemination, and degree of faculty mentorship and oversight. Some universities require students to complete a practice improvement project over the span of a course, whereas others require students to initiate an evidence-based practice (EBP) innovation project when they begin the program and continue it through the final semester.
Despite projects’ various forms, many elements—including planning, implementation, evaluation, and sustainability—must be consistent across programs. Without concrete guidelines, programs have employed several interpretations, including portfolios, case studies, systematic reviews, and writing projects. (See Project dissemination variability.)
Project dissemination variability
Several doctor of nursing practice (DNP) project types are included in the DNP Essentials . The table compares the American Association of Colleges of Nursing’s (AACN’s) white paper recommendations and AACN DNP Tool Kit with regard to dissemination.
Reasons for variability include:
- lack of faculty familiarity with quality improvement (QI) and EBP methods
- strain on faculty capacity and time commitment for project completion
- lack of faculty expertise in DNP education
- inability to find clinical sites that allow students to implement projects
- lack of DNP faculty resulting in programs led by PhD faculty
- lack of graduate-level writing skills
- differing student education levels (for example, BSN-DNP, MSN-DNP)
- time constraints within the iterative process requiring multiple revisions of written work.
Although some program variability is expected, concern about the lack of adherence to the DNP Essentials exists . In response, the AACN is committed to enhancing program congruency. To ensure consistency, post-master’s and post-baccalaureate DNP students (who begin their doctoral programs with different education and practice backgrounds) should graduate with the same comprehensive skill set as described in the DNP Essentials .
Project fundamentals
The DNP project, previously called the capstone project or the scholarly project, should demonstrate translation of acquired knowledge into clinical practice and exhibit the student’s growth in clinical knowledge, expertise, and use of the DNP Essentials and DNP Tool Kit. (See DNP Essentials and Tool Kit.)
DNP Essentials and Tool Kit
The American Association of Colleges of Nursing’s (AACN’s) eight DNP program essentials prepare nurse leaders for advanced practice.
- Scientific underpinnings for practice
- Organizational and systems leadership for quality improvement and systems thinking
- Clinical scholarship and analytical methods for evidence-based practice
- Information systems/technology and patient care technology for the improvement and transformation of healthcare
- Healthcare policy for advocacy in healthcare
- Interprofessional collaboration for improving patient and population health outcomes
- Clinical prevention and population health for improving the nation’s health
- Advanced nursing practice
DNP Tool Kit
The DNP Tool Kit, which continues to evolve, provides schools with the resources for formatting a DNP program. It combines information from the DNP Essentials and recommendations from the AACN DNP white paper to provide templates, exemplars, frequently asked questions, and other resources.
Projects can focus on QI, executive outcomes management, or an EBP change initiative aimed at strengthening healthcare. (See DNP project examples.)
Project examples
The following are examples of doctor of nursing practice (DNP) projects completed by the authors when they were DNP students.
Quality improvement projects
- After evaluating evidence-based practices for type 2 diabetic foot management, the student developed a new standardized protocol for staff education and patient care practices for foot care assessment and management.
- The student reinforced nursing education as a means to overcoming adherence barriers to an evidence-based sedation protocol for improved ICU outcomes.
Evidence-based practice projects
- The DNP student used an evidence-based survey tool to measure student anxiety when caring for dying patients. Based on the results, an education module was developed to help students manage their stress.
- To decrease nonurgent use of the emergency department and increase fever knowledge, the student created an educational program for caregivers of pediatric patients.
Guideline development and improvement project
- After a systematic evidence search, the student developed a neonatal abstinence syndrome treatment guideline to standardize care and reduce treatment duration, symptom severity, length of hospitalization, and costs.
While working on their projects, students learn to build strong, collaborative partnerships with stakeholders and mentors.
DNP programs throughout the United States require students to conduct various types of projects, which contributes to ongoing confusion about DNP preparation and role. However, all projects should reflect the DNP Essentials in a single, cumulative work that evolves as the student progresses through the program. In addition, this scholarly synthesis should serve as a platform for future scholarship after graduation.
According to the AACN DNP Tool Kit, all projects should:
- focus on a change that impacts the outcome of healthcare through direct or indirect care
- have a systems (micro-, meso-, or macro-level) or population/aggregate focus
- demonstrate implementation in the appropriate practice area
- include a plan for sustainability (it should take into account financial, systems, or political realities, not only theoretical abstractions)
- include an evaluation of processes and outcomes (formative or summative).
Frequently, a project is the outcome of a student’s identified need for improvement in clinical practice or patient outcomes guided by the spirit of inquiry. The project results are a compendium of graduate education immersed in nursing leadership, education, health policy, or clinical practice.
Dissemination
All DNP projects should emphasize positive change that advances quality outcomes, attention to systems thinking, strategies for sustainability with an appraisal of processes and outcomes, and a structure for future practice. The expectation is that DNP-prepared nurses will contribute to the body of knowledge in nursing practice by sharing their work with others so that they can apply it to their practice roles. Platforms for dissemination include social media, peer-reviewed journals, presentations, professional conferences, brochures, posters, policy briefs, organizational team meetings, media interviews, academia, and press releases. Many programs require students to summarize their projects for publication in a peer-reviewed journal.
The final requirement of the DNP project is a student’s presentation before their institution’s doctoral panel. In this venue, students deliver elemental details about their project’s processes and impact, including purpose, evidence synthesis, project design, data analysis, frameworks, and dissemination.
Be a trailblazer
DNP students’ final projects reflect the culmination of their educational journey and prepare them to share their work with others to benefit patients, the healthcare system, and the nursing profession. The result is a body of information that bridges the gap between research theory and clinical practice. As trailblazers, DNP-prepared nurses can empower other professionals to improve patient outcomes and achieve benchmarks for practice change supported by collaborative endeavors.
The following authors are DNP graduates from the University of Texas at Tyler in Tyler: Barbara Chapman is a family NP with the INTUNE Mobile Unit and assistant clinical professor in the school of nursing at The University of Texas at Tyler. Chiquesha Davis is department head of post-licensure programs, graduate programs, and assistant professor at Tarleton State University in Stephenville, Texas. Sonya Grigsby is a critical care NP at CHRISTUS Mother Frances Hospital in Tyler, adjunct nursing faculty at University of Texas at Tyler, and locum NP at OSF St. Francis Medical Center in Peoria, Illinois. Cyndi B. Kelley is a nurse manager in the special care nursery and chair of the doctoral collaboration council at Texas Health Presbyterian Hospital of Dallas and adjunct faculty in the ADN-to-BSN program at Grand Canyon University in Phoenix, Arizona. Rebecca Shipley is a family NP at CHRISTUS Trinity Mother Frances Health System. Christian Garrett is a DNP student at the University of Texas at Tyler, a family NP at CHRISTUS Trinity Mother Frances Hospital, and an adjunct professor in the school of nursing at The University of Texas at Tyler.
Alexander S. Scholarship in clinical practice: An update on recommendations for doctor of nursing practice programs. Clin Nurse Spec. 2016;30(1):58-61. doi:10.1097/NUR.0000000000000177
American Association of Colleges of Nursing. The doctor of nursing practice (DNP) tool kit. aacnnursing.org/DNP/Tool-Kit
American Association of Colleges of Nursing. The Doctor of Nursing Practice: Current Issues and Clarifying Recommendations. August 2015. aacnnursing.org/Portals/42/DNP/DNP-Implementation.pdf
Anderson BA, Knestrick JM, Barroso R. DNP Capstone Projects: Exemplars of Excellence in Practice. New York, NY: Springer Publishing Company; 2014.
Bednash G, Breslin ET, Kirschling JM, Rosseter RJ. PhD or DNP: Planning for doctoral nursing education. Nurs Sci Q. 2014;27(4):296-301. doi:10.1177/0894318414546415
Broome ME, Riner ME, Allam ES. Scholarly publication practices of doctor of nursing practice-prepared nurses. J Nurs Educ. 2013;52(8):429-34. doi:10.3928/01484834-20130718-02
Brown MA, Crabtree K. The development of practice scholarship in DNP programs: A paradigm shift. J Prof Nurs. 2013;29(6):330-7. doi:10.1016/j.profnurs.2013.08.003
Dols JD, Hernández C, Miles H. The DNP project: Quandaries for nursing scholars. Nurs Outlook. 2017;65(1):84-93. doi:10.1016/j.outlook.2016.07.009
Dreher HM, Glasgow MES. DNP Role Development for Doctoral Advanced Nursing Practice. 2nd ed. New York, NY: Springer Publishing Company; 2017.
Grigsby S, Chapman B, Kelley CB, et al. DNP and PhD: Complementary roles. Am Nurse Today. 2018;13(7):8-13.
Holly C. Scholarly Inquiry and the DNP Capstone. New York, NY: Springer Publishing Company; 2014.
Moran KJ, Burson R, Conrad D. The Doctor of Nursing Practice Project: A Framework for Success. Burlington, MA: Jones & Bartlett Learning; 2019.
Murphy MP, Staffileno BA, Carlson E. Collaboration among DNP- and PhD-prepared nurses: Opportunity to drive positive change. J Prof Nurs. 2015;31(5):388-94. doi:10.1016/j.profnurs.2015.03.001
Pandi-Perumal SR, Akhter S, Zizi F, et al. Project stakeholder management in the clinical research environment: How to do it right. Front Psychiatry. 2015;6(71). doi:10.3389/fpsyt.2015.00071
Shipley R, Chapman B, Davis C, et al. (2019). DNPs: Healthcare change agents. Am Nurse Today. 2019;14(7):16-8.
White KA, Hitzler ET, Anderson KM, et al. Essential knowledge, skills, & attitudes of mentors and mentees for successful DNP scholarly projects. Nurse Educ Today. 2018;71:107-10. doi:10.1016/j.nedt.2018.09.015
Zaccagnini ME, White KW. The Doctor of Nursing Practice Essentials. 3rd ed. Burlington, MA: Jones & Bartlett Learning; 2017.
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DNP Capstone project Abstract Examples [Outline & How-to]
In this article, we will be discussing writing the abstract of a DNP capstone project and give four DNP Capstone Project Abstract Examples.
We will outline the objectives of the abstract of a DNP capstone project, provide an overview of the process involved in completing one, and describe some key considerations that should be taken into account when designing the abstract part of a DNP capstone project.
The DNP Capstone Project Abstract is a key component of your project proposal. It should provide a concise, yet detailed, overview of the project you are proposing.
This document should answer key questions such as: what is the significance of the project? What are its objectives? What methods will you use to achieve those objectives? Will the project have any significant effects on practice?
What is the purpose of a DNP capstone project abstract?
A DNP capstone project abstract is a document that summarises the purpose of your DNP project, and outlines the key findings and conclusions of your research. The abstract should be brief, but it should also provide enough information to allow readers to understand your project and its implications.
Abstract: A DNP capstone project abstract is a document that provides an overview of your project and its goals. The abstract should be no more than one or two pages long, and it should provide a clear description of your project’s objectives, as well as how you plan to achieve them.
Finding it challenging to find a nursing capstone topic, here are 240+ Fresh Nursing Capstone Project Ideas [BSN & MSN]
How to write DNP capstone project Abstract
The DNP Capstone project abstract is a document that summarizes the main goals and objectives of a DNP project. It provides an overview of the research undertaken and the resulting findings, highlighting the importance of the project to practice.
- The abstract should summarize your work. It allows readers to quickly review the main points and purpose of your paper.
- Abbreviations and acronyms used in the paper should be defined in the abstract.
- The abstract for a DNP project should be a minimum of 150 words and a maximum of 350 words.
- When you submit your DNP project final draft to the Graduate College, you will be required to include an extra copy of the abstract for storage in the online abstract archive. The text format and style remain the same for both versions (i.e., versions for both abstract archive and final document. • Note. It might be necessary to paste or type the archive copy in during the submission process.
- Conclusions (Significance to Practice)
Background and Significance:
Provides the background and signifance of the topic and the research to practice and outcomes.
Provides a summary of the main goals and objectives of a DNP project. It highlights the importance of the project to practice.
Highlights the methods used in this DNP Capstone project and nature of the research undertaken. The methods used in the project can include literature reviews, data analysis, case studies, and interviews.
Summarizes the results of the project and an overview of the research undertaken and the resulting findings.
Significance for Practice:
Highlights the importance of the project to practice.
Read more on Patient Falls Nursing Capstone Project Ideas & Topics With Prompts
Here’s a short DNP Capstone Project Abstract examples
Background and significance: A DNP capstone project can be life and time-saving for patients. It is important to have a well-designed and executed capstone project to ensure the success of a DNP program.
Purpose: The purpose of this DNP capstone project is to develop a prototype medical device that can improve patient outcomes.
Methods: This DNP capstone project will use an iterative development methodology to create a prototype medical device.
Results: The results of this DNP capstone project will be evaluated using a validated clinical trial methodology.
Significance to practice: This DNP capstone project will help improve the success rate of patients who undergo a DNP program.
Background and significance: DNP is a innovative medical practice that provides comprehensive care for patients with diabetes.
Purpose: The purpose of this capstone project is to develop a case study that illustrates how DNP can improve the quality of life for patients with diabetes.
Methods: The methods used in this capstone project include literature review, interviews, and surveys.
Results: Based on the results of the literature review and interviews, it was found that DNP can improve the quality of life for patients with diabetes. The survey was also used to gather data on patient preferences and perceptions about DNP.
DNP Capstone Project Abstract Examples
Topic: Implementation of a Nursing Driven Mobility Protocol: A Quality Improvement Project to Evaluate Impact on Fall Rates, Pressure Ulcer Rates, Length of Stay, and Discharge Destination in Older Adults.
Background and Significance
Since the Affordable Care Act of 2010 and hospital designations as Accountable Care Organizations, it has become mperative for organizations to prevent functional decline and their associated complications. Improved functional ability has also been linked to a decrease rate of falls, pressure ulcers, length of stay, and post discharge rehabilitation. Yet, under-mobilization is still a pervasive problem in healthcare. This project determined that a nurse driven mobility protocol and information technology had a positive influence on these patient outcomes.
Two mobility protocols were merged to provide an overarching approach to mobility in an acute care community hospital. This comprehensive approach to mobility was then integrated into information systems and care processes. A quasi-experimental pre- post design with sample stratification based on age was used to evaluate the protocol. The first 100 patients, 60-99 years of age with orders for the mobility protocol comprised the experimental group. The control group was found by reviewing discharge diagnoses of patients admitted within 4 months prior to protocol implementation and matching patients by discharge diagnoses, gender, mobility level prior to admission, and age within 1 year. Fiftyone matches were obtained.
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In comparison with the control group, length of stay was shorter for mobility protocol patients (4.01 days vs 5.19 days). There were no falls or pressure ulcers in the protocol group but 3 falls and 2 pressure ulcers were documented in the control group. Lastly, only 12 patients needed a higher level of skilled care that required a new discharge location in a skilled nursing facility or rehabilitation setting compared to 19 control patients. This study suggests that a nurse driven mobility protocol has favorable effects on patient outcomes in comparison to standard mobility orders.
Although the benefits of improving mobility have been studied in many settings separately, the benefits of using one protocol across settings has not been investigated. This mobility protocol was integrated into the electronic medical record throughout a community hospital. All patient outcomes studied were positively effected.
Key Words: Nursing Mobility Protocol, Mobility, Outcomes
In this article, we will be discussing writing the abstract of a DNP capstone project and give DNP Capstone Project Abstract Examples
DNP Capstone Project Abstract Example 2
Topic: Analysis of Knowledge and Competencies Required to Prepare Entry Level Nurses to Address Violence Prevention in Practice
Background : Youth violence is a complex and pervasive problem, and comes in many forms: child maltreatment, interpersonal violence, gang violence, adolescent dating violence, bullying, self-harm, suicide and homicide. Once weapons are introduced to the situation, what started as a fistfight may end in a funeral. Whether youth are victim of or witness to violence, the consequences are significant and may include anxiety, depression, self-harm, posttraumatic stress, learning roblems, somatic complaints, and impaired psychosocial functioning that may carry into adulthood. Entry level nurses work in a variety of settings that provide care to youth, placing them in a distinct position to facilitate violence prevention and detection, however the education of nurses is central to their participation.
Purpose: to explore what entry level nursing competencies are necessary for violence prevention and detection, and therefore what undergraduate curricula content is needed to adequately prepare new nurses to address violence as a public health problem. The Ecological Model for Human Development was used as the underlying theoretical framework. This model views interpersonal violence as the outcome of interaction among many factors at four levels – the individual, immediate relationships, the community, and societal.
Methods: This qualitative study used a purposive convenience sample of 16 individuals from a variety of professions who work in primary, secondary, and tertiary levels of violence prevention. The selected design was premised on the fact that violence prevention is a complex issue that requires collaboration among many professions and community disciplines. Eight participants were professional nurses representing pediatric health, emergency departments, child protective services, school health, community and public health, homeless health services, and nurse educators. The other eight included individuals involved in youth violence prevention in other capacities and represented teachers, physicians, emergency responders, community activists, youth service providers, and violence prevention advocates who have been personally impacted by gun violence. Data were collected through individual interviews using a semi-structured investigator developed guide. Thematic analyses identified categories, patterns and themes.
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Results : Preliminary results demonstrated consensus among key informants on many aspects of youth violence. All agreed that it is a significant public health issue that has far-reaching implications for individuals, families, communities and society as a whole in terms of lives lost, injuries requiring life-long care, quality of life, and economic impact on the health system. There was also agreement that the risk factors for violence are multifactorial and complex necessitating a multidisciplinary approach to the problem from both the health sector and community stakeholders, and that nurses should have a role within that team. The most common themes identified for the role of the nurse included preparing nurses to perform screening, education, counseling, advocacy, and to promote positive parenting skills. All participants agreed that nurses should screen for guns in the homes of children as part of anticipatory guidance about safe storage, but a common sub-theme within this topic was how to de-politicize the issue and make it objective. Themes that emerged for incorporating violence prevention into basic nursing education included the importance of threading the topic throughout the curriculum, addressing linkages between multiple forms of violence, and providing skills in communication when asking sensitive questions. Another theme was to give nurses the skills on how to respond when they identify a positive case of violence, and how to “connect the dots” – prepare nurses to be able to appropriately connect clients to services. Additional themes that emerged were the importance of educating nurses on personal safety, and giving them skills to assess the workplace environment to identify queues that may escalate to a violent situation. Participants also recommended that nurses know how to behavioral signs and somatic symptoms of violence exposure among youth.
Here’s a nursing capstone project example
Significance for Practice: As the largest group of health professionals, and often the first point of contact for actual or potential violence, it is imperative that the educational system provide entry level nurses with adequate knowledge and skills to prepare them to address violence in youth as well as prepare nurses to protect themselves in the workplace. The participants in this study identified and described the competencies or skills needed by entry level nurses to adequately address violence as a public health problem in practice.
Key Words: Violence prevention, violence screening, entry level nursing competencies
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Tips for writing a successful DNP capstone project abstract
- Make the time to plan your project thoroughly. This will help you to avoid common mistakes and create a more effective abstract.
- Make sure that your project is relevant to the DNP program. This will help you to attract attention from potential reviewers and increase the chances of being awarded a grant or scholarship.
- Keep your abstract concise yet comprehensive. This will allow reviewers to understand the overall project without having to read through lengthy text.
- Be sure to include information about your project team and research methodology. This will help reviewers evaluate the impact of your work and determine whether it is applicable to the DNP curriculum.
- In addition to presenting data quantitatively and qualitatively, be sure to include a discussion of how your research has contributed to knowledge in the field. This can show reviewers that your project was well-planned and thoughtfully executed.
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DNP Capstone Projects Examples
- January 9, 2022
- Posted by: admin
- Category: DNP Nursing
Examining The Impact of A Standardized Nursing Handoff Tool On Patient Falls and Nursing Communication
Doctor of Nursing Practice
Ineffective communication between healthcare practitioners, such as registered nurses, increases the risk for adverse patient events. Nursing handoff reports help to ensure vital patient information is discussed between incoming and outgoing nurses to promote continuity of care, and therefore, patient safety. The purpose of this project was to determine to what degree does the use of a standardized handoff tool, I PASS the BATON, impact the rate of patient falls on medical/surgical and direct observation units. The project also aimed to identify the degree to which the use of this standardized handoff tool impacted the level of nurse satisfaction with the handoff report process. The implementation of the standardized handoff tool was assisted by using Lewin’s Change Model and Roger’s Innovation Diffusion Theory. This quasi-experimental quantitative project measured patient safety by obtaining patient fall data pre- and post-tool implementation. Nurse satisfaction with the handoff report process was determined by nurse satisfaction surveys pre- and post-tool implementation. The data found an improvement in the level of nurse satisfaction after the implementation of the I PASS the BATON tool. However, there was no significant change in the patient fall rates after the implementation of the handoff tool. Nurse satisfaction improved, which may indicate that the continued use of a standardized tool may positively impact nursing handoff reports. Due to the small sample size measuring patient fall data, it is recommended that the tool be utilized for a longer period of time in an effort to collect more sufficient data in order to determine more significant outcomes.
Table of Contents
List of Tables. viii
Chapter 1: Introduction to the Project 1
Background of the Project 2
Problem Statement 3
Purpose of the Project 4
Clinical Question(s) 5
Advancing Scientific Knowledge. 6
Significance of the Project 7
Rationale for Methodology. 9
Nature of the Project Design. 10
Definition of Terms. 11
Assumptions, Limitations, Delimitations. 12
Summary and Organization of the Remainder of the Project 12
Chapter 2: Literature Review.. 15
Theoretical Foundations 16
Review of the Literature. 19
Theme 1. Communication. 19
Theme 2. Nursing Care.. 28
Summary. 37
Chapter 3: Methodology. 39
Statement of the Problem.. 39
Clinical Question. 40
Project Methodology. 41
Project Design. 42
Population and Sample Selection. 43
Instrumentation or Sources of Data. 43
Validity. 44
Reliability. 44
Data Collection Procedures 45
Data Analysis Procedures. 46
Ethical Considerations 46
Limitations 47
Summary. 47
Chapter 4: Data Analysis and Results. 49
Descriptive Data. 49
Data Analysis Procedures. 51
Summary. 55
Chapter 5: Summary, Conclusions, and Recommendations 57
Summary of the Project 57
Summary of Findings and Conclusion. 57
Implications. 58
Theoretical implications. 59
Practical implications. 61
Future implications. 61
Recommendations 61
Recommendations for future projects. 62
Recommendations for practice. 62
Appendix A.. 74
Appendix B.. 78
List of Tables
Table 1. Pre-Implementation Medical/Surgical Unit Surveys
Table 2. Pre-Implementation Direct Observation Unit Surveys
Table 3. Post-Implementation Medical/Surgical Unit Surveys…………………….……
Table 4. Post-Implementation Direct Observation Unit Surveys …………………… . .65
Chapter 1: Introduction to the Project
Communication is an important tool in any human interaction, which goes beyond what is said verbally as it also includes nonverbal behaviors such as eye contact, posture, and body language. Performing effective handoffs requires proper communication methods and the use of tools, such as electronic handoff tools, may help to ensure that important patient information is discussed during verbal communication methods. Key characteristics of communication during handoff include responsibility, authority, and transfer of information (Santos, Campos, & Silva, 2018).
Handoff, also referred to as handover, reports are essential in providing safe care for patients. During the handoff report process, patient status and other information is communicated between healthcare practitioners, such as between two nurses during a “change of shift” report. During this time, it is critical to communicate important information regarding patient care to ensure continuity of care as well as patient safety. As stated by The Joint Commission (2017, p. 1) “a hand-off is a transfer and acceptance of patient care responsibility achieved through effective communication.” Some causes for poor communication may include “inaccurate, incomplete, not timely, misinterpreted, or otherwise not was is needed” (The Joint Commission, 2017), leading to adverse events resulting in sentinel events. The Joint Commission defines a sentinel events as “patient safety” events, such as death, permanent harm, or short term but severe harm (2017, p. 1).
There are many factors that may lead to ineffective handoff reports including
“sharing too little information, inconsistent procedures, limited opportunities to ask questions and verify content, unfamiliarity with documentation systems, and interruptions and noise” (Kear, 2016). Studies have shown that the implementation of a standardized nursing handoff tool can increase effective communication during handoff reports. However, there has not been a significant amount of research regarding the implementation of a standardized handoff tool among medical/surgical and direct observation unit nurses in the Southern California acute care setting. The purpose of this topic is to further examine the effect of a standardized tool among medical/surgical and direct observation unit nurses in a small Southern California hospital.
Background of the Project
Ineffective communication between healthcare practitioners significantly increases the risk for adverse events. According to Johnson, Carta, & Throndson (2015), effective handoff communication can be negatively impacted by having too little information, poor quality of information, frequent interruptions, and minimal opportunity for follow up questions, all of which may impact patient safety. Streeter & Harrington (2017) state that communication failures during handoff reports account for approximately 65% of sentinel events in the acute care setting. A literature review found that a number of studies have found a significant amount of information is not discussed during handoffs, thus putting patients at higher risk for injury. The literature review findings indicate that the use of a standardized handoff tool help to ensure patient safety by communicating vital information to the oncoming shift or during a transfer of care (i.e. unit or facility transfers).
Over the last several years, there has been increasing recognition for the need of handover improvement in the clinical setting. Handoff reports are one of the most important tools in communication patient status to ensure patient safety (Hada, Coyer, & Jack, 2018, p.10). This increased recognition has lead to further research on the implementation of a standardized tool for handoff reports. While the needs may vary between settings, the implementation of a an appropriate handoff tool has shown to decrease the rates of adverse patient events (Santos, Campos, & Silva, 2018; Patton et al., 2017; Fryman, Hamo, Raghaven, & Goolsarran, 2017). While no single standardized tool has been identified as the most effective, Bakon & Millichamp (2017) note that the implementation of any standardized structure may help to improve handoff communication. Utilizing a standardized tool, such as I PASS the BATON, may help to guide nurses on how to provide effective handoffs and the implementation of an evaluation tool can help to ensure the report-receiver is receiving the vital information regarding patient care on medical/surgical and direct observation units in a small acute care setting.
Problem Statement
While the literature indicates that the use of a standardized handoff tool increases effective communication among nurses, it is not known if and to what degree using a standardized handoff tool among medical/surgical and direct observation unit nurses will reduce the number of falls. The risk for adverse events increases significantly when there are poor handoff reports given, which could result in death or serious harm to the patients Santos, Campos, & Silva, 2018; Campbell & Dontje 2019). Literature recognizes that the use of tools in nursing practice help to foster and improve communication skills.
Handoff, also referred to as handover, reports are essential in providing safe care for patients. During the handoff report process, patient status and information is communicated between healthcare practitioners, such as between two nurses during a “change of shift” report. During this time, it is critical to communicate important information regarding patient care to ensure continuity of care as well as patient safety. As stated by The Joint Commission (2017) “a hand-off is a transfer and acceptance of patient care responsibility achieved through effective communication.” Some causes for poor communication may include “inaccurate, incomplete, not timely, misinterpreted, or otherwise not was is needed” (The Joint Commission, 2017), leading to adverse events resulting in sentinel events.
The hospital in which the project will be conducted does not use a standardized method of handoff delivery, resulting in handoff reports being performed at the discretion of the nurse giving report. However, it is standard practice in the hospital to perform handoff reports at the bedside. The problem was identified by observing shift-change handoff reports and through discussion of the current practices with the unit managers and the hospital educator. Moreover, patient safety, fall rates in particular, are of high concern on both units. By the implementation of a standardized tool, fall rates may decline related to a more thorough handoff report and more time effective handoff reports. Through the use of a standardized handoff tool on medical/surgical and direct observation units in a small Southern California hospital, patient safety will be monitored by gather patient fall data in an effort to determine if the use of the standardized tool in this setting is beneficial.
Purpose of the Project
The purpose of this quantitative project is to determine to what degree a relationship exists between the use of a standardized I PASS the BATON tool in reducing the number of patient falls by improving communication during handoff reports among registered nurses on medical/surgical and direct observation units in a Southern California acute care setting. The I PASS the BATON tool will be utilized to determine if nurse handoff communication methods are more effective and to determine if the rate of falls on both units are affected by the handoff tool. A minimum of 25 nurses will be needed to identify the effects of a standardized handoff tool, I PASS the BATON. The unit of analysis will involve quantitative methods and will be analyzed using descriptive statistics by using the SPSS program to compare efficacy of reports before and after the implementation of a report tool.
Quantitative methods will involve operational and measurement levels for the variable. These levels will involve evaluation of nurse performance in giving a handoff report before and after the implementation of a handoff tool. This will involve surveys to be completed by the nurse receiving report. The report-receiver will answer a survey with questions regarding the handoff report that was received. The standardized handoff tool will be defined by an existing standardized tool, I PASS the BATON tool. The efficacy of handoff communication will be measured by the report-receiver via numeric grading system.
This project may contribute to the field of nursing by promoting more effective communication during handoff reports. Patient safety remains to be a priority in the acute care setting and may be better maintained with more effective handoff reports. The use of I PASS the BATON, a standardized handoff tool, may help nurses to discuss all vital information while decreasing the time spent performing handoff reports, thus allowing more time spent with patients.
Clinical Question(s)
This project focused on the effect of the implementation of the I PASS the BATON tool among nurses on medical/surgical and direct observation units. The aim was to determine if the I PASS the BATON tool would help improve nurses’ ability to communicate critical patient information. Lewin’s Change Model and Roger’s Diffusion Theory were both critical components in implementing the tool. Providing positive feedback as well as clear definitions of the purpose of the standardized tool may have assisted nurses in adopting this tool.
The following clinical questions guided this quantitative project:
Q1: To what degree does using the I PASS the BATON tool as a standardized handoff tool impact on the fall rates on medical/surgical and direct observation units?
Q2: To what degree does using the I PASS the BATON tool as a standardized handoff tool increase nurse satisfaction with the handoff process as demonstrated by survey questions regarding satisfaction with handoff reports pre- and post-tool implementation?
In an effort to determine the outcome of the use of a standardized tool, nurses receiving report (i.e. report-receiver) were asked to rate the quality of the report-giver’s communication of patient information in the handoff report. Several components were involved in this evaluation, including the quality of communication, inclusion of critical information, decrease in errors, and improving patient safety. Patient safety was monitored by identifying patient fall rates on both units during the project. Data was collected pre- and post-tool to determine if the rate of falls decreased with the use of the I PASS the BATON tool.
Advancing Scientific Knowledge
The need for further examination of the efficacy of handoff communication among acute care nurses in Southern California has not been determined. The implementation of a handoff communication tool may aid nurses in more effective communication methods during handoff reports. Effective handoff reports help to ensure continuity of care and, therefore, patient safety as well as nursing satisfaction with the handoff communication process (Hada, Coyer, & Jack, 2018). It was proposed that should the project provide evidence that the use of a standardized tool among medical/surgical and direct observation unit nurses was effective with improving communication, this could potentially be an additional component to incorporate hospital-wide at the project site.
With the use of a standardized tool, nurses may more effectively demonstrate effective handoff communication skills, which will in turn promote patient safety, thus improving patient outcomes. Moreover, this could help to improve morale and working relationships among nurses on the unit by allowing them to more effectively communicate in a timely fashion, which may allow more time for vital nursing duties to be completed. The long term results of this could demonstrate improved patient safety and decreased adverse events related to poor communication.
Significance of the Project
Effective communication is key to providing effective handoff reports. Approximately 80% of serious medical errors are related to poor communication during handoff reports (Kear, Bhattacharya, & Walsh, 2016, p. 379). Kear (2016) recognizes the need for complete and accurate patient information during the handoff report in order to prevent preventable adverse events from occurring (p. 379). Such preventable events may include patient falls, medication errors, and delays in patient treatment (The Joint Commission, 2017). Kear, Bhattacharya, & Walsh (2016) found that information is frequently “falling through the cracks” due to involvement of multiple healthcare providers, varying methods of handoffs, unfavorable work culture, and poor time management. Insufficient data may not be communicated during the handoff reports for a variety of reasons such as poor communication methods, which may be related to “fast-paced, loud, and chaotic environments, unplanned timing in handoffs,…and the need to exchange a large amount of information in a compressed timeframe” (Kear, Bhattacharya, & Walsh, 2016).
According to Hada, Coyer, & Jack (2018), “The Garling Report” released by The Commission of Inquiry into Acute Care Services in New South Wales Public Hospitals acknowledges that handover reports are one of the most important tools in communicating patient status to ensure patient safety. The Garling Report strongly recommends the use of a “structured tool” that is enforced by hospital policy. However, in order to appropriately use the handover tool, proper training should be implemented to ensure it is being used to its full potential. Research suggests that there is a significant increase in the compliance of a handover tool between groups that received training versus those who do not. Hada et al. (2018) found there was an improvement in patient safety with a 9.37% decrease in falls, 75% decrease in pressure injuries, and 11.1% decrease in medication errors (Hada et al. (2018).
Communication is not just limited to verbal forms but also includes written form as well as body language. Carroll, Williams, and Gallivan (2012) states that while handoff reports are a part of everyday work duties for nurses, there is little information on what constitutes a “good handover.” Carroll et al (2012) found that many handoff sessions last between two to thirteen minutes and only 26% of the active medical issues were included in the reports. Nurse opinions of handoff interactions vary, which could be a factor in the amount of information that is discussed during the handoff process as well as varying opinions regarding communication methods (i.e. body language, eye contact).
Recognition of professional responsibilities and liabilities is necessary in practicing effective change of shift reports (Lee, Phan, Dorman, Weaver, & Pronovost, 2016). By identifying factors among medical/surgical nurses for this project, more insight may be provided on factors directly related to this unit within the small Southern California hospital. Identification of common barriers within the hospital may help to modify a standardized tool to suit the needs of the units within the hospital. If the use of a standardized tool proves to be helpful with improving handoff reports, adopting the use of the tool long-term may help to improve patient outcomes by improving safety measures.
Rationale for Methodology
The purpose of the doctoral project was to introduce a standardized handoff tool in an effort to improve nursing handoff reports on a medical/surgical and direct observation units in a Southern California hospital. Using a quasi-experimental design, data collection allowed for statistical analysis. In order to obtain more concrete evidence regarding the efficacy of standardized handoff tools, quantitative design was the most appropriate. Quantitative data increased the probability of more validity and reliability in the findings. Quantitative data provides statistical data to demonstrate the relationship between variables (Center for Innovation in Research and Teaching, 2019). Quantitative data is often viewed as more “scientific” as the findings may “not be seen as a mere coincidence” (Daniel, 2016, p. 94). It is not unknown that handoff reports are an area in which improvement is needed. However, it was not known how nurses on Southern California medical/surgical and direct observation units perceived the handoff process.
Kear, Bhattacharya, & Walsh (2016) performed a study on nephrology units across the United States with a similar design utilizing assessment tools from the Agency for Healthcare Research and Quality (AHRQ) and handoff tools created by the Joint Commission in an effort to collect objective data regarding the handoff process. The objectivity of the data allowed for more concrete data findings. Obtaining the quantitative data by requesting participating nurses to complete a set of questions pre- and post- tool implementation helped to determine if handoff communication improved with the use of the tool. Because handoff communication occurs between a minimum of two nurses, a set of questions were to be completed by the report-receiver after receiving report. The report-receiver rated the report-giver’s ability to provide clear, concise, and pertinent patient information. Lastly, patient fall rate data were collected in order to determine if the rate of falls decline after implementing I PASS the BATON tool.
Nature of the Project Design
This quasi-experimental pre and post design project involved a brief set of questions to be completed by the participating nurses on the medical/surgical and direct observation units. Brief training handouts were provided to day and night shift nurses that discussed the pre- and post-tool implementation process as well as the proper use of the I PASS the BATON tool. A 1 to 5 scale was utilized for the set of questions with 1 meaning strongly disagree, 2 disagree, 3 neutral, 4 agree, and 5 strongly agree. With the permission of the authors, surveys for the project were used from a research article by Anderson & Mangino (2006). The pre-and post-tool set of questions asked questions regarding the staff accountability for completing nursing care prior to the change-of-shift, whether or not questions were answered during report, satisfaction of interpersonal relationships, patient condition, provision of pertinent information, and satisfaction with report time.
Data collection performed prior to the implementation of the I PASS the BATON tool. After implementation of the tool, data collection continued for the remaining one week of the project to determine if fall rates changed during the implementation of the tool. Upon completion of the project, data was analyzed using SPSS to identifying any changes in the fall rates. Lastly, the data from set of questions was analyzed to determine if the nurses’ perception of handoff communication improved with the use of the tool.
Definition of Terms
“The following terms were used operationally in this project.”
Adverse event. An unintentional physical injury that occurs due to medical management that needs more monitoring, such as treatment or longer hospitalization, and may, in some cases, lead to death (Agency for Healthcare Research and Quality, 2019).
Patient falls. “ An unplanned descent to the floor with or without injury to the patient” (Agency for Healthcare Research and Quality, 2019b).
Handoff report . A handoff report, also known as handover, shift report, shift change report, nursing report, is the communication of patient care information between healthcare professionals, such as nurses. This involves communication may be performed during a change of shift, during which time responsibility of patient care is transferred from one nurse to another. The handoff report allows the nurse assuming care to “ask questions, clarify and confirm” (Friesen, White, & Byers, 2008).
I PASS the BATON tool. The I PASS the BATON tool is a standardized handoff mnemonic that guides handoff communication. This tool identifies the following: illness/severity; patient summary; action list; situation awareness and contingency planning; synthesis by receiver.
Sentinel event. An event, or risk for, that results in death or a serious psychological or physical injury, such as loss of limb or function (The Joint Commission, 2012).
Assumptions, Limitations, Delimitations
It is assumed that participants in this project were not deceptive with their answers, and that the participants answered questions honestly and to the best of their ability. There is a risk that nurses may be overly gracious with their ratings for nurses with whom they have a friendly relationship. On the other hand, they may be more critical towards those whom they do not know or do not have a good cohesive working relationship.
It is assumed that this project is an accurate representation of the current situation in small hospitals in Southern California acute care settings. Many of the larger for-profit hospitals in the region have stricter policies and procedures regarding nursing handoff. However, the smaller for-profit and community based hospitals do not always have the funding or manpower to implement tools such as standardized handoff tools. Moreover, the management within each hospital, and each unit, may vary regarding the support of implementing a standardized tool into everyday practice.
Potential limitations of the project included participant bias, resistance to adopting a handoff tool, and the small number of participants. Delimitations of the project include the location of the project, the units on which the project was performed, and the tool used for the project. This project was focused solely on the medical-surgical and direct observation units, which could have lead to a smaller sample size.
Summary and Organization of the Remainder of the Project
Patient safety remains to be of highest importance in healthcare. Certain measures must be taken in an effort to maintain patient safety, and thus improving patient outcomes. Due to the increasing recognition regarding the need for effective communication in handoff reports, more research is being conducted to find effective tools in order to promote effective handoffs. Some causes for poor communication may include “inaccurate, incomplete, not timely, misinterpreted, or otherwise not was is needed” (The Joint Commission, 2017), leading to adverse events resulting in sentinel events. In an effort to prevent adverse events, the implementation of a standardized handoff tool may prove to be beneficial in improving the efficacy of nursing handoff reports.
In an effort to evaluate the impact of the use of a standardized handoff tool, this project will be performed in a small Southern California hospital on the medical/surgical and direct observation units with the participation of a minimum of 25 nurses. The standardized tool, I PASS the BATON, will be utilized to help guide nursing handoff communication during shift change. A survey created by Tidwell et al. (2011) will be completed by the nurses to identify perception of the handoff efficacy and patient safety. Patient fall rates will also be analyzed to determine if the implementation of a standardized handoff tool is helpful in decreasing the rate of falls on these units.
Chapter 2: Literature Review
Over the last several years, there has been increasing recognition for the need of handover improvement in the clinical setting. Halm (2013) notes that The Institute of Medicine reported that the majority of adverse outcomes in the acute care setting are linked to failures in communication. Handoff reports are one of the most important tools in communicating patient status and ensuring patient safety by providing accurate patient information about the patient’s care and treatment (Hada, Coyer, & Jack, 2018, p. 9). The increased recognition has lead to further research on the implementation of a standardized tool for handoff reports. While the needs of this tool may vary depending on setting, the implementation of a setting-appropriate tool has shown to increase communication efficacy and decrease adverse patient events. Research studies recommend further research on the development of more effective handoff tools and standards but there has been minimal evaluation of the use of this tool among nurses on medical surgical and direct observation units in a small Southern California hospital. Utilizing a standardized tool may help to guide nurses in performed effective handoffs reports.
While the literature indicates that the use of a standardized handoff tool increases effective communication among nurses, little is known on the use of a standardized tool among nurses and the effect of effective communication. The real issue affecting nurses and patients is the ability to communicate effectively during handoff reports. The risk for adverse events increases significantly when there are poor handoff reports given, which could result in death or serious harm to the patients. The importance of effective communication is becoming more recognized but there has not been significant research indicating the impact of more in-depth education regarding handoff reports among nurses. Literature recognizes that the implementation of a standardized tool may not only help to improve efficacy of handoff reports but will also help to increase patient safety and nurse satisfaction.
Using CINAHL, Science Direct, Academic OneFile, InfoTrac and Health Reference Center Academic, a literature review was conducted in an effort to further investigate the topic. Two major themes were identified, including communication and nursing care. Communication contains three subthemes: handoff failures, standardized handoff tool, and bedside report. Three subthemes associated with nursing care include: patient safety, nurse satisfaction, and behavioral change.
Theoretical Foundations
Kurt Lewin’s Change Theory is comprised of three stages: unfreezing, change, and refreezing. This model may help to identify issues that require change and how to implement the necessary changes. Lewin’s theory is applicable to implementing a new handoff tool as it has been recognized that patient safety may be at risk directly related to poor handoff reports. This may help with the change process by providing a framework during the unfreezing and change process as well as the final freeze process in which they continue to practice the changes implemented.
For the implementation of a standardized handoff tool, the unfreezing stage would include information on the importance of effective handoffs as well as the expected outcomes of the change (Vines, Dupler, Van Son, & Guido, 2014). The change stage is the actual process of learning and implementing the standardized tool and the freezing stage would involve the nurses’ ability to continue to utilize the tool. Refreezing would involve the adoption of the tool and continuing to utilize the standardized tool beyond the project period.
Malekzadeh, Mazluom, Etezadi & Tasseri (2013) implemented a standardized handoff protocol in the intensive care unit and performed the unfreezing stage by discussing the tool with charge nurses, initiating formal announcements, and involved various employees to participate in this stage (p. 180). This project will have a similar implementation of the unfreezing stage in that the primary investigator will be informally speaking with staff nurses prior to the start of the project and will be obtaining the assistance from unit charge nurses, the medical/surgical and direct observation unit managers, and the hospital educator.
Using Lewin’s change stage, the I PASS the BATON standardized handoff tool will be implemented. Malekzadeh, Mazluom, Etezadi & Tasseri (2013) performed this stage by providing a total of 90-minute education sessions on the new handoff protocol (p. 180). The investigators observed and evaluated the nursing handoffs to determine if the new practices were performed appropriately. Those who did not perform the handoff reports effectively had follow-up education sessions (Malekzadeh et al., 2013, p. 180). For the purpose of this project, the primary investigator will be discussing the I PASS the BATON briefly during change-of-shift and by providing written information and guidelines for the nurses. The investigator will also be on-site for several of the days the new tool is implemented in order to provide clarification on any questions the nurses may have with the new tool or how to answer the survey questions after receiving report.
Lewin’s last stage, refreezing, is the stage in which the “new practice has altered the organization setting, forcing it to accommodate” (Manchester et al., 2014, p. 85). During this stage, reinforcement maybe necessary to ensure nurses continue to practice the use of the standardized tool (Manchester et al., 2014, p. 85). In an effort to maintain the refreeze stage, Malekzadeh et al. (2013) performed strict supervision to ensure nurse adherence to the use of the new standardized tool (p. 180). For this project, the refreeze stage may be the most challenging as the primary investigator will not be present to do so. In this case, the unit managers will determine if they would like to supervise and ensure there is continued use of the I PASS the BATON standardized tool.
Another change model that is applicable to the implementation of a standardized handoff tool is E.M. Roger’s Innovation Diffusion Theory. This theory, which is an expansion of Lewin’s original theory, contains five steps that identify how an individual, or organization, acknowledges an issue and adopts the measures for change. In this theory, it is recognized that leaders play a crucial role when implementing change. Moreover, this theory recognizes factors that may prevent adoption to change, which may include strengths or weaknesses of the group and managing factors (Wagner, 2018). Wagner notes this theory identifies the “how, why, and at what rate new ideas are taken up by individuals” (2018). The five levels of adopting change include: innovators, who thrive on change; early adopters, who are cautious of change but are willing; early majority, who take longer to adopt change but are not necessarily resistant; late majority, who are highly skeptical of the new practices; and the laggards, who are the last to adopt change practices (Wagner, 2018). Identifying the level of acceptance of new practices may assist leaders in recognizing individuals that are more resistant to change versus those who may be more accepting to the new practices, such as the implementation of a standardized tool. Identification of those who are more open to the use of a standardized handoff tool may provide more encouragement for the individuals who may be more resistant to the new handoff practices.
Lewin and Roger’s theories may be applied to implementing the use of a standardized handoff tool. Both theories provide an understanding of the change process, which provides conceptual framework to the project design. Moreover, the understanding that individuals adopt new practices at different rates allows for planning for measures to overcome this barrier. Some may be resistant to change for various reasons, however, if there is not a solid understanding regarding the need for change, resistance levels may be higher. The primary investigator will provide information on the potential safety risks directly related to current handoff practices in an effort to encourage nurses to be more receptive to adopting a standardized handoff tool. By utilizing Lewin and Roger’s theories, the change process will be more appropriately planned, which may help to increase compliance rates as well as decrease the risks for patient safety related to poor handoff reports.
Review of the Literature
Communication. Communication is an important tool in any human interaction. This goes beyond what is said verbally as it also includes nonverbal behaviors such as eye contact, posture, and body language. Some of the discussed research indicates that verbal ad nonverbal behaviors play an important role in nurse satisfaction but other factors, such as duration of report, may also be influential on satisfaction levels. The discussed studies found that incomplete or incorrect information lead to poor team communication, ultimately resulting in putting patients at risk for adverse events.
Human factors influences one’s ability to properly communicate patient information are apparent in each study. Barriers to effective handoff reports include the “sharing too little information, inconsistent procedures, limited opportunities to ask questions and verify content, unfamiliarity with documentation systems, and interruptions and noise” (Kear, 2016). Because needs of units vary, Kear (2016) recommends that nurses and coordinators work together to identify the needs of that unit in order to effectively implement tools for more effective handoff reports. Subthemes within this category include: handoff failures, standardized handoff tool, and bedside report.
Handoff Failures .
Project 1 . Abraham et al. (2016) note that of the events involving transfer of patient information in the acute care setting, nursing handoff reports are the most frequently occurring and account for approximately 35% of sentinel events. In a mix-methods design, the researchers identified common contributors to poor handoff reports. The researchers argue that sentinel events occur due to communication failures during the handoff reports. These failures may include, but are not limited to: varying communication methods, time permitted for reports, interruptions, distractions, “lack of training, and communication bottlenecks” (Abraham et al., 2016, p. 76). While The Joint Commission has proposed standardized handoff reports to avoid sentinel events, an understanding of the content required for effective communication needs further evaluation.
In a mixed-methods design utilizing an exploratory sequential conversational analysis, Abraham et al. (2016) evaluated the communication properties, interaction, and the relationships with communication characteristics. The study was performed in a medical intensive care unit at an academic hospital in Texas involving 16 participating nurses during change-of-shift reports, which occurred twice a day. The findings recognize that an interactive handoff report leads to more effective communication, which is not a concept that was frequently observed. Interactive communication methods include practices such as read-backs (i.e. reading back information received to confirm accuracy) and equal participation between the incoming and outgoing nurses. The investigators found that nurses who practice self-reflection and metacognition have an easier transition into adopting new communication processes (Abraham et al., 2016).
Project 2 . Poot, de Bruijne, Wouters, de Groot, and Wagner (2014) performed an observational study aimed at identifying current practice and opinions of the handover process in a perinatal setting. The researchers were evaluating several different aspects of the handover process, including “situational awareness” which consisted of the common SBAR (situation, background, assessment, and recommendation) tool and the handover process, which included duration, amount of interruptions, eye contact, questions, and reading information back to the outgoing nurse. On average, nurses spend 2 minutes or more per patient, 52% experienced distractions, 43% did not involve active questioning, 32% had no eye contact, and 97% did not read back information obtained during the handover report. While the researchers found the handoff reports to be insufficient through their observations, they found that receiving nurses rated the handover process highly. Due to the high ratings by the nurses, the researchers indicate there is a lack of awareness of patient safety during the handover process. The researchers recommend simulation training or video reflection in order to encourage more awareness and engagement during the handover process. Subthemes include situational awareness, distractions during handover reports, and eye contact between participants.
Project 3 . Goncalves, Rocha, Anders, Kusahara, & Tomazoni (2016) note several handoff communication failures in a descriptive-exploratory design on neonatal intensive care units (NICU) at three hospitals in Brazil. There were 70 nurses participating in the data collection process between the three hospitals. The researchers note “the excessive or reduced amount of information; limited opportunity to ask questions; inconsistent information; omission or transfer of mistaken information; nonuse of standardized processes; unreadable records; lack of teamwork; interruptions and distractions” (Goncalves, Rocha, Anders, Kusahara, & Tomazoni, 2016). The researchers do note that NICUs tend to be high stress environments that involve highly technical equipment that may contribute to the barriers to communication methods. The findings indicated that handoff failures include items such as: delays and early departures, side talk, and noise. While some of these barriers are dependent on the setting, the researchers recommend implementing more training on handoff communication among current nurses as well as during nursing school in an effort to develop appropriate communication habits early in practice.
Standardized Handoff Tool .
Project 1 . According to Fryman, Hamo, Raghaven, & Goolsarran (2017), approximately two-thirds of adverse events in hospitals are related to inefficient handoff reports. The researchers stress the importance of a standardized handoff tool, which have been shown to decrease adverse events when comparing to a non-standardized approach. In this study, the researchers utilized the IPASS method integrated into electronic health records to test the practicality and effectiveness. The findings showed a significant decrease in adverse events.
Limitations of the study included a lack of measurement regarding length of time it took to use I-PASS. Another limitation was the results were based off surveys completed by residents instead of a data analysis regarding the effect of patient care. The researchers also found that there was difficulty in maintaining compliance with the use of the tool. Upon a six month follow up of the compliance in utilizing the tool, the researchers found that only 60% of residents were using it. The researchers then created a sustainability model which increased the compliance to 100%. The findings of this study show that the implementation of a standardized tool is greatly beneficial to patient safety. However, monitoring in compliance as well as follow up training may be necessary to maintain compliance.
Project 2 . In a pre-post intervention study on a pediatric intensive care unit (PICU) utilizing the I-PASS Nursing Handoff tool, Starmer, Schnock, Lyons, Hehn, Graham, Keohane, & Landrigan (2017) evaluated the quality of the verbal handoff process and the duration of time required for the handoff. The results showed significant improvement in the quality of handoff, which increased communication regarding important patient information. Examples of these aspects pre-intervention versus post-intervention include illness severity (37% versus 67%), patient summary (81% versus 95%), and opportunity for oncoming nurse to ask questions (34% versus 73%). The findings indicate that the use of a standardized tool, such as I-PASS significantly increase the handoff communication process. Information exchange was more efficient and timely, thus allowing time for more follow up questions.
Project 3 . A mixed methods quantitative-qualitative study performed by Abraham, Kannampallil, Almoosa, Patel, & Patel (2013) recognize that handoff reports vary “in their structure and content,” which increases the probability of inappropriate or ineffective handoff reports. This study involved a nonrandomized pre-post intervention study that was conducted in an ICU setting. The goal was to identify patterns in handoff characteristics and types of communication by utilizing two different handoff tools, HANDoff Intervention Tool (HAND-IT) and Subjective-Objective-Assessment-Plan (SOAP). The study found that the HAND-IT tool was more effective in promoting more interactive and proper communication techniques. This tool prompted follow up questions from the receiver while the tool itself guided the interaction to provide a more seamless interaction. With improved communication, critical patient information was discussed which lead to promotion of continuity of care.
Project 4. Approximately 80% of serious medical errors are related to poor communication during handoff reports (Kear, Bhattacharya, & Walsh, 2016). Using a mixed-methods research approach, Kear et al. (2016) examined the handoff report process in the nephrology setting. The researchers found that nephrology unit nurses reported information frequently “falling through the cracks” due to involvement of multiple healthcare providers, varying methods of handoffs, and varying hours of operation within the nephrology setting. The researchers developed a survey with the use of three sections: socio-economic data and employment information, 50 closed-ended questions regarding a handoff tool that combined items from the Agency for Healthcare Research and Quality (AHRQ) and the Joint Commission, and lastly, several open-ended questions inquiring about the handoff process. The survey including findings such as “insufficient staffing, lack of time for patient care, and low level of importance related to safety and handoff procedures.” The researchers also found that insufficient data was being communicated during the handoff reports. Several factors may play a role in poor communication during handoffs, including “fast paced, loud, and chaotic environments, unplanned timing in handoffs,…and the need to exchange a large amount of information in a compressed timeframe.” The researchers argue that recognition of professional responsibilities and liabilities is necessary in practicing effective change of shift reports.
Conclusion. Communication is an important tool in any human interaction, which goes beyond what is said verbally as it also includes nonverbal behaviors such as eye contact, posture, and body language. Performing effective handoffs requires proper communication methods but other tools, such as electronic handoff tools, may help to ensure that important patient information is discussed during verbal communication methods. Key characteristics of communication during handoff include responsibility, authority, and transfer of information (Santos, Campos, & Silva, 2018). Moreover, Chapman, Scheickert, Swango-Wilson, Aboul-Enein, & Heyman (2016) recommend the involvement of leadership, which in the case of nursing students refers to nursing faculty. Standardized handoff tools have shown to increase the efficacy of handoff reports. Standardized tools not only help to ensure all necessary information is discussed, but can also help to decrease the amount of time spent during report, which then allows for more time spent providing patient care. Nursing leadership should remain involved in the development of a standardized tool to ensure that items included in the tool are pertinent to the unit in which it will be utilized.
Bedside Report.
Project 1. Over the last decade, that has been increasing recognition for the need of handover improvement in the clinical setting Hada, Coyer, & Jack, 2018, p.10). According to Hada, Coyer, & Jack (2018), “The Garling Report” released by The Commission of Inquiry into Acute Care Services in New South Wales Public Hospitals acknowledges that handover reports are one of the most important tools in communicating patient status to ensure patient safety. Based off the findings, The Garling Report strongly recommends the use of a “structured tool” that is enforced by hospital policy and is performed at the bedside. In order to appropriately use the handover tool, proper training should be implemented to ensure it is being used to its full potential. The use of a handover tool at the bedside has also been found to improve overall patient satisfaction. Based off the findings of the Garling Report, Hada et al. (2018) designed a pilot study aimed at determining the efficacy of handover training with a standardized tool. The study was performed in two geriatric and rehabilitation unites of a teaching hospital in Australia, which totaled 78 beds between the two units. A total of 58 registered nurses, both full time and part time, were participants in this study. The findings of this study found that there was a significant increase in the compliance of a handover tool between the groups that received training and those that did not. Moreover, patient safety improved with a 9.37% decrease in falls, 75% decrease in pressure injuries, and 11.1% decrease in medication errors. Overall, the pilot study had positive findings in patient safety as well as satisfaction with the use of a handover tool. Two subthemes found in this article include bedside report and the use of a standardized tool.
Project 2. Bigani & Correia (2018) performed an exploratory-descriptive qualitative study to determine what experiences were among nurses, family, and patients after implementing bedside handoff reports. The study involved 25 nurses and 15 patients and families who answered multiple choice and open-ended questions. The findings indicated that many nurses did not prefer bedside reports due to increased length of time to perform reports and a sense that patients and families do not want to be bothered during shift-change. Patients and families, however, did not recognize any barriers to bedside report. Some of the patients and families stated they had difficulty understanding their role in the report and a small number noted they were too fatigued to understand or fully participate.
While nurses reported a small amount of barriers, there were a significant amount of safety concerns that were identified while performing report at the bedside. These included: “missing safety equipment, missing orders, and issues relating to pain, dressings, medications, intravenous access, and diagnosis” as well as corrections or updates regarding patient history (Bigani & Correia, 2018). The patients and families reported several benefits to bedside reporting including a sense of comfort and caring. The researchers argue that bedside reporting ultimately enhances the relationship between nurses and patients/families and allows active participation in care.
Project 3. Campbell & Dontje (2019) performed a qualitative pre- and post-implementation project in the emergency department at a small trauma center. The questionnaire was scored with 7 questions and another part of the questionnaire included 2 of the Hospital Survey on Patient Safety Culture questions. In addition, handoff observations were performed by leadership. The findings of this project showed there was an increase in nurses feeling they received complete and accurate handoff reports post-implementation. In regards to handoff style, 62% of the nurses noted a preference of the bedside handoff reports. The authors asked two questions from the Hospital Survey on Patient Safety Culture questionnaire, which included the loss of patient information during handoff reports and shift changes being problematic. After the implementation of bedside reports, both of these items had a significant decrease in the amount of nurses who agreed with these statements, which the authors note have had poor ratings since 2012. More importantly, nurses reported more situation awareness during their handoff, which ultimately better maintained patient safety. While this project was limited to one department, it provides support that bedside reports not only promote better communication between the nurses but also allows for an increase in patient safety.
Conclusion. The literature review regarding implementation of bedside report provides insight on the opinions, barriers, and benefits of this handoff method. While the handoff reports may take longer, it allows the incoming and outgoing nurse to more actively participate in the report. Moreover, it allows family and patients to participate by asking questions or providing updated information. Most importantly, bedside reports increase patient safety as this promotes more situational awareness.
Nursing Care. In the acute care setting, nurses spend the largest amount of time with patients. Efficient handoff reports is one of the main methods of maintaining patient safety. The transfer of critical patient information ensures the transition of care goes smoothly and all pertinent patient information is discussed. This section includes subthemes: patient safety, such as patient falls, nurse satisfaction, and behavioral change.
Patient Safety.
Project 1. Patient safety is dependent any many different factors but the primary factor is communication and situational awareness. According to Johnson, Carta, & Throndson (2015), effective handoff communication can be negatively impacted by having too little information, poor quality of information, frequent interruptions, and minimal opportunity for follow up questions. In a qualitative study, the researchers aimed to examine the exchange of information during handoffs and documentation. Upon gaining a deeper understanding, methods to increase patient safety can be better identified and addressed.
Four themes emerged during the study, which included: inconsistent documentation, inconsistency of patient assignments, lack of care plans, and various methods of communication during handoffs. The participants in the study revealed that reasons for inconsistent documentation was largely due to time constraints related to high patient acuities and turnover. Inconsistent patient assignments prevented nurses from developing better rapport, and therefore more effective therapeutic communication, with their patients leading to gaps in care and decreased patient satisfaction. Lack of care plans lead to delays in patient treatment as well as discharge planning. Lastly, various methods of communication lead to a decrease in the quality of information exchanged during the handoff process.
Most of the participants expressed a preference of verbal handoff methods as this allowed them time to ask follow up questions on information. The nurses had mixed opinions on the efficacy of bedside handoff reports but research has shown that bedside reports can increase patient satisfaction. The researchers suggest implementing a standard SBAR tool to aid in the information exchange, however, the other themes would need to be addressed in order to increase patient safety.
Project 2. In a validation study performed by Ferrara, Terzoni, Davi, Bisesti, & Destrebecq (2017), the researchers validated the quality of the handoff process by utilizing the Handoff CEX-Italian scale in an Italian hospital on medical surgical units. The findings discovered that the lowest scoring areas with the use of the scale included communication skills, context, and organization. While personality can affect communication methods, the researchers acknowledge that this is not the sole cause for ineffective handoff reports. Poor scores for organization was related to lack of a structured method, poor organization by the nurse, and too little time to discuss necessary patient information. The organization and communication may be potential factors in the context of information that is shared. Addressing these areas of concern can help to improve patient handoff reports, and therefore increase patient safety.
Project 3 . According to Streeter & Harrington (2017), communication failures during handoff reports account for approximately 65% of sentinel events in the acute care setting. In a cross-sectional online survey, the Streeter & Harrington evaluated the information exchange process as well as the communication behaviors associated with efficient patient handoff reports. The findings of the study revealed a preference for organized, detailed, and comprehensive report from the outgoing nurse with quality follow up questions from the incoming nurse. Factors related to poor handoff reports consisted of poor outgoing nurse organization and knowledge of patient information as well as side “chit chat” or discussion about information that is not pertinent to patient safety and care. The ability to provide concise and relevant information from the outgoing nurse while the clarification of information from the incoming nurse are important behaviors that are necessary in an effective handoff report.
Conclusion. Patient safety, such as prevention of patient falls, is reliant on several aspects of care but is especially reliant on effective handoff reports. Some of these aspects include well organized reports with relevant information provided by the outgoing nurse and follow up questions from the incoming nurse. Participation by both nurses can help increase rapport and encourage information giving, therefore a sharing of critical patient information. With the implementation of a structured handoff tool, such as SBAR, this can allow nurses to have a more organized report, which will ultimately increase report efficiency and patient safety.
Nurse Satisfaction.
Project 1 . Performing effective handoffs requires proper communication methods and tools to ensure that important patient information is discussed during verbal communication in an effort to prevent the occurrence of adverse events. Chapman, Scheickert, Swango-Wilson, Aboul-Enein, & Heyman (2016) performed a descriptive qualitative study to determine nurse satisfaction levels with communication of care and report received, comfort levels with the use of electronic tools, and satisfaction with the use of electronic tools. The researchers implemented the use of an electronic Situation-Background-Assessment-Recommendation (SBAR) tool and followed up with a survey on nurse perceptions of the handoff process. Evaluation of the nurses’ surveys found there was a high level of satisfaction with an electronic SBAR report that was performed at the bedside, which indicates that the use of an electronic tool may help to ensure communication of important patient information.
The researchers recommend the involvement of information technology (IT) and leadership to ensure handoffs are being performed appropriately and to ensure nurses do not revert back to relying on “verbal handoffs at the nurses’ desk” but are instead performed at the bedside. Chapman et al. (2016) note there have been several positive benefits to bedside handoffs, which included communication benefits, improvement of collaboration among the nurses, increased handoff efficiency, and decreased amount of time spent on handoff reports.
Project 2. In a prospective pre-post intervention study, Nagpal et al. (2013) aimed to determine if the quality of the handover improved with a standardized tool in a post anesthesia care unit (PACU). A trained researcher observed 50 pre-intervention and 40 post-intervention, with twenty percent of the reports being observed by second observer to assess for interrater reliability. Quality of handoffs included five categories: information omissions, tasks errors, teamwork, nurse satisfaction, and duration. Limitations of the study included smaller sample size, potential for compromised authenticity due to the nature of the study.
The finding of the study indicated that the use of a standardized handoff tool significantly increased the quality of handoff reports. While the aim of the study was not meant to evaluate the new handoff tool, but more to determine if the use of a standardized tool improved handoff efficacy. This study provides evidence that a standardized tool improves patient safety measures by reducing errors, improving teamwork, and nurse satisfaction.
Project 3 . A mixed methods study performed by Bakon & Millichamp (2017) aimed to evaluate the handover process and identify best practices when transferring patients from the emergency department to other units in an Australian hospital. The study involved 28 nurses between the emergency department other units within the hospital. The study found that nursing handoff reports were the most efficient when implementing a standardized tool to ensure critical information is discussed during the report process. The researchers developed and implemented a standardized tool utilizing an ISBAR (identity, situation, background, assessment, plan) format that was easy to use but still addressed important patient information.
There were several versions made in an effort to meet the needs and priorities of different units. Bakon & Millichamp found that other units had priorities, such as resuscitation status whereas the emergency department nurses prioritized monitoring of vitals. The final version was utilized by an emergency department nurse completing this form prior to patient transfer to another unit. Once it was completed, it was faxed to the received unit and followed up by a phone call from the emergency department nurse. The phone call allow and opportunity for the receiving nurse to ask questions and gather any further information regarding the patient.
Over a four-week period, surveys were sent to the participating units and nurses to gather data. Limitations of the study included a smaller number of participating emergency department nurses, possibly due to the nature of staffing in this department. In addition, this study was limited to one hospital and therefore did not include patients who were transferred to units that were not on-site. There was positive feedback regarding the use of the tool, which indicates nurses may be amenable to the implementation of standardized tools. The researchers argue that standardized tools should be structured and easy to use.
Project 4. A study performed by Carroll, Williams, and Gallivan (2012) states that while handoff reports are a part of everyday work duties for nurses, there is little information on what constitutes a “good handover.” This multi-method study was conducted on two medical-surgical units and included survey questionnaires, direct observation, audio taping, and a post-handoff questionnaires. The researchers found that most of the handoff sessions lasted between two to thirteen minutes and only 26% of the active medical issues were included in the reports. The subtheme of the study was nurse perceptions of the handoff report. Nurses’ opinions on the handover interaction found that oncoming nurses were more satisfied with increased eye contact whereas the outgoing nurses rated the interaction higher when the interaction was shorter with fewer questions and less eye contact.
The study was limited to two medical-surgical nursing units, which may have affected the outcomes of the study. Further research is recommended on what a “good handover” is and should include other types of acute care units to determine if the findings are similar. Carroll acknowledges the importance of handoff reports, there appears to be crucial information on the patient status that is not discussed during the process. Nurse opinions of the handoff interaction varies as well, which could be a factor in the amount of information that is discussed during the handoff process. The development of handoff guidelines may be an appropriate intervention in helping to improve the handoff process while ensuring all pertinent patient information is discussed.
Conclusion . Nursing satisfaction has shown to increase with effective handoff reports. Oncoming nurses who receive and short and concise handoff report may then begin their day in a timely fashion, which will in turn allow for increased patient safety. Moreover, this will help to ensure continuity of care and prevent the occurrence adverse events. Nonverbal and verbal forms of communication may be factors in the level of satisfaction for nurses but other factors, such as the culture of the unit, can also be influential.
Behavioral Change.
Project 1. A mixed methods study by Leijen-Zeelenberg, van Raak, Duimel-Peeters, Kroese, Brink, Ruwaard, & Vrijhoef (2014) aimed to identify barriers to implementing change in the implementation of handoff tools in the acute care setting. The study implemented a standardized electronic communication tool with an emphasis on information transfer and feedback. The study involved six acute care units in the Netherlands, with five of the units serving as control groups. Interviews via focus groups were performed in addition to questionnaires that were completed by nurses, general practitioners, psychiatrists, and medical specialists from a variety of acute care units, which totaled 40 participants. Three main barriers were identified, which included a change to providers’ existing handoff routines, implementation methods, and lack of urgency in the need for improved handoff tools. Organizational change is necessary to implement new practice methods, such as the use of a new handoff tool. Each practitioner must also be willing to participate and accept new methods of communication, which involves learning new methods but also requires unlearning old habits. In order to unlearn old habits, the researchers “suggests that openness to vulnerability, willingness to listen, reflection of feeling and a high tolerance for raised feelings are important qualities for unlearning” (Leijen-Zeelenberg et al., 2014).
Project 2. A survey study performed by Lee, Phan, Dorman, Weaver, & Pronovost (2016) utilized the Agency for Healthcare Research and Quality’s (AHRQ) Hospital Survey on Patient Safety Culture (HSOPSC) to examine the relationship between perceptions of handoff reports, patient safety culture, and patient safety. The study was performed in a large pediatric medical center containing two campuses. The study found that staff perceptions of the hospital’s safety culture had an impact on safety practices, such as handoff reports. While the researchers note the “psychological links between perception, attitude, and behavior,” patient safety can be increased by effective handoff communication (Lee, Phan, Dorman, Weaver, & Pronovost, 2016). In regards to behavior, the results found that transfer of care (whether during shift change or transfer of units) was influenced by handoff reports. The researchers note that individual behavior and organization need to be addressed “before shared beliefs and values on perceptions of patient safety cane be formed” (Lee, Phan, Dorman, Weaver, & Pronovost, 2016). While communication methods are key in providing effective handoff reports, behavior also plays a large role in the ability to perform this duty. The overall safety culture of the facility may also play a role in staff behavioral approach to patient safety.
Project 3. Patton, Tidwell, Falder-Saeed, Young, Lewis, & Binder (2017) performed a quality improvement project to identify safest practices during unit transfers among pediatric patients. The study created and implemented a facility wide handoff tool to promote patient safety and to ensure patient information was addressed. While there was an increase in patient safety, there was also an increase in nurse satisfaction. Prior to the implementation of the tool, nurses expressed concern regarding receiving patients from other units due to limited patient information communication. While the use of a standard tool was implemented, the researchers involved the nurses to identify areas in which the transfer process may be improved. In terms of behavioral change, this study represents the importance involving staff to increase compliance when implementing change. If staff are involved, they may gain more of a sense of ownership and become more accepting to adopting new practices.
Conclusion . Behavioral change is an important factor when implementing new practice methods. Having an understanding of the need for unlearning old practices while implementing new methods needs to be recognized. Staff behaviors are affected by overall culture of the unit and hospital or facility, therefore leadership plays a significant role in promoting patient safety. Leadership involvement and promoting a sense of urgency may help to decrease resistance among staff and therefor increase the willingness to adopt new handoff methods. Moreover, leadership involvement may help to ensure staff are continuing to utilize the standardized handoff protocols.
The need for efficient nursing handoff reports is becoming more recognized. Handoff reports are crucial in communication patient status during the transition of care. This helps to maintain patient safety and prevent, or decrease, the occurrence of sentinel events. The Joint Commission has identified standardized nursing handoff tools as a viable measure to increase the efficacy of handoff reports. While Medical Surgical units tend to have patients that are considered to be more stable, many of them have comorbities, thus increasing their risk for adverse events related to poor handoff reports. Research has shown that the implementation of a standardized tool has been effective in improving handoff reports, however, little research has been done on medical surgical units, particularly in Southern California.
The theoretical foundations related to this project are Kurt Lewin’s change theory and E.M. Roger’s Innovation Diffusion Theory. These theories help to identify a framework to address the need for change while taking the individuals’ (i.e. nurse’s) involvement and acceptance of the change. Moreover, shared values and beliefs related to safety culture between individuals and the organization are also a factor in maintaining patient safety.
A literature review was performed using CINAHL, Science Direct, Academic OneFile, InfoTrac and Health Reference Center Academic to further investigate current practices and studies regarding handoff reports. Two major themes, communication and nursing care, were identified and six subthemes were further investigated: handoff failures, standardized handoff tool, bedside report, patient safety, nurse satisfaction, and behavioral change. The literature review indicates that patient safety is at high risk directly related to poor handoff reports. Several factors can be related to poor handoff reports, including lack of training, frequent interruptions, poor verbal and nonverbal communication, and a lack of situational awareness.
The literature review supports the need for improvement of handoff reports. Utilizing standardized tools, such as I-PASS or HAND-IT, may help to ensure nurses are discussing all important aspects of patient care. A mixed-methods design will be used for this project utilizing surveys. The quantitative portion will involve a points-based system and the qualitative portion will ask an open-ended question to the report-giver and the report-receiver. The aim of the project is to determine if a standardized handoff tool improves handoff reports among nurses on a Medical Surgical unit in a Southern California hospital.
Chapter 3: Methodology
Handoff reports are critical discussions regarding patients during transition of care. Poor communication during handoff reports can result in sentinel or near-miss events in the acute care setting (The Joint Commission, 2017). Increasing recognition regarding the need for effective communication has led to the belief that the use of a standardized handoff tool may help to improve communication during handoff reports (Hada, Coyer, & Jack, 2018, p.10). The purpose of this project was to determine how the use of standardized handoff reports influence the efficacy of handoff reports among medical/surgical and direct observation unit nurses in a Southern California hospital. This chapter will discuss the project methodology, findings, and recommendations.
Statement of the Problem
While the literature indicates that the use of a standardized handoff tool increases effective communication among nurses, it was not known if and to what degree using a standardized handoff tool among medical/surgical and direct observation unit nurses will reduce the number of falls. The real issue affecting nurses and patients is the ability to communicate effectively during handoff reports. The risk for adverse events increases significantly when there are poor handoff reports given, which could result in death or serious harm to the patients (Kear, Bhattacharya, & Walsh, 2016, p. 379). The importance of effective communication is becoming more recognized but there has not been significant research indicating the impact of more in-depth education regarding handoff reports among nurses. Literature recognizes that the use of tools in nursing practice help to foster and improve communication skills.
Handoff, also referred to as handover, reports are essential in providing safe care for patients. During the handoff report process, patient status and information is communicated between healthcare practitioners, such as between two nurses during a “change of shift” report (Kear, Bhattacharya, & Walsh, 2016, p. 384). During this time, it is critical to communicate important information regarding patient care to ensure continuity of care as well as patient safety. As stated by The Joint Commission (2017) “a hand-off is a transfer and acceptance of patient care responsibility achieved through effective communication.” Some causes for poor communication may include “inaccurate, incomplete, not timely, misinterpreted, or otherwise not was is needed” (The Joint Commission, 2017), leading to adverse events resulting in sentinel events. With the use of the standardized I PASS the BATON tool on the medical/surgical and direct observation units in a Southern California hospital, patient safety may be improved and maintained.
Clinical Question
Several clinical questions will help guide this quantitative project.
Q1: To what degree does using the I PASS the BATON tool as a standardized handoff tool impact on the fall rates on medical/surgical and direct observation units? Fall rates will be obtained on both the medical/surgical and direct observation units before and after the implementation of the I PASS the BATON standardized handoff tool. The aim of this clinical question was to determine if fall rates decline with the use of a standardized tool.
Q2: To what degree does using the I PASS the BATON tool as a standardized handoff tool increase nurse satisfaction with the handoff process as demonstrated by survey responses regarding satisfaction with handoff reports pre- and post-tool implementation? The degree to which nurse satisfaction is impacted by the use of the I PASS the BATON standardized handoff tool was measured. A survey created by Anderson & Mangino (2006) was to be completed by the nurses in an effort to collect quantitative data regarding nurse satisfaction with the handoff reports pre- and post-tool implementation. This was determined by requesting nurses receiving report to complete a brief set of questions regarding the quality of communication pre- and post-tool implementation. There will be a total of 6 questions and will be based off a 1 to 5 scale, 1 meaning very dissatisfied, 2 dissatisfied, 3 neutral, 4 satisfied, and 5 meaning very satisfied. The nurse receiving report were requested to complete two surveys per shift.
The use of the survey pre- and post-tool implementation aimed to determine if there was a change in the level of satisfaction with the handoff process. In an effort to measure patient safety, fall rates were obtained from both participating units to determine if there was a decrease in the amount of patient falls pre- and post-implementation of the standardized handoff tool. The use of questions and fall data collection aimed to provide quantitative data that could be measured to determine if there were variations in the variables pre- and post-tool implementation.
Project Methodology
The purpose of the doctoral project was to introduce a standardized handoff tool in an effort to improve nursing handoff reports on medical/surgical and direct observation units in a Southern California hospital. Using a quantitative quasi-experimental pre- and post-survey design, data was obtained by identifying patient fall rates pre- and post-tool implementation and by determining nurse satisfaction with the handoff process by asking nurses to complete a brief survey. It was not unknown that handoff reports are an area in which improvement is needed. However, it was not known how nurses on Southern California medical/surgical and direct observations units perceived the handoff process.
Obtaining the quantitative data by requesting nurses receiving report to respond to a set of 6 questions pre- and post- tool implementation helped to determine if nurse satisfaction with handoff reports improved with the use of the tool. On a scale of 1 to 5, the report-receiver rated the report-giver’s ability to provide clear, concise, and pertinent patient information as well as the level of satisfaction with the handoff communication.
Project Design
Quasi-experimental quantitative design was chosen due to the ability to measure the variables, which include the fall rates and nurse satisfaction with handoff reports in this project. This design was selected over descriptive or correlational research due to the ability to measure and manipulate the variables instead of simply observing (Ingham-Broomfield, 2014, p. 33). Surveys provide a standardized procedure for obtaining answers to questions and maintains objectivity (Morgan, 2014, p. 52). The use of quantitative methods via survey allowed for generality, however, in this project the range of survey participants was limited to registered nurses on the medical/surgical and direct observation units (Morgan, 2014, p. 52).
Data collection was performed by asking set of questions pre- and post-tool implementation. The falls data will be provided by the hospital educator for the medical/surgical and direct observation units. The data sets included the first week of the project prior to implementing the I PASS the BATON tool and the second set included patient fall data post-tool implementation. The rates of falls were compared to determine if there is a variation in the fall rates before and after the tool was implemented.
Prior to the start of the project, the night and day shift nurses were educated on the purpose of the project during shift change report. There was a very short discussion on the I PASS the BATON tool, the appropriate use of the tool, and the set of questions that will be required after each handoff report pre- and post-tool implementation. There was written material for the nurses to review throughout their shift so they had an understanding on the purpose of the tool as well as the requirements. The author was also be on-site during the beginning stages of implementing the pre-tool series of questions as well as during the implementation period. The author was also be available via phone when not on-site in case the nurses had any questions or concerns regarding the handoff process.
Population and Sample Selection
The project was completed on medical/surgical and direct observation units and involved a combined total of 16 nurses pre-implementation and 10 post-implementation. The sample size was determined by using a 95% confidence level with a 5% margin of error based off of the number of nurses who work on the medical/surgical and direct observation units. The project population included both day and night shift registered .
The project site was at a hospital in Placentia, California on the medical/surgical and direct observation units. The medical/surgical units have a high number of minor post-surgical and orthopedic patients. The direct observation unit has more unstable patients, particularly those who require constant cardiac monitoring and are at high risk for decline in status. The nurses who participated were limited to registered nurses who work on these units. Data will be stored for 3 years (until approximately November 17, 2022) and will personally be destroyed by the primary investigator by shredding all documents.
Instrumentation or Sources of Data
The sources of data included the pre- and post-tool implementation surveys, which will provide quantitative data. Utilizing SPSS, the variables were analyzed to determine if there was a variation between the pre- and post-tool implementation regarding nurse satisfaction with the handoff process. The nurses used the I PASS the BATON mnemonic for handoff reports during the second half of the duration of the project. Data regarding patient falls were obtained by the hospital educator pre- and post-tool implementation to determine if there was an impact in patient safety during the two week period of the project.
Validity refers to the accuracy of data results in a quantitative study (Heale & Twycross, 2015). “Validity determines whether the research truly measures what it was intended to measure or how truthful the research results are” (Golafshani, 2003, p. 599). In an effort to maintain validity of the project, a score system will be utilized for the surveys previously utilized by Anderson & Mangino (2006) study related to bedside handoff reports. The surveys were completed pre- and post-tool implementation by the nurses receiving report. The use of a scored system allowed for construct and criterion-related validity to ensure data is valid (Heale & Twycross, 2015). Internal validity may have posed a concern as some nurses may be more generous with scoring instead of giving accurate scores. In an effort to avoid a breech in internal validity, it was reinforced that that information on the questionnaires provided will not be shared with individuals other that the primary investigator and project chairs. The validity of the I PASS the BATON tool was determined by the use of the set of questions to be completed by the nurses to determine the level of satisfaction with handoff report as well as the number of patient falls before and after the implementation of the tool.
Reliability
Reliability refers to how consistent measurements are in a study (Heale & Twycross, 2015). Reliable research would allow for other researchers to replicate the study in the future utilizing similar methodology (Golafshani, 2003, p. 598). Golafshani (2003) recognizes that a “high degree of stability,” which refers to the ability to reproduce similar results in a test-retest method, leads to a higher level of reliability )p. 599). In an effort to ensure reliability, descriptive statistics was utilized in order to provide quantitative data analysis from the series of questions regarding nursing satisfaction with handoff reports and for patient falls pre-and post-tool implementation. The project design and methods will be clearly described as well as the data analysis process and findings.
Data Collection Procedures
The primary investigator attended shift change report at 7am and 7pm on several different days prior to the start of the project. The primary investigator verbally described what was expected of the nurses, such as completing a series of questions pre- and post-tool implementation, performing handoff report as the usually do for one week, and then performing handoff report for one week utilizing the I PASS the BATON mnemonic. Flyers regarding the project were posted in the unit breakrooms and nurses station in order to gain recognition for the need of participants. Nurses had the freedom to choose if they would like to participate in the project after receiving education on the purpose and procedure of the project.
Data collection began with obtaining fall rates on the medical/surgical and direct observation units, which were provided by the hospital educator. For the first week of the project, nurses were asked to complete the pre-tool implementation series of questions after they performed their usual method of handoff reports. After the pre-tool implementation stage, a brief orientation the standardized tool provided to the participants via verbal discussion during change of shift and handwritten tools. At the end of the tool implementation period, a second set of patient fall data was obtained from the hospital educator.
The patient fall data was obtained over the two week period of the project. Patient fall data was collected during the first week of the project, during which time the I PASS the BATON tool will not be utilized. This time frame of the patient fall data was over the course of 7 days, ending on the evening prior to the implementation of the I PASS the BATON tool during handoff reports. Patient fall data post-tool implementation was collected for the same duration of time, which was 7 days after the tool was being used by the nurses. Once all patient fall data had been collected, data was analyzed to determine if there was a change in patient fall rates.
Data Analysis Procedures
Using descriptive statistics, data was analyzed in SPSS. The quantitative data included the scored surveys that were answered by the nurses to determine if there wass a significant change in scores between pre-and post-tool implementation. The variables that were measured will included: accountability for completing nursing, ability to seek clarification during report, satisfaction of interpersonal relationships, patient condition, pertinent information included in report, and satisfaction with report time. Another variable that was analyzed was the patient fall rates pre- and post-tool implementation.
Ethical Considerations
The basic ethical principles identified in the Belmont Report shall be upheld in this project. Such basic principles include respect for persons, beneficence, and justice (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1979). The respect for nurse autonomy will be maintained by allowing nurses to choose whether or not they wish to participate in the project. Beneficence was maintained as no individuals (i.e. nurses or patients) will be harmed in this project. The project consisted of data collection related to patient fall rates and involved nurse participation in utilizing the I PASS the BATON handoff tool, neither of which will involve a risk for harm. All nurses will be treated justly and will not be discriminated based off age, gender, or experience (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1979). However, for the purpose of this project, it will be required that participating nurses have an active registered nursing license in the state of California. During the data collection, nurses’ information will be kept anonymous and stored in a sealed envelope at the charge nurses’ desks. Patient privacy concerns related to falls data were addressed by omitting patient identifiers from the data collected during the pre- and post-tool implementation periods.
Limitations
Limitations of the project included a smaller sample size related to the size of the hospital and the limitation to two units within the site. Another possible limitation was the length of time for the training of the standardized tool as well as a smaller sample size. Some nurses may not have been willing to score their peers honestly for fear of breech of privacy or directly related to interpersonal relationships with peers.
Handoff reports are critical components in ensuring patient safety. The literature indicated that the use of a standardized handoff tool increases effective communication among nurses during handoff reports. However, little is known how the use of a standardized tool in a small Southern California hospital would be affected by the permeation of a standardized tool. The purpose of this doctoral project was to introduce a standardized tool to a Medical Surgical Unit and Direct Observation Unit in an effort to determine if communication methods improved. Quantitative and qualitative data were obtained via surveys and data collection regarding patient falls and medication errors. Limitations of the project include a smaller sample size and potential for internal validity concerns related to peer relationships among nurses.
Chapter 4: Data Analysis and Results
Upon performing a literature review, it was found that the use of a standardized handoff tool helps to improve the communication between nurses during handoff reports. However, it was not known if the rate of patient falls is affected by the use of a standardized handoff tool on a medical/surgical and a direct observation unit in a Southern California hospital. Streeter & Harrington (2017) note that a large number of adverse events in the acute care setting are directly linked to poor communication among healthcare practitioners. Adverse events, such as falls, may lead to serious patient harm or even death.
The purpose of the project was to determine if the use of a standardized handoff tool affected the frequency of patient falls pre- and post-implementation of the I PASS the BATON tool. Another clinical question investigated during the project was to determine if nursing satisfaction was impacted with the use of a standardized handoff tool. Using a quasi-experimental quantitative design, statistical data was obtained and analyzed to identify the relationship between the two variables: patient falls and nursing satisfaction. This chapter will discuss the descriptive data, data analysis procedures, and the findings of data analysis.
Descriptive Data
The population involved in this project consisted of registered nurses working on medical/surgical and direct observation units at a small hospital in Southern California. Surveys were anonymous and only requested years of experience as a registered nurse. The years of experience ranged from 1 year to 16 years between the two units. There was otherwise no personal or identifiable data collected during the project. As noted in Tables 1 through 4, nurses completed 10 surveys pre-implementation and 6 surveys post-implementation while the nurses on the direct observation unit completed 22 pre-implementation and 14 surveys post-implementation.
Pre-Implementation Medical/Surgical Unit Surveys
Pre-Implementation Direct Observation Unit Surveys
Post-Implementation Medical/Surgical Unit Surveys
Post-Implementation Direct Observation Unit Surveys
To examine the clinical questions, quantitative research design was most appropriate to measure the affect of the I PASS the BATON tool on nursing satisfaction and patient fall rates. During week one of the project, nurses continued to perform handoff report as they normally did and the oncoming nurses were asked to complete satisfaction surveys after receiving report. During the second week of the project, the I PASS the BATON tool was implemented. Nurses were asked to use the tool when giving report to the oncoming nurses. The oncoming nurses were again asked to complete satisfaction surveys after receiving report from the outgoing nurse using the handoff tool. Data was analyzed with the assistance of a data analyst using Fisher’s exact tests to determine if the results were statistically significant.
Potential sources of error in the project regarding patient falls could include unreported patient falls on the units. There is potential for errors regarding nursing satisfaction with the use of a standardized tool. First, if nurses did not fully understand how to use the I PASS the BATON tool, it may not have been used appropriately. Second, there is no guarantee that all of the nurses were using the I PASS the BATON tool during the post-implementation stage. This could have affected nursing satisfaction among the oncoming nurses during this stage. Lastly, despite the surveys remaining anonymous, some nurses may not have truthfully answered surveys, perhaps because of feeling overly generous with answers (i.e. agree or disagree). This could have affected internal validity but it is unknown if nurses were completely honest on the surveys.
Despite the potential for breech of internal validity, validity was maintained with the analysis of the data. The validity of the data was maintained by using a score system for the nursing satisfaction surveys, which allows for criterion-related validity (Heale & Twycross, 2015). Reliability was maintained in the project due to the ability to reproduce similar results. However, factors may influence the level of nurse satisfaction in other acute care settings, such as interpersonal relationships, years of experience, and nurse workload. The fall rates were not as reliable due to the low rates of falls on the units. Because fall rates were overall low, the fall rate analysis was not statistically significant with the Fisher test.
The first clinical question aimed to examine was to what degree does using the I PASS the BATON tool as a standardized handoff tool impact on the fall rates on medical/surgical and direct observation units. On the medical/surgical unit, there was one fall during pre-implementation period and one fall during post-implementation period. The direct observation unit had one fall during pre-implementation period and two falls during the post-implementation period. Thus, the total number of falls slightly increased overall from two to three overall, a 50% relative increase. Table 5 demonstrates the fall rates pre- and post-tool implementation with the medical/surgical unit described as “Med/Surg” and the direct observation unit listed as “DOU.”
Patient Fall Rates Pre- and Post-Implementation of a Standardized Handoff Tool
The second clinical question aimed to examine to what degree does the use of the I PASS the BATON tool as a standardized handoff tool increase nurse satisfaction with the handoff process. This question was demonstrated by survey questions regarding satisfaction with handoff reports pre- and post-tool implementation. The results are presented by unit and for the total sample. As shown in Table 6, there was a statistically significant improvement in perceptions for the medical/surgical unit on four out of the six survey items. The direct observation unit had improvements on all but one item with no statistically significant changes on any of the six items.
Handoff Survey Responses by Unit
Note. Sample sizes for Med/Surg Unit were n=10 at pre and n=6 at post; sample sizes for DOU unit were n=22 at pre and n=14 at post.
When evaluating the responses for the total sample (Table 7), there were statistically significant improvements on four of the six items, although all items showed improvement in responses. The data suggests that the use of a standardized handoff tool improved nurse satisfaction with the handoff report for the oncoming nurses on both units.
Handoff Survey Responses for Total Sample
This section provides a concise summary of what was found in the project. It briefly restates essential data and data analysis presented in this chapter, and it helps the reader see and understand the relevance of the data and analysis to the clinical question(s). Finally, it provides a lead or transition into Chapter 5, where the implications of the data and data analysis relative to the clinical question(s) will be discussed. The summary of the data must be logically and clearly presented, with the factual information separated from interpretation. For qualitative studies, summarize the data and data analysis results in relation to the clinical question(s). For quantitative studies, summarize the statistical data and results of statistical tests in relation to the clinical question(s). Finally, provide a concluding section and transition to Chapter 5.
Chapter 5: Summary, Conclusions, and Recommendations
Efficient communication during nursing handoff reports is essential in maintaining patient safety. During change of shift reports, critical patient information is passed on from one practitioner (i.e. the outgoing nurse) to the practitioner assuming care (i.e. the oncoming nurse). Ineffective handoff reports may be related to incorrect or too little information, untimely, or is left to inaccurate interpretation (The Joint Commission, 2017). Streeter & Harrington (2017) note that about 65% of sentinel evens in the acute care setting are directly related to poor communication during handoff reports. Due to the high risk for patient harm, it is essential that proper handoff reports be performed.
Summary of the Project
The purpose of this project was to determine if the standardized I PASS the BATON tool affected patient safety by measuring the rate of patient falls. The level of nurse satisfaction with the use of a standardized handoff tool was also investigated. Research indicates that the use of standardized handoff tools can help to promote more effective communication and may, therefore, positively impact patient safety.
Summary of Findings and Conclusion
Effective communication plays a significant role maintaining patient safety and may promote nursing satisfaction with handoff reports. The Joint Commission (2017) states that poor communication during handoff reports may lead to adverse patient events, causing harm, or in some cases, death, to patients. The I PASS the BATON tool is a standardized handoff tool that may be utilized during nursing handoff reports to ensure that all pertinent patient information is discussed before the oncoming nurse assumes care of patients.
A literature review was performed to determine if a standardized handoff tool has been shown to affect the efficacy of nursing handoff reports. The major themes identified upon literature review were communication and nursing care, both of which directly affect patient safety. The findings of the literature review indicate that handoff failures have a significant impact on the safety of patients in the acute care setting Abraham et al. (2016). While there has been research indicating a positive impact on patient safety and nursing communication with the use of a standardized handoff tool, there has been minimal research performed in smaller acute care settings in Southern California.
Using a quantitative quasi-experimental research design, this project aimed to determine if the fall rates on medical/surgical and direct observation units were affected by the use of the I PASS the BATON handoff tool. Another aspect that was investigated was the impact of the I PASS the BATON tool on nurse satisfaction with the handoff reports. Nursing satisfaction surveys were completed by registered nurses on medical/surgical and direct observation units to determine if nursing satisfaction improved with the use of the standardized handoff tool. Patient safety was measured by obtaining patient fall data pre- and post-implementation of the handoff tool. This chapter will summarize the findings of the project and will discuss the conclusions of the project findings.
Implications
The project aimed to examine the effect of the use of the I PASS the BATON tool as a standardized handoff tool in the acute care setting. This section will discuss the theoretical implications, particularly regarding the influence of Lewin’s Change Theory and Roger’s Innovation Diffusion Theory. Secondly, the practical implications of the project findings will be discussed. Lastly, future implications will be identified.
Theoretical implications.
Kurt Lewin’s Change Theory is comprised of three stages: unfreezing, change, and refreezing. Roger’s Innovation Diffusion Theory, which is an expansion of the Lewin’s Change Theory, identifies how change may be influenced by individuals or organizations. When implementing change among nurses, such as the use of a standardized handoff tool, these tools may prove to be helpful in carrying out the planning and implementation stages. While thy may have been helpful in this project, such as the unfreezing (i.e. recognizing the need for more efficient reports) and the change stages, a longer period of time to perform the project may have allowed for more reinforcement with the change process. Moreover, this may have allowed a better utilization of Roger’s theory by identifying the leaders and those willing to adopt change may have lead to more participation among the nurses, particularly on the medical/surgical unit.
The first clinical question examined in this project was to determine to what degree using the I PASS the BATON tool as a standardized handoff tool would impact the fall rates on medical/surgical and direct observation units. The overall fall rates were fairly low at the hospital in which the project took place. The rate of falls between the medical/surgical and direct observation units during the pre-implementation period was 2 while the number of falls during the post-implementation period was 3. The reason for increase in falls is unclear but it may be related to factors such as increased general patient acuity, years of experience of staff, or poor handoff reports.
The purpose of the second clinical question was to examine to what degree does the use of the I PASS the BATON tool as a standardized handoff tool affect nurse satisfaction with the handoff report process. The nurses on the medical/surgical and direct observation units completed surveys after receiving handoff report from the outgoing nurse during the pre- and post-implementation periods. Overall, nurse satisfaction with the handoff reports appeared to improve during the post-implementation period in which the I PASS the BATON tool was used.
The findings of the project indicate there was an improvement with nurse satisfaction with reports, there was no significant improvement in the patient fall rates. While the literature review found that patient safety improved, many of these literature reviews were performed in larger hospitals in the United States and performed for a longer duration. Therefore, a limitation to this project was that it was in a smaller hospital in Southern California. Another limitation is the duration of the project, which was two weeks, may not have allowed enough time for sufficient data collection.
Practical implications.
Literature review had found that nurse satisfaction with handoff reports varied among settings but many of the findings indicated that nurses felt there was room for improvement. This project did find an increase in nurse satisfaction with the report process after the use of a standardized tool was implemented. If nurses are more satisfied with handoff reports, this may encourage a more positive interaction between outgoing and oncoming nurses and therefore improve communication regarding vital patient information.
Future implications.
Upon the initial literature review, it had been identified there is evidence that supports the need for more efficient nursing handoff reports. While there were a variety of settings discussed in the literature review, there was little information on the effect of a standardized handoff tool in a small acute care setting. While the findings of the project found there to be an increase in nursing satisfaction with the nursing handoff reports, there was no significant improvement in the patient fall rates. It is possible that as nurses become more familiarized with the I PASS the BATON tool, handoff reports will continue to improve and therefor positively impact the rate of patient falls. Future projects may benefit from a longer data collection period in an effort to collect more fall data and to determine if a longer period of time continues to improve the handoff report process.
Recommendations
Several recommendations were identified for future projects. The first recommendation is to implement a standardized handoff tool to help nurses ensure all pertinent information is discussed in report. Several recommendations for future projects include a longer duration for data collection, more nurse education regarding the use of the tool and data analysis tools, and performing a project at a site with a larger patient population.
Recommendations for future projects.
It is recommended that future projects examining the use of the I PASS the BATON tool perform the data collection period over a longer time frame. This may allow more ample time to obtain data, such as nursing satisfaction surveys and monitoring the rates of patient falls. Due to the increase in overall nurse satisfaction with the handoff report process, patient safety may be positively impacted over a longer timeframe. The longer duration of project implementation may also allow for more time to educate the nurses on the appropriate use of the handoff tool as well as the data collection tools. Lastly, a larger patient population may provide more sufficient data regarding patient safety, such as falls.
Recommendations for practice.
The use of a standardized handoff tool may be helpful in increasing the level of nurse satisfaction with handoff report. Handoff report is an essential tool in ensuring the oncoming nurse has vital information regarding patient status and upcoming activities scheduled during the shift. While there is no clear identification of a change in nurse satisfaction with interpersonal relationships between shifts, the use of a standardized handoff tool and the improvement of handoff reports may positively impact these relationships. Patient safety remains to be a priority in the acute care settings. The use of a standardized handoff tool may aid in effective handoff reports, thus improving patient safety measures and outcomes.
Abraham, J., Kannampallil, T.G., Almoosa, K.F., Patel, B., Patel, V.L. (2013). Comparative evaluation of the content and structure of communication using two handoff tools: implications for patient safety. Journal of Critical Care, 2013 . doi.org/10.1016/j.jcrc.2013.11.014
Abraham, J., Kannampallil, T., Brenner, C., Lopez, K.D., Almoosa, K.F., Patel, B.,… Patel, V.L. (2016). Characterizing the structure and content of nurse handoffs: A sequential conversational analysis approach. Journal of Biomedical Informatics, 59 (2016) , 76-88 .
Agency for Healthcare Research and Quality (2019). Adverse Events, Near Misses, and Errors. Retrieved from https://psnet.ahrq.gov/primers/primer/34/Adverse-Events-Near-Misses-and-Errors
Agency for Healthcare Research and Quality (2014). TeamSTEPPS® Pocket Guide
“Handoff–I PASS THE BATON.” Retrieved from https://www.ahrq.gov/teamstepps/instructor/essentials/pocketguide.html
Agency for Healthcare Research and Quality (2019). Patient Falls in Hospitals. Retrieved from https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/fallpxtkover.html
Agency for Healthcare Research and Quality (2019). Guide to Patient and Family Engagement in Hospital Quality and Safety – Strategy 3: Nurse Bedside Shift Report (Implementation Guide). Retrieved from https://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy3/index.html
Aliakbari, F., Parvin, N., Heidari, M., & Haghani, F. (2015). Learning theories application in nursing education. Journal of education and health promotion , 4 , 2. doi:10.4103/2277-9531.151867
Anderson, C.D. & Mangino, R.R. (2006). Nurse shift report; who says you can’t talk in front of the patient? Nurs Admin Q, 30 (2), pp 11-122.
Bakon, S., Millichamp, T. (2017). Optimising the emergency to ward handover process: a mixed methods study. Australasian Emergency Nursing Journal, 20 (2017); p 147-152.
Bigani, D., & Correia, A.M. (2018). On the same page: nurse, patient, and family perceptions of change-of-shift bedside report. Journal of Pediatric Nursing, 41 (2018), 84-89.
Boat, A.C., Speath, J.P. (2013). Handoff checklists improve the reliability of patient handoffs in the operating room and postanesthesia care unit. Pediatric Anesthesia, 23 (2013); pp 647-654.
Campbell, D. & Dontje, K. (2019). Implementing bedside handoff in the emergency department: a practice improvement project. Journal of Emergency Medicine, 45 (2); pp 149-154.
Carroll J.S., Williams, M., Gallivan, T.M. (2012) The ins and outs of change of shift handoffs between nurses: a communication challenge. BMJ Quality & Safety . 21, 7, 586-593.
Center for Innovation in Research and Teaching (2019). An Overview of Quantitative Research. Retrieved from https://cirt.gcu.edu/research/developmentresources/research_ready/quantresearch/overview_quant
Chapman, Y.L., Schweickert, P., Sango-Wilson, A., Aboul-Enein, F.H., Heyman, A. (2016). Nurse satisfaction with information technology enhanced bedside handoff. MedSurg Nursing, September-October 25 (5).
Da Silva dose Santos, G.R., Campos, J.F., da Silva, R.C. (2018). Handoff communication in intensive care: links with patient safety. Esc Anna Nery, 22 (2), p 1-12. DOI: 10.1590/2177-9465-EAN-2017-0268
Daniel, E. (2016). The usefulness of qualitative and quantitative approaches and methods in researching problem-solving ability in science education curriculum. Journal of Education and Practice, 7(15), p 91-100. Retrieved from https://files.eric.ed.gov/fulltext/EJ1103224.pdf
Ferrara, P., Terzoni, S., Davi, S., Bisesti, A., Destrebecq, A. (2017). A tool for assessing the quality of nursing handovers: a validation study. British Journal of Nursing, 26 (15), p 882-888).
Foronda, C., VanGraafeiland, B., Quon, R., Davidson, P. (2016). Handover and Transport Of Critically Ill Children: An Integrative Review. https://doi.org/10.1016/j.ijnurstu.2016.07.020
Friesen MA, White SV, Byers JF (2008). Handoffs: Implications for Nurses. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 34. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2649/
Fryman, C., Hamo, C., Raghaven, S., Goolsarran, N. (2017). A quality improvement approach to standardization and sustainability of the hand-off process. BMJ Quality Improvement Reports 2017 (6). doi:10.1136/bmjquality.u222156.w8291
Golafshani, N. (2003). Understanding Reliability and Validity in Qualitative Research. The Qualitative Report, 8(4), 597-606. Retrieved from https://nsuworks.nova.edu/tqr/vol8/iss4/6
Goncalves, G.I., Rocha, P.K., Anders, J.C., Kusahara, D.M., & Tomazoni, A. (2016). Communication and patient safey in the change-of-shift nursing report in neonatal intensive care units. Texto Contexto Enferm, 2016 (1):e2310014. http://dx.doi.org/10.1590/0104-07072016002310014
Griffin, T. (2010). Bringing change-of-shift report to the bedside: A patient and family centered approach. Journal of Perinatal and Neonatal Nursing, Vol 24 (4), pp 348-353.
Hada, A., Coyer, F., Jack, L. (2018). Nursing bedside clinical handover: a pilot study testing a ward-based education intervention to improve patient outcomes. JRNA, 21, No 1 April 2018; p9-18.
Halm, M.A. (2013). Nursing handoffs: ensuring safe passage for patients. American Journal of Critical Care, March 2013, Vol 22, No. 2, ; p 158-152.
Heale, R., Twycross, A. (2015). Validity and reliability in quantitative studies. Evidence-Based Nursing 2015;18:66-67. http://dx.doi.org/10.1136/eb-2015-102129
Ingham-Broomfield, R. (December 2014 – February 2015). A nurses’ guide to quantitative research. Australian Journal of Advanced Nursing, 32(2), pp 32-38.
Johnson, C., Carta, T., Throndson, K. (2015). Communicate with me: information exchanges between nurses. Canadian Nurses, 111 (12), p 24-27.
Kear, T.M (2016). Patient handoffs: what they are and how they contribute to patient safety. Nephrology Nursing Journal, July-August 2016, Vol 43 (4); p 339-342.
Kear, T.M, Bhattacharya, A., Walsh, M. (2016). Patient handoffs in nephrology nurse practice settings: a safety study. Nephrology Nursing Journal, September-October 2016, Vol 43, No 5 ; p 379-387.
Klee, K., Latta, L., Davis-Kirsch, S., Pecchia, M. (2012) Using continuous process improvement methodology to standardize nursing handoff communication. Journal of Pediatric Nursing . 27, 2, 168-173. doi: 10.1016/j.pedn.2011.08.005
Lee, S., Phan, P.H., Dorman, T., Weaver, S.J., Pronovost, P.J. (2016). Handoffs, safety culture, and practices: evidence from the hospital survey on patient safety culture. BMC Health Services Research, 20116 (16); p 1-8. DOI 10.1186/s12913-016-1502-7
Leijen-Zeelenberg, J.E., van Raak A., Duimel-Peeters, I., Kroese, M., Brink, P., Ruwaard, D., Vrijhoef, H. (2014).
Lowe, J.S & Georfe-Gay, B. (2017). A high-fideltiy simulation study of intraoperative latent hazards and their impact on anesthesia care-related handoff outcomes. ANA Journal, 85 (40); p 250-254.
Malekzadeh J., Mazluom, SR.., Etezadi T., & Tasseri, A. (2013 August 27). A standardized shift handover protocol: improving nurses’ safe practice in intensive care units. J Caring Sci . 2013;2(3):pp 177–185. doi:10.5681/jcs.2013.022
Manchester, J., Gray-Miceli, D. L., Metcalf, J. A., Paolini, C. A., Napier, A. H., Coogle, C. L., & Owens, M. G. (2014). Facilitating Lewin’s change model with collaborative evaluation in promoting evidence based practices of health professionals. Evaluation and Program Planning , 47 , 82–90. https://doi.org/10.1016/j.evalprogplan.2014.08.007
Morgan, D. (2014). Research design and research methods. In Integrating qualitative and quantitative methods (pp. 45-62). 55 City Road, London: SAGE Publications, Inc. doi: 10.4135/9781544304533
Nagpal K, Abboudi M, Manchanda C, Vats A, Sevdalis N, Bicknell C.,…Moorthy, K. (2013). Improving postoperative handover: a prospective observational study. Am JSurg 2013;206(4):494. http://dx.doi.org/10.1016/j.amjsurg.2013.03.005.
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Patton, L.J., Tidwell, J.D., Falder-Saeed, K.L., Young, V.B., Lewis, B.D., Binder, J.F. (2017). Ensuring safe transfer of pediatric patients: a quality improvement project to
standardize handoff communication. Journal of Pediatric Nursing , 2017 . doi.org/10.1016/j.pedn.2017.01.004
Poot, E.P, de Bruijne, M.C., Wouters, M., de Groot, C.J., Wagner, C. (2014). Exploring perinatal shift-to-shift handover communication and process: an observational study. Journal of Evaluation in Clinical Practice, 20 (2014), 166-175.
Riesenerg, L.A., Leitzsch, J., Cunningham, J.M., (2010). Nursing handoffs: a systematic review of the literature. American Journal of Nursing, April 2010, Vol 110 (4).
Robinson, N.L. (2016). Promoting patient safety with perioperative hand-off communication. American Society of PeriAnesthesia Nurses . Retrieved from http://dx.doi.org/10.1016/j.jopan.2014.08.144
Rosenbluth, G., Destino, L, Starmer, A., Landrigan, C., Spector, N., Sectish, T. (2018). I-PASS handoff program: Use of a campaign to effect transformational change. Pediatric Quality & Safety, July/August 2018 (3) , p e088. doi: 10.1097/pq9.0000000000000088.
Santos, G.R., Campos, J.F., Silva, R.C. (2018). Handoff communication in intensive care: links with patient safety. Esc Anna Nery, 22 (2), p 1-12. DOI: 10.1590/2177-9465-EAN-2017-0268
Seada, A.N., Bayoumy, S.A. (2017). Effectiveness of handoff eduational program on nurses interns’ knowledge, and communication competence. American Journal of Nursing Science, 6 (6), p 467-477. doi: 10.11648/j.ajns.20170606.14
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Stramer, A.J., Schnock, K.O., Lyons, A., Hehn, R.S., Graham, D.A., Keohane, C., Landrigan, C.P. (2017). Effects of the I-PASS Nursing Handoff Bundle on communication quality and work. BMJ Quality & Safety, 26 (12). http://dx.doi.org/10.1136/bmjqs-2016-006224
Streeter, A.R., Harrington, N.G. (2017). Nurse handoff communication. Seminars in Oncology Nursing, 33 (5); p 536-543.
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The Joint Commission (2017). Inadequate hand-off communication. Sentinel Event Alert, issue 58. Retrieved from https://www.jointcommission.org/assets/1/18/SEA_58_Hand_off_Comms_9_6_17_FINAL_(1).pdf
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Vadhanan, S. (2017). Transfer of care: weakest link in critical care. Indian Journal of Health and Wellbeing, 8 (2), p 161-163.
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DNP projects may take the form of quality improvement initiatives, practice change programs, program evaluation or translating evidence into practice. See examples of DNP student projects below. Recommend a project 2021 Graduates Teresa P. Abernathy, BSN, RN, CGRN, DNP-FNP Student Quality Improvement: Implementing a Screening,
For example, your DNP project may be a practice portfolio that explores the impact or outcomes of nursing practice, or it may be a practice change initiative represented by a program evaluation. It may be a quality improvement project, a consulting project, or the evaluation of a new practice model.
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DNP Projects from 2022 PDF Save the Children Community Health Worker Program—Project Management, Lauren Loree Burchfield PDF Increasing vaccination rates in the Latin X communities through a public health initiative for increasing education and vaccination, Gabriela Carrico PDF
DNP Student Project Examples DNP Student Project Examples Here are some examples of projects from former DNP students. Addressing maternal outcomes in rural Indiana mothers through improved prenatal care utilization Yadira Santiago Banuelos, MSN, RN, FNP-BC, CLC | PowerPoint Presentation (PDF)
The DNP program is a distance accessible program offered through Continuing and Professional Education. Follow Submissions from 2022 PDF Addressing Implicit Bias to Improve the Engagement and Retention Rate of the Under-Represented Minorities in Substance Use Treatment., Adekemi Victoria Adeleye PDF
inclusion in Doctor of Nursing Practice (DNP) Projects by an authorized administrator of [email protected] Amherst. For more information, please [email protected] Samuel, Annie, "A Quality Improvement Project to Improve Type 2 Diabetes Mellitus Screening in Asian Americans Using Body Mass Index Cut Point of 23" (2018).
Doctor of Nursing Practice (DNP) Capstone Projects Cohort 6 Student Speakers: Kandree Hicks & Leah McKinnon-Howe 1. Georgia Agganis, MSN, RN, CPNP Capstone Title: Preventing Sexually Transmitted Infections (STIs) in Adolescence: A Quality Improvement Project to Determine if Adolescent Females with the Long Acting
The FREE listing of DNP scholarly projects is available for your download. We now archive complete projects - not just the abstract. To participate in DNP Studies and Surveys, click here. Posting abstracts and background information is voluntary. This should not be considered a "publication" of professional work.
DNP Final Manuscripts from 2022. PDF. Improved Monitoring of Depression and Suicidal Ideation in Low-Income Adolescents through Evidenced Based Provider Education, Sunday Adeyeye. PDF. Increasing Mental Health Literacy in the Black Church, Jonathan Allotey. PDF.
The Doctor of Nursing Practice Final Projects collection contains the completed works of students from the DNP Program at Arizona State University's College of Nursing and Health Innovation. These projects are the culminating product of the curricula and demonstrate clinical scholarship. Collaborating Institutions:
Type of category: Type of Organization: Total Projects : Load More. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. By clicking "Accept All", you consent to the use of ALL the cookies. However, you may visit "Cookie Settings" to provide a controlled consent.
Bone health education for osteoporosis risk reduction in premenopausal women: A quality improvement project . Nichols, Gloria. In the United States, about 8.5 million women live with osteoporosis. Osteoporosis is a debilitating systemic skeletal disorder characterized by low bone mass and reduced bone mineral density that occurs with the ...
Project examples. The following are examples of doctor of nursing practice (DNP) projects completed by the authors when they were DNP students. ... Anderson BA, Knestrick JM, Barroso R. DNP Capstone Projects: Exemplars of Excellence in Practice. New York, NY: Springer Publishing Company; 2014. Bednash G, Breslin ET, Kirschling JM, Rosseter RJ ...
Doctor!of!Nursing!Practice!(DNP)! Capstone!Projects! Cohort5!! Student'Speakers:' ... The goal for sample size will be 35 participants per group. Inclusion criteria: Adolescents 13-17 years old at time of initial evaluation for hypertension, being overweight or obese as defined by the CDC, and having a diagnosis of essential ...
Examples of DNP Capstone Projects Our company offers capstone nursing project assistance to students in DNP programs. We provide a full range of services to help you complete a capstone nursing project for the program you are in.
Here's a short DNP Capstone Project Abstract examples Example 1 Background and significance: A DNP capstone project can be life and time-saving for patients. It is important to have a well-designed and executed capstone project to ensure the success of a DNP program.
About the DNP Doctoral Project. A DNP doctoral project is a formal manuscript written to address a problem in nursing practice. Walden DNP doctoral projects consist of five sections. You can access the Office of Research and Doctoral Services's Doctoral Capstone and Project Resources for information on the process, checklists, and rubrics for ...
DNP Capstone Projects Examples January 9, 2022 Posted by: admin Category: DNP Nursing No Comments Examining The Impact of A Standardized Nursing Handoff Tool On Patient Falls and Nursing Communication Doctor of Nursing Practice Examining The Impact of A Standardized Nursing Handoff Tool On Patient Falls and Nursing Communication Abstract
Receive an illustrative PowerPoint presentation for any DNP capstone project papers. Your slideshow will include summarizing information presented in comprehensible graphs, diagrams, and tables. No missing or irrelevant details possible. Get help Our free features Hiring preferred writer Bibliography and cover page
Choose and download a suitable example or order help in DNP capstone writing with a discount! 7% OFF your first order ... DNP Capstone Project Examples . CapstoneWriting / Capstone Project Examples / DNP . All samples Filters ...