Table of Contents
To Err is Human…. to Collaborate is Divine…Collaboration: The Key to Positive
Patient Outcomes and Professional Satisfaction ..................................................................2
The influence a Nurse-Driven Palliative Care Screening Tool Has on the Timing of
Palliative Care Consults ......................................................................................................3
Effectiveness of Periop 101: A Core Curriculum ™ in the Orientation of the Novice
Perioperative Nurse ..............................................................................................................4
Effectiveness of Nurses’ Preparedness in Education and Assessment of Patients
Receiving Oral Cancer Therapies ........................................................................................5
The Impact of Pre-Procedure Phone Calls in an Endoscopy Suite ......................................6
Exploring the Role of the Nurse in the Care and Support of Autistic Children and
Their Family: A Family Resilience Approach .....................................................................7
Cardiac Rehabilitation Enrollment: A Study of the Effects of Patient Education ..............8
Assessment of Education Regarding Heart Attack Symptoms and the Proper Response ...9
The Integration of Spirituality in Nursing Curriculum: Improving Spiritual Care of
Patients ...............................................................................................................................10
August 2014 MSN Capstone Project
Page 1
To Err is Human…. to Collaborate is Divine
Collaboration: The Key to Positive Patient Outcomes and Professional Satisfaction
Kimberly Johnson, MSN(c), BSN, RNC-NIC
Immaculata University
Significance
The Institute of Medicine, and the American Association of Colleges of Nursing, are two
major organizations that call for innovative measures to ensure optimal patient outcomes.
Effective nurse physician collaboration is essential to achieve these outcomes.
Introducing opportunities for nurses and physicians to collaborate in staff education
sessions may increase the respect the two disciplines have for one another and may
increase awareness of the unique knowledge and skills each contributes to the safe
delivery of health care.
Purpose/Aim
Provide an opportunity for physician and nurses to work together in disseminating
information to bedside caregivers. This collaborative effort may increase respect for
individual roles, improve job satisfaction and ultimately lead to optimal health outcomes.
Jean Watson’s Caring Science Theory will be applied to this as it addresses respect for
roles as they impact professional satisfaction.
Method
This action research study will gather data from a recent hospital National Database of
Nursing Quality Indicators (NDNQI) survey, focusing on questions regarding nurse
physician collaboration and perception of each other’s role in health care delivery to
newborns in a 12-bed Neonatal Intensive Care Nursery. A review of evidence-based
research and strategies will be utilized to develop opportunities for nurses and physicians
to co- present at lectures.
Results/Interpretations
Trust and respect for interdisciplinary roles are affected by multiple variables, which are
discussed in this proposal. Results of future NDNQI survey will be analyzed to indicate
if co-presenting lectures improved communication and respect for nurse physician roles.
Conclusion/Implications
Positive feedback came from physicians and nurses indicated interest in improving
collaboration by co-presenting lectures. External variables impact ability for nurses and
physicians to work collaboratively. Increased training on communication and
presentation skills should be implemented to improve collaborative efforts.
August 2014 MSN Capstone Project
Page 2
The Influence a Nurse-Driven Palliative Care Screening Tool Has on the
Timing of Palliative Care Consults
Joyce R. Kish, MSN(c), BSN, RN, CCRN
Immaculata University
Significance
Chronic illnesses such as cancer and heart disease are rising in the U.S. When the burden
of treatments for the individual exceeds their benefit it is appropriate to involve the
Palliative Care Team. Physicians often consider a palliative care consult (PCC) as a last
resort. Palliative care offers the patient an option to focus on quality-of-life issues while
allowing them to live with dignity and control.
Purpose/Aim
The purpose of this action research project is to identify the triggers for a PCC and use
them to develop a nurse-driven palliative care screening tool. Development of a
screening tool to facilitate communication between nurses and physicians will assist in
identifying the need for a PCC earlier in the patient's disease process.
Methods
A retrospective review of 30 electronic medical records was completed for patients that
received a PCC during April 2014. Through collaboration with the hospital's Palliative
Care Team a nurse-driven screening tool was developed.
Results/Interpretation
The study revealed the top two diagnoses were acute respiratory failure and cancer.
Primary triggers for a PCC were pain and dyspnea. The leading reasons for a PCC were
symptom management and discussion of code status. Of the 30 patients reviewed there
were 10 deaths which occurred within hours and up to 11 days after the PCC.
Conclusion and Implications
When a PCC occurs hours or days prior to the patient dying they are deprived of the
physical and psychological support the Palliative Care Team can offer. Nurses are in the
perfect position to facilitate earlier PCCs. The use of a screening tool will standardize
information used to communicate with the physician promoting a positive effect on
earlier timing of a PCC.
August 2014 MSN Capstone Project
Page 3
Effectiveness of Periop 101: A Core Curriculum ™ in the Orientation of the
Novice Perioperative Nurse
Rosalyn J. McGrath, MSN(c), BSN, RN, CNOR
Immaculata University
Significance
Healthcare institutions across the country are facing an unparalleled nursing shortage.
Contributing factors include an aging baby-boomer population nearing retirement age and
a high turnover rate among new graduate hires. Many Perioperative leaders report
difficulty in filling staff positions. In a high risk clinical area such as the Perioperative
Area, a quality driven, evidence-based orientation program is critical to safe patient care.
Critical thinking skills must also increase in this environment due to the rapid pace and
increasing acuity of patients. Nurse educators have a professional and ethical
responsibility to ensure novice nurses gain the confidence and are competent to be
successful in the Perioperative setting.
Purpose
The purpose of this action research project is to evaluate the effectiveness of Periop 101
as a learning platform for novice perioperative nurses in relation to safety, cost,
confidence and competence.
Method
An action research approach was used to survey the perioperative staff as the novices
were rotating through their clinical specialties. Also, ongoing evaluations of
competencies, test scores, self-evaluation, and practice errors were examined among the
novices. A cost benefit analysis was also used to determine if Periop 101 is more costeffective than a department based program.
Results/Interpretation
The findings in this study emphasize the effectiveness of an evidence-based, quality
driven, orientation program. The implementation of Periop 101 as a learning platform
enhances the skills, competence, and confidence which are fundamental to the success of
a nurse new to the perioperative area.
Conclusion/Implications
Preparation of the novice perioperative nurse with an evidence-based quality orientation
program can lead to a safe, successful and rewarding career. Novice nurses who
transition from the novice to advanced beginner are competent, confident, satisfied, and
committed to their organization. An area where further research is needed is in the
effectiveness of the program over time.
August 2014 MSN Capstone Project
Page 4
Effectiveness of Nurses’ Preparedness in Education and Assessment of
Patients Receiving Oral Cancer Therapies
Mary C. Rooney, MSN(c), BSN, RN, OCN, CBCN
Immaculata University
Significance
The paradigm in cancer care is changing with oral cancer therapy accounting for an
estimated 25% of treatments. This shift in care provides an opportunity for nurses to be
leaders in this modality of cancer treatment. Historically, nurses have been educating
patients receiving cancer therapy for years, at the bedside, and in infusion suites. Nurses
giving these treatments are required to be certified. With oral cancer therapy patients are
responsible for obtaining, administering, adhering and managing side effects of oral
cancer therapy. Education and assessment is even more important for both nurses and
patients. Nurses must be prepared to take the lead in educating and assessing for barriers
prior to the initiation of oral cancer therapy and provide continued support to patients to
promote safety, efficacy and improved patient outcomes.
Purpose
This action research study will examine the preparedness and current practices among
nurses in various settings who are responsible for the education and assessment of
patients receiving oral cancer therapies in order to set standards to improve safety and
outcomes for patients.
Method
An action research approach was used to survey nurses who currently work in oncology
care. Causal conversations among colleagues both in the community and academic
settings were conducted. Information was also obtained by professional nursing blogs
and by observation.
Results
Information collected supports that nurses are not prepared or confident in the changing
paradigm of cancer care. Among practices no standardization exists, no formal training
is provided or required in contrast to parental chemotherapy administration.
Conclusion
Nurses need to be prepared to educate and assess patients on complex oral cancer
therapies. Effectiveness will reduce adverse events, increase adherence and lead to
improvements in efficacy and safety for patients. Further research is required to identify
strategies to implement an educational requirement for nurses in this role.
August 2014 MSN Capstone Project
Page 5
The Impact of Pre-Procedure Phone Calls in an Endoscopy Suite
Marianne D. Saunders, MSN(c), BSN, RN
Immaculata University
Significance
Outpatient Endoscopy Suites experience high numbers of patient no-shows and
cancellations. Depending on the procedure, preparation can be complicated, unpleasant,
distasteful, embarrassing, and disruptive of one’s daily routine. Colonoscopy is one
endoscopic procedure that involves the ingestion of a purging agent and evacuation of the
bowels. The prepping process can be daunting for some individuals, influencing their
decision to make or break their appointment. Gastroenterology nurses can take an active
role in educating patients on adherence to procedural instructions. Through use of preprocedure phone calls, nurses can positively influence patient outcomes and decrease the
no-show rate in the Endoscopy Suite.
Purpose/Aim
The purpose of this action research is to develop a process to communicate with patients
prior to their procedure and address the barriers to arriving to their scheduled
appointment. This requires an appreciation of their knowledge base of the procedure as
well as the preparatory instructions. Patients’ comprehension plays a vital role in the
success of their endoscopic procedure.
Method
Phone calls will be made to patients one week prior to their procedure. Review of the
electronic medical record will provide a guide for the nurse caller to assess the patients’
medical history, discuss and document concerns, and communicate to key medical team
members in preparation for the endoscopic procedure.
Results/Interpretations
A weekly electronic report of patient no-shows and cancellations was compared to
identical data prior to intervention of phone calls. The report demonstrated a decrease in
no-show and cancellation rate of patients arriving for their endoscopic procedures.
Conclusions/Implications
Pre-procedural calls can identify knowledge deficits and enhance preparatory behaviors.
Improved knowledge is likely to bring about a commitment to compliance and a decrease
in the no-show and cancellation rates.
August 2014 MSN Capstone Project
Page 6
Exploring the Role of the Nurse in the Care and Support of Autistic Children and
Their Family: A Family Resilience Approach
Celina M. Siwula, MSN(c), MEd, BSN, RN, CSN, CLNC
Immaculata University
Significance
Nurses are caring for an increasing number of children with autism spectrum disorders
(ASD). The nurse must foster family resilience and have an understanding of the child’s
perceptions and special needs in order to achieve positive outcomes for the child.
Families of children with a diagnosis of ASD lead lives that are full of challenges and
adversity. Family resilience theory must be fostered by cultivating family strengths and
providing supports.
Purpose/Aim
The purpose of this action research is to explore the application of family resilience
theory in the care and support of children with ASD in the school setting. The aim of this
study is to improve care and achieve positive outcomes for the children and their
families.
Methods
Following a pre-intervention survey, a family resilience pamphlet was given to each
participant to reinforce knowledge about the use of family resilience theory. This was
followed by an informal discussion and a simulation activity that provided each
participant with a series of stimulatory interruptions that are common to children with an
ASD. A debriefing session was held after the simulation. A post-intervention survey
was done to determine if the interventions improved care and outcomes.
Results/Interpretation
The results of this study suggest that patients with an ASD benefit when nurses who care
for them understand and foster family resilience. After participating in the simulation,
participants had a clearer understanding of the struggles of the ASD patient and positive
patient and family outcomes were demonstrated.
Conclusion/Implications
The fostering of the theory of family resilience should be further investigated with a
broader sample which includes other members of the multidisciplinary team of which the
nurse is a part.
August 2014 MSN Capstone Project
Page 7
Cardiac Rehabilitation Enrollment:
A Study of the Effects of Patient Education
Lisa Springer, MSN(c), BSN, RN, PCCN
Immaculata University
Significance
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the U.S.
Despite the American Heart Association (AHA) support of cardiac rehabilitation (CR) in
the secondary prevention of CVD, less than one-third of patients enroll after an acute
coronary syndrome (ACS). CR develops health habits that lower coronary risk profile
and improve quality of life after a cardiac event. The AHA calls for the study of
interventions to understand how nurses can promote CR enrollment and build a transition
from hospital to home.
Purpose
The action research project will study the effects of a nurse intervention focused on
patient education to improve CR enrollment among individuals hospitalized for ACS.
The study uses Leventhal’s Self-regulatory Model (SRM) as a framework to influence
health beliefs and health behaviors in relation to five attributes of ACS and rates of CR
enrollment.
Method
A Clinical Nurse Leader (CNL) applies the five attributes of ACS using an individualized
teaching plan during one-to-one sessions. The CNL education session focuses on
perception of ACS as controllable, serious, and caused by internal factors related to CVD
that are amenable to change through CR enrollment. Trends in relation to the efficacy of
patient education and CR enrollment are under examination for 12 weeks.
Results/Interpretation
Baseline data for the past 6 months indicates that 18% of patients treated for an ACS
have enrolled in CR at the study site. An improvement in CR enrollment rates will
support the use of patient education as a therapeutic nursing intervention.
Future Implications
Further research on using the model as a nurse intervention in other cardiac illnesses may
prove useful to promote CR as a transitional program from hospital to home. Nursing
plays a key role in the study of interventions to advance cardiac outcomes and promote
quality of life.
August 2014 MSN Capstone Project
Page 8
Assessment of Education Regarding Heart Attack Symptoms and the
Proper Response
Duane Stanton, MSN(c), BSN, RN
Immaculata University
Significance
Cardiovascular disease is the number one cause of death in the United States. One form
of heart disease, myocardial infarction (MI) is responsible for the majority of these
deaths. Studies show that more than half of cardiovascular deaths are due to acute
myocardial infarction (AMI), causing a quarter of a million people to die within one hour
of symptom onset and before reaching a hospital. The majority of patients do not seek
care within two hours of symptom onset. Two factors that cause delay are seeking the
opinion of others and not calling EMS.
Purpose
Knowledge and recognition of heart attack symptoms is important in order to respond
appropriately. The aim of this study was to explore if heart attack education at one
hospital effectively addresses heart attack symptoms and the appropriate response. Items
of interest were whether education was consistent across all units, and whether spouses
and significant others were targeted to receive the same education- as consultation with
others has been shown to affect delay in seeking care.
Methods
Interviews were conducted with staff whose responsibilities include education of patients
admitted with AMI. Information collected included material used for education, when
education was delivered and by whom, and whether education was identical for all heart
attack patients.
Results/Interpretation
The process of education of AMI patients was uneven across all units, the word
“inconsistent” was used by staff to describe the education process. An inconsistent
approach to the education of these patients, who are at risk for a subsequent MI, for how
to respond in the event of an MI is concerning.
Conclusion/Implications
The educational process should be delivered more uniformly. Patient’s significant others
should be specifically targeted to receive the same information as the patient, to act as a
support in case of recurrent MI.
August 2014 MSN Capstone Project
Page 9
The Integration of Spirituality in Nursing Curriculum:
Improving Spiritual Care of Patients
Lauren E. Stoltzfus, MSN(c), BSN, RN
Immaculata University
Significance
Caring for a patient as a whole, including their mind, body, and spirit, is essential in
overall patient care and patient satisfaction. Spirituality, specifically, can play a
significant role in a patient’s life as he/she experiences illness, challenges, and even
death. Often nurses have difficulty in providing spiritual care because of the lack of
preparedness provided in their basic nursing education. By incorporating spirituality into
nursing curriculum, nurses will promote their own spiritual growth, thus laying an
essential foundation for providing spiritual care to others.
Purpose
The purpose of this action research study is to examine if the integration of spirituality
into nursing curriculum improves students’ ability to recognize and care for patients’
spiritual needs.
Methods
An action research method was used to assess the incorporation of the concept of
spirituality into the Medical Surgical I course of a practical nursing program. The
utilization of case studies, role play, and lecture educated the nursing students on how to
assess a patient’s spirituality as well as meet his/her spiritual needs. After implementing
lessons on spirituality, the effectiveness of the teaching was evaluated by NCLEX style
pilot questions and nursing care plans of the researcher’s clinical group of students.
Results/Interpretation
The findings in this study revealed that integrating spirituality into the Medical Surgical I
nursing course allowed spiritual growth among practical nursing students. Furthermore,
addressing the spiritual needs of patients occurred more frequently.
Conclusion/Implications
Having an understanding of one’s own spirituality allows nursing students to better care
for their patients and their spiritual needs. Threading spiritualty throughout the nursing
program rather than one course will allow for further spiritual growth and essentially
allow for patient’s spiritual needs to be met. In conclusion, providing spiritual care will
improve overall patient satisfaction.
August 2014 MSN Capstone Project
Page 10