1697 research outputs found
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Evidence-Based Pain Management Bundle for Pediatric Postoperative Orthopedic Patients
Full text linkProblem: Postoperative pain management in pediatric orthopedic patients is often inconsistent due to variability in provider practices and a lack of standardized protocols. At a Central Texas pediatric orthopedic clinic, all patients received opioid prescriptions post-knee surgery regardless of procedure severity, leading to frequent caregiver calls for clarification. This practice revealed a critical gap in preoperative education and multimodal pain management strategies, contributing to patient safety concerns and increased clinic workload.
Aim of the Project: The primary aim of the project was to improve pain control, reduce opioid reliance, and decrease postoperative pain-related follow-up calls by implementing a standardized, evidence-based multimodal pain management bundle.
Review of the Evidence: A comprehensive literature review showed that multimodal strategies, combining non-opioid medications and non-pharmacologic methods, significantly improve pain outcomes and reduce opioid use. Preoperative education was identified as essential for enhancing caregiver understanding and reducing postoperative confusion.
Project Design: The quality improvement project utilized the Institute for Healthcare Improvement’s Plan-Do-Study-Act cycles and the OhioHealth Change Management Model to guide structured testing, stakeholder engagement, and change readiness throughout the 12-week implementation. The lead APRN provided standardized preoperative education using evidence-based materials. The orthopedic surgeon aligned prescribing practices with the project. Key stakeholders included the APRN, surgeon, nurses, and administrative staff.
Intervention: An evidence-based pain management bundle adapted from Michigan Medicine’s pediatric protocols was implemented. Staff education, bilingual materials, non-opioid strategies, and a standardized checklist were included. The bundle was applied to pediatric patients ages 5 to 18 undergoing knee surgery. Data were collected from the electronic health records, and a secure Excel tracking tool was utilized.
Significant Findings/Outcomes: Postoperative pain scores averaged 3.55 on a 10-point scale, with no opioid refill requests. The average duration of opioid use decreased from 7 days to 3.04 days. Preoperative education was completed for all patients, yielding 100% compliance. Although 38.5% of caregivers made follow-up calls, these were unrelated to pain management, suggesting the intervention effectively supported families. No adverse outcomes were reported.
Implications for Nursing: This project demonstrates the role of advanced practice nurses in leading evidence-based improvements that enhance patient safety, standardize care, and support opioid stewardship. Alignment with the Institute of Medicine’s domains of effective, patient-centered, and timely care supports the Institute for Healthcare Improvement\u27s Triple Aim by the bundle’s seamless integration into the clinic’s workflow and onboarding
AI and the Doctoral Schism: Institutional Resistance vs. Adoption in Doctoral Education
No full textThis paper examines the schism emerging in doctoral education regarding the integration of Generative AI (GenAI). Drawing on Rogers’ Diffusion of Innovations Theory (DIT), this analysis examines how higher education institutions are responding to the disruptive potential of AI in doctoral writing, research, and dissertation defense. A historical examination spanning from Socrates’ resistance to written texts (370 BCE) through contemporary AI debates reveals a recurring pattern: initial resistance to technological innovations, followed by gradual institutional adoption as new frameworks emerge that accommodate the technical tools while preserving the core values of graduate education. DIT-grounded analysis reveals three key factors driving the current schism: structural compatibility alignment differences between AI tools and doctoral program values, limited trialability due to restricted time for AI experimentation, and failure to reach the diffusion tipping point necessary for widespread adoption. Institutions currently employ a range of divergent strategies, from prohibition and AI detection tools to transparent integration policies and the development of AI literacy. A four-step framework addresses this schism. Suspending AI detection tools, developing discipline-specific policies, redesigning curricula to emphasize higher-order human competencies, and introducing a mandatory module into the doctoral program, which culminates in an AI Integration and Ethics Plan. The dissertation defense should evolve to assess intellectual judgment in AI augmented environments through transparent documentation protocols. Historical precedent suggests that the current doctoral schism is a temporary phase on a predictable diffusion cycle
Navigating the Maze of the Healthcare System in the United States: An Insight Into the Experiences of African Refugees
No full textAfrican refugees resettled in the United States (U.S.) face persistent challenges when accessing healthcare services. Although initial federal and state support exists, the broader US healthcare system is characterized by complexity, administrative demands, and an insurance-based structure, making it difficult for refugees arriving from different health systems. African refugees must quickly adjust to unfamiliar appointment procedures, insurance requirements, and communication norms while managing linguistic and cultural barriers. Existing research identifies language gaps, cultural misunderstandings, racialization, trauma histories, and limited provider cultural competence as major factors influencing refugees’ health experiences and outcomes.\u3c .p\u3e
This qualitative study using an interpretive framework examines how African refugees navigate the U.S. healthcare system and its associated barriers. The study explores refugees’ perceptions of provider interactions, medical decision-making, insurance processes, and overall system navigation. The research also highlights refugee reliance on community networks, informal advice, and adaptive strategies to overcome barriers. Centering on participants’ experiences, the study contributes to broader discussions on health equity, cultural responsiveness, and refugee-centered models of care.
Qualitative design was used to gather descriptive accounts from 18 African refugees originating from various regions who resettled across the U.S. Semi-structured interviews focused on experiences with healthcare institutions, providers, insurance agencies, interpreters, and community support systems. Thematic analysis allowed patterns related to communication difficulties, cultural expectations, and structural inequities to emerge and provided insight into how participants interpret and navigate the healthcare environment.
Challenges included linguistic, cultural, and systemic domains. Participants frequently iv described difficulty understanding medical terminology, treatment plans, and insurance processes, often related to limited interpretation services. Reliance on family members, including children to translate, raised concerns about accuracy and confidentiality. Cultural gaps contributed to feelings of dismissal, misunderstanding, and reduced trust. Structural barriers, including fragmented services, complex paperwork, and financial constraints, further hindered access and continuity of care.
Despite obstacles, refugees demonstrated resilience, adaptability, and strong reliance on community networks. Ethnic organizations, religious groups, and peer mentors played critical roles in helping individuals navigate healthcare systems and advocate for appropriate services. The findings underscore the need for improved interpretation services, culturally responsive care practices, health literacy initiatives, and trauma-informed provider training to support equitable healthcare access for African refugees in the U.S
Optimizing Pressure Injury Prevention: Implementation of the SSKIN Bundle in Acute Care
Full text linkProblem: Hospital-acquired pressure injuries (HAPIs) contribute to increased morbidity, extended hospitals stay, and significant healthcare costs. At the project site in northwest, Indiana, HAPI rates averaged 6.29%, which significantly higher than the national benchmark of 2.24%. Inconsistencies in documentation, a lack of standardized preventive practices, and variable staff engagement contributed to these increased rates. Despite the use of the Braden Scale, staff inconsistently implemented preventive interventions.
Aim of the Project: The aim of the project is to reduce HAPI incidence by 30% over 10 weeks by implementing the surface, skin inspection, keep moving, incontinence/moisture management, and nutrition (SSKIN) bundle and improve staff compliance and documentation.
Review of the Evidence: Multiple studies have shown the SSKIN bundle reduces HAPI prevalence and improve consistency in care. Research by Gupta et al. (2020), Kennedy (2023), and Singh et al. (2023) demonstrated statistically significant reductions in HAPIs and highlighted the need for ongoing staff education and leadership engagement.
Project Design: This quality improvement initiative used the plan-do-study-act (PDSA) model and the OhioHealth Change Management Model (OHCM) to guide implementation. These frameworks supported testing, continuous adaptation, and staff engagement.
Intervention: The intervention involved education, weekly chart audits, staff rounding, and three PDSA cycles focused on engagement of float and night shift nurses, improved nutrition workflows, and early detection of skin damage. The project targeted adult medical-surgical patients over a 10-week implementation period.
Significant Findings/Outcomes: HAPI rates declines to 0.00% by the final month of implementation, achieving the 30% reduction goal. Compliance with the SSKIN bundle reached 60%, with progress in appropriate surface usage and timely consults. No new stage III or IV HAPIs occurred and deep tissue injuries (DTIs) were proactively addressed in PDSA cycle 3.
Implications for Nursing: Standardizing preventive practices improves patient safety and reduces financial burden. Engagement across all staff levels and real-time reinforcement is vital for sustainability
Time for Some Progress: An Analysis of Policy Efforts in Urban School Districts
No full textThe United States has experienced ongoing difficulties in urban education reform to reduce achievement and opportunity gaps affecting minority students. This qualitative research through thematic analysis methods studied school reform programs which targeted the reduction of achievement and opportunity gaps in an urban Connecticut school district. The research used semi-structured interviews with 15 participants who included administrators and teachers and community partners to study their views about reform success and implementation obstacles and effective practices. The study revealed seven major themes: (1) Resource Challenges and Structural Constraints, (2) Reform Implementation Patterns and Sustainability, (3) Stakeholder Voice and Decision-Making, (4) School Choice and Community Fragmentation, (5) Career Education and Pathways to Success, (6) Academic Standards and College and Career Readiness, and (7) Early Education Investment and Experiential Learning. The research established that successful urban education reform needs revolutionary leadership systems which unite all participants while tackling classroom issues and community problems and establishing various achievement routes and substantial early childhood funding and equal educational standards. The research provides strategic recommendations to educational leaders and policymakers and community stakeholders who want to build more equitable and effective urban education systems that deliver meaningful education to students
Integrating Kangaroo Care into Cesarean Delivery Practices: A Pathway to Enhanced Health Outcomes
Full text linkProblem: Cesarean deliveries often interrupt early mother-infant bonding, delaying the initiation of breastfeeding and limiting opportunities for skin-to-skin contact. Despite national guidelines promoting immediate postpartum contact, cesarean-born infants receive kangaroo care (KC) at significantly lower rates than those born vaginally. Prior to this project, only 2% of cesarean births at the project site received KC, highlighting a significant gap in care delivery.
Aim of the Project: The aim was to evaluate the feasibility and impact of implementing kangaroo care during cesarean deliveries in a community hospital to improve neonatal outcomes and adherence to evidence-based postpartum practices.
Review of the Evidence: Research shows KC improves thermoregulation, breastfeeding success, and bonding while reducing neonatal morbidity. Meta-analyses and systematic reviews support KC as a standard intervention for all delivery types, yet barriers in surgical settings hinder implementation.
Project Design: This quality improvement initiative followed the Plan-Do-Study-Act (PDSA) cycle within the Organizational Health Change Model (OHCM) framework. A pre-post implementation design assessed outcomes over eight weeks, comparing vaginal and cesarean deliveries. Measures included KC initiation within 10 minutes, breastfeeding within 60 minutes, and neonatal temperature regulation within 30 minutes.
Intervention: The intervention involved staff education, workflow modifications, and EHR documentation enhancements to support immediate KC in the operating room. Interprofessional collaboration ensured safe integration without disrupting surgical protocols.
Significant Findings/Outcomes: Post-implementation, cesarean KC rates increased from 2% to 71.8%. The majority of infants achieved timely breastfeeding and stable temperatures. These findings demonstrate the feasibility of KC in surgical settings and reflect alignment with national standards promoting equitable neonatal care.
Implications for Nursing: Nurses play a pivotal role in implementing and sustaining KC practices. This project highlights how nursing-led initiatives, supported by institutional policies and continuous education, can overcome systemic barriers and advance equitable, evidence-based maternal-infant care across all delivery settings
Improving Hospital Throughput Through Flash Rounds and Standardized Discharge Readiness Assessments
Full text linkProblem: The target hospital faced serious throughput challenges, with emergency department overcrowding and discharge inefficiencies impacting patient outcomes and organizational performance. Discharge order to depart times exceeded the 90-minute benchmark, averaging 154 minutes, while 41.2% of patients exceeded the geometric mean length of stay (GMLOS) target of 40.17%. Gaps included inconsistent discharge planning, poor communication, and limited follow-through on barriers. Aim of the Project: The project aimed to improve hospital throughput by reducing GMLOS and discharge order to depart times on Unit A. This was achieved through implementation of proactive, evidence-based interventions to streamline discharges, reduce delays, and support safe patient transitions. Review of Evidence: A literature review supported interventions like focused flash rounds and the Readiness for Hospital Discharge Scale (RHDS) assessment to enhance discharge planning, reduce GMLOS, and improve team communication. Evidence highlighted proactive, patient-centered approaches as essential for improving care coordination and system efficiency. Project Design: Guided by the Plan-Do-Study-Act (PDSA) cycle and OhioHealth Change Management model, the project employed continuous feedback, stakeholder engagement, and iterative adjustments. Weekly check-ins, change readiness assessments, and electronic medical record (EMR) based communication ensured real-time problem-solving and alignment. Intervention: The intervention included daily EMR secure-chat flash rounds and RHDS assessments for patients with a disposition to home. These tools identified readiness gaps early and triggered targeted actions including PT/OT or care management consults, improving discharge preparedness. Significant Findings/Outcomes: Discharge order to depart time improved by 32 minutes, from 175 to 143. RHDS assessment completion reached 96%, with 84% compliance for flash rounds. Although GMLOS improvement was minimal, 0.03%, results indicated process adoption and stakeholder support for sustainability. Implications for Nursing: This initiative emphasized nursing’s role in proactive discharge planning and interdisciplinary communication. It enhanced patient-centered care, reduced risks from prolonged hospitalization, and demonstrated potential for system-wide adoption. Ongoing nursing leadership and integration into EMR workflows are key to long-term impact and cost savings
What Do Employees Actually Want? Leveraging Employee Value Proposition (EVP) Preferences to Improve Employee Retention
No full textThis quantitative research study sought to determine the predictive influence of one’s unique individual attributes on employee value proposition (EVP) preferences so that organizations might use those findings to devise more effective talent retention strategies. Researchers have published abundant scholarly literature shaping a broad perspective of what drives an employee to leave their organization (Bolt et al., 2022; Hur, 2022). However, the disjointedness of study foci and conclusions drawn from the collective research has not yet definitively improved human resource strategists’ ability to generate actionable insights that methodically enhance employee retention outcomes (Rubenstein et al., 2018; Tenakwah, 2021). Remediating this issue by introducing a systemic employee retention and turnover model thus seemed a natural next step. The subject research achieved this by designing a quantitative, cross-sectional, correlational study to investigate the predictive relationship that unique employee attributes have on employee experience and voluntary turnover decisions. The researcher leveraged a compound survey instrument to capture demographic, socioeconomic, psychological, EVP preference, EVP satisfaction, and turnover intention self-assessment data on a sample of 216 full-time professional employees between the ages of 20 and 59 who live and work in the United States. Five stepwise multiple regression analyses determined that individual attributes can predict EVP domain preferences; one standard multiple regression analysis determined that EVP domain preferences and satisfaction interactions can predict turnover intention. The subsequent findings and insights could help organizations optimize their employee value proposition framing and delivery in a manner implicitly congruent with each employee’s needs and wants, thus improving employee retention outcomes via systemic minimization of voluntary turnover rates
Golf Outing, Undated
No full textThis photograph features four alumni setting at a table in a bar after an Alumni Golf Outing.https://fuse.franklin.edu/golfoutings/1006/thumbnail.jp
Fall Reduction Utilizing Fall Tailored Intervention for Patient Safety in Acute Care
No full textProblem: Hospitalized patient falls cause physical, psychological, and financial harm and persist despite prevention bundles. A Midwest Ohio acute medical unit experienced higher-than-benchmark fall rates (1.53–7.58 falls/1,000 patient days; unit rate 113% of the national median), with a rising trend in FY25. Reliance on the Schmid tool and existing interventions lacked structured patient/family engagement, as well as comprehensive medication assessment, leading to under-recognition of risk and limited nurse-driven prevention.
Aim of the Project: The aim of the project was to reduce inpatient fall rates and fall-related injuries on a medical unit by implementing the Agency for Healthcare Research and Quality Fall-Tailored Interventions for Patient Safety (TIPS) toolkit over 12 weeks, increasing patient/family engagement and integrating the toolkit into bedside workflows.
Review of the Evidence: The evidence supports multifactorial, patient-centered interventions and stakeholder engagement in reducing hospital falls. Significant reductions in total and severe falls have been documented with the use of Fall TIPS. Other studies show variable outcomes when nurse-driven measures exclude patient collaboration. Many studies are limited by small samples and limited diversity, indicating the need for pragmatic quality improvement (QI) evaluations.
Project Design: A multidisciplinary QI initiative used the Plan-Do-Study-Act (PDSA) cycles and the OhioHealth Change Management model. Staff education included licensed and unlicensed personnel. Fall TIPS infographics were integrated into admissions and bedside shift reports, with weekly audits, daily shift huddles, and secure de-identified data collection. Process, outcome, and balancing measures were monitored.
Intervention: Laminated Fall TIPS infographics were completed with patients at admission and updated during bedside shift reports twice daily. PDSA-driven small tests of change addressed placement and completion barriers. Leadership audits and weekly KPI reporting reinforced compliance.
Significant Findings/Outcomes: The total fall rate decreased from 5.05 to 4.45 per 1,000 patient days (12% reduction); the injury fall rate decreased from 2.88 to 1.47 per 1,000 patient days (49% reduction). Falls decreased from nine to four during the implementation period. Bedside shift report compliance increased by 40%. Project supply costs were 187,581.
Implications for Nursing: Embedding Fall TIPS into bedside workflows enhances patient engagement, communication, and safety culture, resulting in measurable reductions in falls and injuries. Nurse-led, leadership-supported implementation using PDSA cycles is a low-cost, scalable strategy to improve patient-centered fall prevention and advance DNP and Triple Aim goals