<p> The national nursing shortage and high nurse turnover rates in the United States have been negatively affecting the quality of health care services since providing optimal patient care requires fulfilling necessary standards including nurse-to-patient ratios. The failure to maintain the mandated nurse-to-patient ratio not only will cause a penalty for a health care facility, but also will compromise the quality of health care service to the patients. Amerindo, an international nurse recruitment agency, intends to address these challenges by supplying qualified internationally educated nurses to the U.S. Amerindo will provide three levels of nursing vocations from Certified Nurse Assistants, Licensed Practical Nurses, and Registered Nurses, for all nursing domains including pediatric nursing, geriatric nursing, medical surgical nursing, maternity nursing, and psychiatric nursing. </p><p> Amerindo&rsquo;s mission is to be a trusted connector between internationally educated nurses and health care facilities in Southern California, by supplying qualified nurses with two years of initial employment contract. With the unique initial employment contract and several additional qualities, Amerindo distinguishes itself from other health care recruitment agencies. Moreover, Amerindo helps the health care facilities maintaining their nurse-to-patient ratio, and reducing the nurse turnover rate. Thus, in general, Amerindo helps improving health care access and quality.</p>

<p> Medical error, patient safety and nurses&rsquo; performance are some of the critical concerns within healthcare systems. Several factors contribute to nurses&rsquo; performance and patient safety including fatigue, sleepiness and work system parameters.</p><p> Furthermore, because of a shortage of nurses, working nurses are often experiencing high workloads. They often work in 12- hour shifts and/or consecutive night shifts without receiving enough sleep or recovery. Thus, they frequently are fatigued and suffer from sleep deprivation, which again is negatively associated with patient safety. Therefore, health care researchers and decision makers are interested in developing policies and tools that help decrease nurses&rsquo; errors and increase their performance.</p><p> Thus, there is a need for a promising approach to understanding nurse fatigue and its causes and consequences that is able to capture dynamic nature of the problem. This study aimed to address this need. In the first step, data were collected from a private hospital. Next, a data mining technique was applied to uncover the patterns and associations among contributing factors that affect performance and patient safety. Finally, a model was developed to measure nurses&rsquo; responses to different work system parameters and stressors.</p>

<p> Heart failure readmissions place a significant financial burden on the healthcare system. Stakeholders of this system have utilized many approaches to reduce the number and costs of heart failure readmissions, without significant improvement. The purpose of this practice improvement project was to determine whether education on the financial impact associated with readmissions improved a patient&rsquo;s measured quality of life, encouraged adherence to a therapeutic regimen, and thereby reduced readmission rates in Medicare and Medicaid patients diagnosed with heart failure. Theoretical support is derived from the theory of self-care of chronic illness, which recognizes the complex self-care processes a patient with chronic illness negotiates. The project used a quantitative methodology with a pre-test/post-test design. A convenience sample was enrolled of 10 Medicare and Medicaid patients who had recurrent heart failure readmissions. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) was used to collect pre/ post-intervention data which was then analyzed by two-tailed paired t-test. There was no statistically significant difference from the intervention to determine any impact on the participant&rsquo;s measured quality of life (<i>p</i> = .953; &alpha; = .05). However, none of the participants were readmitted during the 30 day period of this project. The findings indicate heart failure patients acknowledge their financial constraints but quality of life is not as impacted by finances as anticipated. Polypharmacy and uncertainty with managing daily regimens during symptom exacerbation were the greatest concerns. It is recommended that heart failure patient education should be persistent and individualized to address the patient&rsquo;s unique needs. </p><p>

<p> <b>Purpose:</b> The purpose of this DNP quality improvement project was to increase primary care provider knowledge about indications for adolescent depression screening. </p><p> <b>Background:</b> Approximately 13.3% of adolescents experienced depression in the past year. In Oklahoma alone, rates are increasing, with depression totaling 60% of all mental health illness among adolescents. Primary care providers see approximately 75% of adolescents; however, mental health conditions are missed 84% of the time. Current clinical guidelines recommend screening for adolescent depression during wellness visits or when risk factors are present. </p><p> <b>Methods:</b> The providers of interest were nurse practitioners, physicians, and physician assistants providing primary care to children between the ages of 12 and 17 in a private pediatric practice group consisting of three clinics. The Model for Improvement guided the process of developing, implementing, and evaluating an educational intervention through use of a pre-test/post-test quantitative design. An email invited participants to complete an anonymous pre-test survey to evaluate knowledge and beliefs surrounding adolescent depression, then view an educational presentation on adolescent depression and screening guidelines, then complete a post-survey to evaluate any changes in knowledge and intention to screen. Results were shared with clinic representatives to help refine the education for future testing cycles and other clinic sites. </p><p> <b>Results:</b> Data collection took place over one week. Five providers completed both the pre-test and post-test surveys. Provider knowledge scores significantly increased 29% after participating in the education and self-reported knowledge on screening increased. </p><p> <b>Conclusions:</b> DNP quality improvement projects like this help develop strategies to increase best practices, leading to improved patient outcomes. Nurse-led improvement programs like this contribute to healthcare literature and the advancement of the nursing profession by developing patient-centered interventions applicable to a wide variety of providers. Results may be used to develop strategies to increase and align provider practices with best standards to help promote early identification and treatment of adolescents with depression. </p><p>

<p> Stress in the Intensive Care Unit (ICU) and the leadership style of the nurse manager are predictors of job satisfaction, which is linked to intent-to-leave and increased turnover rates among ICU registered nurses. This quantitative correlational study determined that authentic leadership behaviors of transparency, self-awareness, balanced processing, and internalized moral perspective of the nurse manager significantly correlated with job satisfaction and predictor of stress among ICU RNs. A Pearson correlation was used to analyze the data from a stratified random sampling of ICU RNs from the four different not-for-profit hospitals in the northwestern United States. The positive relationship between the nurse authentic leadership behaviors of transparency, self-awareness, balanced-processing, and ethical/moral behaviors and job satisfaction and stress among ICU registered nurses recommends for the nursing leaders to have an authentic leadership training. The information gathered through this study provided the nursing leaders a better understanding of authentic leadership theory to promote a healthy work environment. Thus, a satisfying leadership behavior fosters trust, enhance job satisfaction, and supports a less stressful working situation for the ICU staff nurses.</p><p>

<p> Within the health care system, patient safety outcomes have been criticized for many years. Medical malpractice, common errors, and nosocomial infections (i.e., hospital-acquired infections) are safety concerns, and represent a public health problem. Since the Institute of Medicine (1999) published To Err is Human: Building a Safer Health System in 1999, changes have been made to improve the use of technology and leverage advancements in research that improve patient safety. Nurse leaders can also help to facilitate process improvements in the patient safety culture. The purpose of this capstone project was to explore the nursing leader role in improving patient safety in a hospital setting. The method utilized for this study was a literature review. Prominent articles identifying the role of nursing leadership were included. Seven drivers of patient safety were identified (Sammer, Lyken, Singh, Mains, &amp; Lackan (2011), and subsequently informed this project. The targeted populations were patients, families, nurses, nurse administrators, and medical personnel. Findings regarding the nurse leader role, patient improvements, and barriers to improvements were reviewed. Nurse leaders were found to be of critical importance to patients, medical personnel, and the health care system. The limitations of this review and implications for policy and practice are discussed. </p>

<p> Home care nurses (HCNs) have reported a high rate of exposure to work-related injuries (WRIs). Nurses are challenged by the multidimensional problems associated with home care safety. These contextual risk factors increase the physical and social health problems of health care workers and of community suffering as a whole. This quantitative, cross-sectional study was designed to examine the relationship between the organization-related factors (ORFs) and the environment-related factors (ERFs) and their influences on safety behaviors (SBs) and the WRIs of HCNs. The PRECEDE framework was used to guide the study. Self-reported data were obtained from 74 home health care (HHC) nurses using the Safety Home Care Nursing questionnaire. A linear regression model was applied to determine the nature of the association between the independent variables and dependents variables. Findings showed the ORFs demonstrate a stronger effect on the SBs than the impact of the ERFs. The management commitment and the home-based care significantly affected the SBs. The supervisory support and safety access to a client's home were decreasing the WRIs. Therefore, the integration of efforts: The management and leadership of the health organization, the health care providers, and the clients&rsquo; family would improve safety of HHC. This study is expected to help develop safety strategies for home care and thus attempt to minimize WRIs among HCNs. Nurses free of injuries are able to provide a quality of care and improve patients&rsquo; health outcomes that in turn have an effect on reducing community suffering and financial costs.</p><p>

<p> Patients and families play an important role at the bedside, and that is making sure the transition of care among providers is safe and effective. Bedside shift report (BSR), a type of patient and family engagement, is a process where patients, families, and health care providers work together as partners to improve the quality and safety of hospital care. In 2010, TJC developed and revised the standards for patient-centered care, which were designed to improve the safety and quality of care for patient and family involvement. The purpose of this quantitative descriptive study with a causal-comparative design was to compare two dependent variables of patient and nurse satisfaction from the pre-and post-implementation of BSR as a patient and family engagement strategy and determine if BSR resulted in a positive return on investment for a health care organization. This quantitative descriptive study employed Donabedian&rsquo;s structure-process-outcome (SPO) approach model. This model is a foundation for modern health care quality measurement, studying the structures of process and outcome, and the means to an end of a relationship. The data analysis utilized both descriptive and inferential statistics. The mean and standard deviation were calculated on two dependent variables, nurse satisfaction and patient satisfaction. Both research questions were measured using Chi-square to compare the difference in the yearly data for patient satisfaction and nurse satisfaction pre-and post-implementation of BSR as a patient and family engagement strategy on a surgical unit. The dependent variable patient satisfaction is statistically significant and the dependent variable nurse satisfaction is not statistically significant. Each year, post-implementation BSR for both dependent variables had a positive trend.</p><p>

<p> Inefficiencies in leadership and limited leadership strategies in hospitals contribute to delayed hospital discharges and an increased financial burden on a hospital. Three administrators from 2 hospitals who are part of a hospital conglomerate in Chicago, Illinois were selected for interview in this qualitative multiple case study to explore how hospital discharge strategies reduce delayed hospital discharges and improve profitability. Contingency was the primary theoretical theory for this study. The purposive sampling consisted of the selections of individual who were knowledgeable and had experience to organize, manage, and implement processes in an organization. Data collection occurred using face-to-face semistructured interviews, direct observation, and a review of discharge documents. Data analysis took place using the modified van Kaam method. Two emergent themes were identified relating to strategies for efficient communications and facilitating effective leadership. Implications for positive social change include the potential to improve health services within the community where access to health care is limited or the need exists for additional hospital beds. Positive leadership strategies in hospitals tend to contribute to the success and wellbeing of employees, patients, communities, and the economy.</p><p>