Minimizing Home Health Care-Acquired Pressure Injuries through Effective Nursing Teamwork PDF
Preview Minimizing Home Health Care-Acquired Pressure Injuries through Effective Nursing Teamwork
Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2018 Minimizing Home Health Care-Acquired Pressure Injuries through Effective Nursing Teamwork Juliana Baah Walden University Follow this and additional works at:https://scholarworks.waldenu.edu/dissertations Part of theNursing Commons, and thePublic Health Education and Promotion Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please [email protected]. Walden University College of Health Sciences This is to certify that the doctoral study by Juliana Baah has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Mary Verklan, Committee Chairperson, Nursing Faculty Dr. Anna Valdez, Committee Member, Nursing Faculty Dr. David Sharp, University Reviewer, Nursing Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2017 Abstract Minimizing Home Health Care-Acquired Pressure Injuries through Effective Nursing Teamwork by Juliana Baah, MSN, BSN, RN MSN, Walden University, 2012 BSN, Anna Maria, 2009 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University November 2017 Abstract Pressure injuries (PIs) affect an estimated 2.5 million people in America and cost the nation approximately $11.6 billion each year. The goal of this DNP project was to minimize the rate of PIs at a home health care agency through effective teamwork. Prevention of PIs is very important because PIs damage patients’ skin integrity, cause significant amount of pain, are costly to treat, and cause life-threatening infections. The purpose of this DNP project was to evaluate nursing compliance with PI prevention measures and the level of nursing teamwork at the project agency. The Braden-Bergstrom conceptual framework was used to explain the etiology and progression of PI while Lewin’s Change Theory was used to promote behavioral change in the nursing team. The practice-focused questions for closing the gap between nursing knowledge and practice were what percentage of nurses complied with standard PI prevention guidelines and what was the level of nursing staff teamwork in the agency per the Nursing Teamwork Survey [NTS]. This PI prevention initiative used a cross-sectional design. Data collection involved review of nursing documentation and electronic surveying of all nursing staff using the MISSCARE survey, the NTS, and the AHRQ assessment checklists, which were completed via SurveyMonkey, an online survey software. The impact of the PI prevention initiative was assessed by comparing the results of the documentation review and surveys pretest to the posttest results. There was significant improvement in nursing compliance with PI prevention and treatment. Pressure injury incidence rate fell from 13.6% to 5.1%. The positive social impact includes improving patient care and safety, minimizing PI incidence and producing an efficient team. Minimizing Home Health Care-Acquired Pressure Injuries Through Effective Nursing Teamwork by Juliana Baah, MSN, BSN, RN MSN, Walden University, 2012 BSN, Anna Maria, 2009 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University November 2017 Dedication I would like to dedicate my Doctor of Nursing Practice (DNP) final project to Almighty God for allowing me to achieve my dreams and placing amazing people in my life. To my husband, Emmanuel, children Faithful and Eliaza; brother, Emmanuel, and mother, Margaret, I say a very big “Thank you” for your unflinching support and love. Words cannot express my gratitude to you for your love, support, and understanding during the course of my studies. Thank you all for always believing in me and praying for me from the beginning of my DNP program till now. To all my friends, family members, and co-workers, who have supported and helped me along this journey, this is for you. Acknowledgments I would like to thank Dr. Mary Verklan, the Committee Chair of my DNP project, for her expert mentorship and many hours spent editing and shaping my project paper. I would also like to thank Dr. Anna Valdez, the DNP Project Committee member and Dr. David Sharp, the Walden University Research Reviewer for their invaluable and expert comments and guidance. Dr. Moreen Areh, my preceptor, guide, and support deserves much thanks for being there for me from the project planning stage to its implementation. Finally, I would like to thank Elite Home Health Services for providing me the field site I needed for my project. Table of Contents List of Tables ..................................................................................................................... iv List of Figures ......................................................................................................................v Section 1: Overview of the Project ......................................................................................1 Introduction ....................................................................................................................1 Background and Context ................................................................................................2 Problem Statement .........................................................................................................4 Purpose Statement ..........................................................................................................6 Project Objectives ..........................................................................................................6 Project Questions ...........................................................................................................8 Significance of the Project .............................................................................................8 Reduction of Gaps ................................................................................................... 9 Implications for Social Change ............................................................................. 11 Definition of Terms ......................................................................................................12 Assumptions, Limitations, and Delimitations ..............................................................14 Limitations ............................................................................................................ 15 Delimitations ......................................................................................................... 15 Summary ......................................................................................................................16 Section 2: Review of Literature and Theoretical and Conceptual Framework .........17 Introduction ..................................................................................................................17 Search Strategy ............................................................................................................17 Specific Literature ........................................................................................................19 i General Literature ........................................................................................................28 Theoretical and Conceptual Framework ......................................................................36 Summary ......................................................................................................................40 Section 3: Methodology ..................................................................................................41 Introduction .................................................................................................................41 Project Design/Method ................................................................................................41 Population and Sampling .............................................................................................42 Setting ...................................................................................................................42 Target ...................................................................................................................43 Data Collection ...........................................................................................................43 Instruments ...........................................................................................................46 Protection of Human Subjects .............................................................................51 Anticipated Benefits ..............................................................................................51 Potential Risks .....................................................................................................52 Data Analysis ..............................................................................................................52 Analysis of MISSCARE NursingSurvey ............................................................54 Analysis of Nursing Teamwork Survey (NTS) ..................................................54 Analysis of AHRQ Facility Checklists ................................................................54 Analytical Techniques to Answer Guiding Questions ..........................................55 Project Evaluation .......................................................................................................56 Summary .....................................................................................................................57 Section 4: Findings, Discussions & Implications ..........................................................59 ii Introduction .................................................................................................................59 Summary of Results .....................................................................................................59 Discussion of Results ...................................................................................................68 Implications ................................................................................................................70 Project Strengths & Limitations...................................................................................72 Analysis of Self ............................................................................................................74 Summary & Conclusions .............................................................................................77 Section 5: Scholarly Product ..........................................................................................80 Introduction .................................................................................................................80 Project Design/Method ................................................................................................80 References ..........................................................................................................................81 Appendix A: Approval to Conduct Study ..........................................................................89 Curriculum Vitae ...............................................................................................................90 iii
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