Minimizing Home Health Care-Acquired Pressure Injuries through Effective Nursing Teamwork

142 Pages·2017·2.29 MB·English

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
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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

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