Digital Commons Network^™

An Evaluation Of Adolescent Concussion Management And Guidelines By Primary Care Providers In The Outpatient Setting: Dnp Scholarly Project, Mary Beth Newkirk

Doctor of Nursing Practice Scholarly Project

Understanding the pathology of a concussion has been a challenging task for many experts in healthcare. An agreed upon definition has yet to be developed and many health care providers are not properly educated to assess and care for those suffering from a concussion. Management of concussion in adolescents, a vulnerable population, requires even more consideration and training. The purpose of this study was to determine the knowledge current providers in the four-state region regarding sport-related concussion management in the adolescent population, to improve patient care and outcomes, and to improve knowledge learned through exposure to a clinical practice guideline-based, …

Creating A Thriving Informatics Culture, Nicholas Webb

Doctor of Nursing Practice (DNP) Projects

Nurses thrive best when they are empowered to make decisions that can positively impact healthcare delivery. Knowledge and application of nursing informatics principles can influence clinical, quality, operational, and financial outcomes in ways that were not available in previous professional nursing generations.

If nursing informatics is the solution, what is the problem? A survey regarding use and attitudes about nursing informatics was taken of chief nurse executives (CNEs) at an integrated, not for profit healthcare system in the Northern California region, where the author oversees the electronic health record (EHR). The results were surprising. Half said they did not know …

Workplace Violence: An Urgent Call For Integrated Staff Education In Acute Care Hospitals, Nicole Bellisario

Doctor of Nursing Practice (DNP) Projects

Problem: Type II workplace violence (WPV) in acute care hospital settings has become an epidemic of costly proportions in the United States. Regulatory mandates and healthcare accreditation standards increasingly require healthcare employers to provide a safe and healthy healing environment for patients and a safe work environment for staff. Implementation of a comprehensive WPV prevention program depends largely on organizational culture, participation and commitment from key stakeholders, and readiness for change.

Context: The patient-clinician relationship has drawn urgent attention, as healthcare organizations around the world implement key components of WPV prevention programs. The clinical management of patient aggression …

In-Basket Teamwork: Divide The Work And Multiply The Success The Registered Nurse Role In Ambulatory Clinic Ehr In-Basket Management, James Smoot

Master's Projects and Capstones

Electronic Health Record (EHR) in-basket results (e.g., lab results, pathology reports, etc.) must be reviewed and acted upon in a timely manner by clinical staff in order to provide safe and effective care to ambulatory patients. Delays in reading results are significant contributors to medical errors. A large backlog of in-basket results that have never been appropriately filed is both a safety concern and a symptom of other clinical workflow issues. EHRs have shifted a greater proportion of administrative and triage roles onto providers, contributing to provider burnout. This paper synthesizes some of the best evidenced-based practices available for the …

The Contributing Factors To Student Nurse Medication Administration Errors And Near Misses In The Clinical Setting As Identified By Clinical Instructors, Kristen M. Selig

Theses and Dissertations

The report, To Err is Human, by the Institutes of Medicine (IOM, 2000) brought attention to medication safety in the United States healthcare system. While advances have been made in patient safety, including electronic medication dispensing systems, electronic medication administration records, and scanning systems, it is estimated that 7,000 to 9,000 people die each year due to medication errors (Tariq et al., 2019). The medication administration process involves steps from prescribing to administration. However, nurses administering the medications are the final check point. James Reasons’ Swiss Cheese Model of Accident Causation illustrates the role that systems play in medical errors. …

Application Of Genomics In Nursing Practice, Elizabeth Cameron Hassen

All Dissertations

ABSTRACTThis dissertation begins with the introduction of genetics, genomics, and the Healthcare Genetics (HCG) model. The five concepts of the HCG model, genetics/genomics, education, environment, clinical testing and therapeutics, and ethical/legal/social implications (ELSI) are defined. These concepts are threaded throughout the manuscripts and dissertation chapters. Chapter II defines molecular testing and differences between single-gene and multi-gene testing. The Kaplan Meier Curve and its use in research, to illustrate survival over time, is discussed. The chapter provides specific examples of both predictive and prognostic genomic testing used in breast, lung, colon, and prostate cancers. Chapter III examines the application of the …

Nursing Students’ Knowledge And Attitudes About Pain Management And Opioids, Hedieh Hatami Sirjani

Health Services Research Dissertations

Statement of the problem: healthcare professionals’ knowledge of using opioids for pain management safely is critical in preventing opioid abuse and overdose. Undergraduate curricula of health professional schools, including undergraduate nursing programs, need to improve and adopt a comprehensive education regarding this issue.

Method: the first project was a systematic analysis of the literature regarding the educational interventions’ impact on healthcare professional knowledge and practice behavior regarding prescription opioids. The second project was a qualitative study of nursing students to explore their experience, self-efficacy, and knowledge of prescription opioid use for pain management and whether they feel the need for …

An Exploration Of The Numeracy Skills Required For Safe, Quality Nursing Practice, Anna Wendel

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this study was to explore the numeracy skills required for safe, quality nursing practice. Using a descriptive mixed methods design, this study answered two research questions: 1) What numeracy skills do nurses perceive as important for providing safe, quality nursing care in the first three years of practice? 2) How do nurses incorporate numeracy skills into daily patient care during the first three years of practice? Early career nurses from a not-for-profit health care organization in the mid-Atlantic region of the United States (n=109) responded to an online survey tool developed by the student investigator that ranked …

A Program Evaluation Of A Rural Nursing Academic Partnership, Meagan A. Spencer

Electronic Theses and Dissertations

As the American Association of Colleges of Nursing and Commission on Collegiate Nursing Education continue to promote the implementation and creation of literature on academic partnerships, a Christian university, sought to evaluate its academic partnership with a for-profit hospital for the first time in regard to student perspectives. The purpose of this mixed-methods program evaluation was to describe the student perceptions of the academic partnership in trusting, collaborating, and engaging nursing students and recruiting and retaining nursing graduates to rural hospitals and health care facilities. Measurable impacts included both qualitative and quantitative coding of the levels of trust, collaboration, and …

Using Empathic Design Principles To Improve Surgical Nursing Efficiency, Roberta Sutton

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Improving efficiency to increase operating room utilization, improve turnaround time, and first case on time starts, is a goal of hospitals to increase surgical case volume. Increasing case volumes improves the hospitals bottom line by increasing reimbursement. In addition, improving the utilization will improve patient and caregiver satisfaction, show less wasted time between cases, and allowing for more timely starts. In the hospital that this study was be performed, located in Atlanta, Georgia, there is a need to improve these metrics which will improve the bottom line of the facility. This study addressed inefficiencies in processes, job duties, and preparation …

A Multimodal Analgesic Virtual Reality Program To Reduce Opioid Exposure, Jessica Hovland

Student Scholarly Projects

The opioid crisis continues to be a public health concern. Traditionally, an opioid-centric approach treats postoperative pain.

The following PICOT question guided this project: Will initiating a multimodal analgesic virtual reality quality improvement program (I) compared to current practice (C) decrease opioid requirements (O) in robotic hysterectomy patients (P) during the postoperative period (T)? Several articles promote non-opioid analgesia and non-pharmacological interventions, such as multimodal analgesia and virtual reality (VR) for pain management.

This project reviewed pre- and post-implementation data after implementing new evidence-based multimodal analgesia and VR protocols. The project captured a total of 64 patients in the pre-implementation …

Achieving An Inclusive Nursing Culture: Developing A Model For Diversity And Inclusion Education, Amber K. Charleville

Theses and Graduate Projects

The creation of an inclusive environment is essential in health care. Therefore, this paper describes the development of an educational project to achieve a more inclusive nursing culture with registered nurse case managers at a large Midwest teaching hospital. This project sets forth the goal of establishing and discussing diversity and inclusion education by proposing a model with reflection, learning, and growth as self- sustaining practices in an ongoing cycle of praxis with Chinn and Kramer’s emancipatory knowing. Over the course of a year, monthly modules will be taught by a facilitator who will encourage discussion and reflection on various …

The Treatment And Management Of Chronic Pain Using Cbd, Emily Davis

Honors College Theses

Chronic pain is a common debilitating condition in the United States. The treatment of chronic pain is complex and can sometimes lead to addiction of opioid medications. However, there is another, more natural option in the treatment of chronic pain—the use of CBD, cannabidiol which is a phytocannabinoid from hemp and marijuana, for the treatment and management of chronic pain. While CBD is labeled a schedule I drug by the Food and Drug Administration in the United States, there is evidence that CBD can make an impact on the severity of pain, the amount of opioids in use, and the …

Caring Revisited: A Foucauldian Discourse Analysis On The Association Of Caring With The Profession Of Nursing, Margot Boulton

Electronic Thesis and Dissertation Repository

There have been numerous theories put forward by nursing theorists on the importance of caring in nursing. Very few studies have looked at the impact that this association has on the practice of nursing. This study will add to the existing literature by using a Foucauldian discourse analysis to examine the material effects that the caring discourse has on nurses’ ability to advocate for safe working conditions during a public health emergency. Using the outbreak of COVID-19 in Ontario, Canada in the Spring of 2020 as a context, this study seeks to establish caring as a discourse and examine how …

Acute Pancreatitis, Noah Prebish

Nursing Student Class Projects (Formerly MSN)

The continents of the poster are the result of a literature search that was conducted to find the most up to date information on various aspects of acute pancreatitis. Acute pancreatitis can be categorized as mild, moderate and severe cases. Mild and moderate cases of acute pancreatitis usually subside spontaneously and have no residual effects on patients. Severe acute pancreatitis is a potentially life-threatening disorder that results in the autodigestion of the pancreas. Autodigestion of the pancreas causes a systemic inflammatory response that usually results in rapid deterioration of patient’s hemodynamic status. Severe pancreatitis often leads to long hospital stays …

Improving Care Experience Of Total Joint Home Recovery Patients Through Nursing Education, Earvin Ledi

Master's Projects and Capstones

Problem: At a Northern California hospital (NCH), there is a current effort to ensure the perioperative patients are satisfied with their care. These patients receive the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey after surgery. The scores regarding discharge process and patient knowledge over the last five quarters have fluctuated between the 10th percentile and the 36th percentile. NCH relies on patient satisfaction scores to better serve their members.

Context: NCH understands the higher the scores, the more members they will retain and the higher the overall income. Based on the low OAS …

Pressure Injury Documentation And Reporting: A Quality Gap, Mary Ann Laslo

Master's Projects and Capstones

Abstract

Problem: Inaccurate and incomplete pressure injury (PrI) assessment and documentation leads to inaccurate reporting of PrI quality reporting measures to the Centers for Medicare and Medicaid Services. Inaccurate, incomplete documentation of pressure injuries and wounds adversely affects the quality of care, financial reimbursement, and hospital reputation as well as increasing the risk of litigation to medical providers. Barriers to accurate and complete documentation by the nurses were inaccuracy in identification of PrIs Stage 1 or greater and knowing what and where to document the information in the electronic medical record.

Context: This quality improvement project attempted to improve nurse …

Moral Distress And Moral Residue Among Nurses Working In The Surgical Intensive Care Unit: A Descriptive Qualitative Approach., Adam Tyler Booth

Electronic Theses and Dissertations

Introduction: Approximately one in five Americans will die in the intensive care unit (ICU). Nurses spend more time with chronically ill and end-of-life patients than any other healthcare professional, and may perceive some actions in the ICU as immoral. Moral distress is defined as knowing the right course of action to take but being hindered by institutional constraints. Development of the Moral Distress Scale-Revised revealed that 31% of ICU nurses left a prior position or considered leaving their current nursing job because of moral distress. The purpose of this descriptive qualitative study is to explore surgical ICU (SICU) nurses’ perceptions …

Development Of Guideline And Algorithm For The Integration Of Video-Conferencing-Based Telemental Health At A Regional Medical Center, Yonis Mudey

Capstones & Scholarly Projects

Telemedicine has become a major trend in the delivery of medical services with telepsychiatry becoming the counterpart trend for the delivery of mental health services. For some geographical areas, access to mental health services might be difficult for some patients to make regular, sometimes weekly trips to their mental health provider—hence, the development of telepsychiatry. However, the practice of telepsychiatry might not be standardized in some mental health facilities as they might not have guidelines for their practice. As a result, this project sought to develop telepsychiatry guidelines for a selected medical facility in northern California. Literature was reviewed and …

A Phenomenological Study Of Uninsured Individuals’ Primary Healthcare Experiences At Nurse-Managed Clinics In Mississippi, Linda Hale Banks

Doctoral Dissertations

The purpose of this phenomenological research study is to describe the lived experience of uninsured individuals accessing and receiving healthcare at nurse-led primary care clinics. This study is grounded in the existential phenomenological philosophy of Merleau-Ponty and guided by research procedures developed by Thomas and Pollio (2002). The study answers the question: What is the meaning of the patient’s perception of their lived healthcare experience as an uninsured individual? The research design methodology included a purposeful, convenience sample to recruit participants. Nine participants comprising five women and four men, ranging in age from 34 to 65, were interviewed to elicit …

Transitions: The Lived Experience Of Bachelor Of Science Nursing Students, Rita Peters

Dissertations

Peters, Rita. Transitions: The Lived Experience of Bachelor of Science Nursing Students. Published Doctor of Philosophy dissertation, University of Northern Colorado, 2020. This study explored the lived experience of the Bachelor of Science in Nursing (BSN) nurse utilizing an interpretive phenomenological approach. Transition theory was utilized as the lens to guide the study. Societal needs are demanding nurses who are capable of caring for increasingly complex patients. An aging population continues to increase the need for nurses. The increased need for new nurses is complicated by continuing attrition from schools of nursing. The literature identified many interventions that have been …

Implementation Of American College Of Cardiology / American Heart Association Cardiovascular Evaluation Guidelines For Patients Having Non-Cardiac Surgery, Robert Leeper

Capstones & Scholarly Projects

Leeper, Robert S., Implementation of American College of Cardiology/American Hospital Association Cardiovascular Evaluation Guidelines for Patients having Non-cardiac Surgery. Unpublished Doctor of Nursing Practice Scholarly Project, University of Northern Colorado, (2020).

Anesthesia outcomes in non-cardiac surgery are dependent upon recognition of cardiovascular disease, estimating functional capacity, the status of existing co-morbidities, and degree of end-organ disease. Anesthesia providers in a rural surgery center identified an increase in the number of patients coming to the surgery center with unstable cardiovascular conditions resulting in delayed start-times, postponements, and cancellations. The broader objective for this anesthesia quality improvement project was greater patient access, …

Preceptor Education And Structured Onboarding Process, Charles Morato

Master's Projects and Capstones

Problem: Staff nurse retention is an ongoing problem for this intensive care unit (ICU). Through exit interviews from staff who left, inadequate onboarding and education made them feel unprepared for their job and not part of the team. The preceptors on the unit have never been trained on the roles and responsibilities of being a preceptor. The current onboarding process consists of pairing new hires with a preceptor who either happens to be willing to do it that day or someone who has been there the longest. There is no consistency or personalizing the orientation information to the new hire. …

Compassion Fatigue And The Emergency Department, Alexandra Myers

Dissertations

Problem The emergency department (ED) is a high-stress environment. Nurses exposed to this stress for prolonged periods are subject to compassion fatigue (CF). The purpose of this quality improvement project was to identify and reduce the level of CF in ED nurses by implementing Real Time Transformative Response^© (RTR). RTR^© is a technique that uses combinations of neurofeedback response awareness, biofield therapy intervention, and clearing of unwanted energy.

Method A purposeful sample of ED nurses working at a moderately-sized, suburban, Midwestern hospital ED who were scheduled to work 24-hours or more per week completed a Professional Quality of …

Venous Thromboembolism, Ngwangong Mitti

Nursing Student Class Projects (Formerly MSN)

Venous thromboembolism (VTE) is a serious pathophysiological condition that is a major cause of morbidity and mortality, especially perioperatively (Elisha at al., 2015).

The Pathophysiology Of Acute Respiratory Distress Syndrome (Ards), Alyscia Defrancisco

Nursing Student Class Projects (Formerly MSN)

Acute Respiratory Distress Syndrome (ARDS) is fatal when not recognized early, nursing care can have a positive impact on patient outcomes. ARDS is a disease of the lung caused by an acute lung injury. ARDS accounts for 10-15% of ICU admission and is underrecognized. Key nursing consideration are essential to help identify and treat ARDS.

Utilization Of Peer-Led Education To Enhance Advance Care Planning And Advance Directive Completion, Jenna Juenger

Doctor of Nursing Practice Final Manuscripts

Background: The integration of advance care planning (ACP) and palliative care (PC) into oncology plays a critical role in symptom management and quality of life. Studies reveal a large subset of oncology patients with unmet needs regarding ACP and advance directive (AD) completion. Successful ACP helps to promote congruent medical treatment with patients’ values and preferences and motivates patients to complete ADs.

Objective: An evidence-based practice project was conducted to assess the effectiveness of peer-led education to nursing staff to improve ACP and AD completion among inpatient oncology and PC patients

Design: A standardized survey created from the …

Lowering Antibiotic Resistance Utilizing Breastmilk, Moriah J. Harris

Honors College Theses

Antibiotic resistance is considered an emerging crisis in the healthcare world. This crisis has the potential to cause many bacterial diseases that cannot be cured using antibiotic drugs, which can lead to serious infections and death. There have been numerous studies that have found that sugars, proteins and protein-lipid complexes in breastmilk have antimicrobial properties. It has been proposed that these properties in breastmilk can help solve the antibacterial resistance crisis. This research project involved studying antibiotic resistance and how breastmilk can help solve this increasingly prevalent problem.

The implementation step of this research project involved a PowerPoint presentation detailing …

Using Provider Education About Self Care To Reduce Compassion Fatigue Among Nurses, Priscella Caron

Doctor of Nursing Practice Scholarly Project

Many have scrolled through Facebook and news stories highlighting nurses as “heroes” of the current coronavirus pandemic. Pictures of nurses in personal protective equipment while at work or clips of nurses making fun tiktok video’s celebrating recovered COVID -19 patients. Social media does not capture the sheer emotional, physical, and spiritual wear that nurses experience providing compassionate care to patients facing light threatening illness or events. Health care organizations are under pressure to control cost, increase productivity, and increase patient satisfaction scores, all while facing a pandemic crisis. This type of pressure can create inadequate staffing and increase clinical responsibilities …

Implemented Nurse Education To Improve The Effective Use Of The Sapphire Pca Pump: Achievement Of Quality Pain Control, Fanta Keita Zable

Master's Projects and Capstones

The Sapphire ™ Infusion System Patient-Controlled-Analgesia (PCA) pump is a device that is used to administer high pain medication to manage a patient’s pain level after an invasive procedure such as surgery. In order to achieve this goal, nurses must be able to use the sapphire equipment efficiently to prevent medication overdose and underdose, as well as to preserve safety for both the patients and the nurses themselves. In addition, nurses must be able to document accurately on EPIC. The purpose of this project, led by the team of Clinical Nurse Leader (CNL) students from the University of San Francisco, …