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Transformational Leadership Training For Leaders, Kristie Gilliland

Electronic Theses and Dissertations

The purpose of the study was to evaluate the impact of transformational leadership training on improving a leader’s skills and knowledge in performing daily operations and interacting with frontline staff, decreasing attrition. Ineffective leadership contributes to staff dissatisfaction, poor performance, and attrition. The literature supports transformational leadership is effective in leading teams of nurses and contributes to staff autonomy, staff satisfaction, decreased attrition, and improved patient outcomes. A quasi-experimental research study was completed on a leadership team in a managed care organization. Fourteen leaders with anywhere from 1 to more than 6 years of leadership experience were evaluated. Lewin’s change …

Development Of Nursing Clinical Judgment Using Lasater’S Clinical Judgment Rubric, Hollyanne Heaton Springer

Dissertations

Nursing clinical judgment is evident when multiple complex decisions are made quickly resulting in positive patient health outcomes (Lasater, 2007; Tanner, 2006). Patient safety is dependent on effective nursing clinical judgment but this skill has been declining among new graduate nurses, resulting in only 9% demonstrating entry-level competency in 2020 (Kavanagh & Sharpnack, 2021). To mitigate this decline, nurse educators need to develop methods to teach this skill with increased effectiveness. Tanner’s (2006) clinical judgment model described four cognitions of clinical judgment. Lasater’s (2007) clinical judgment rubric (LCJR) was developed to build on this model and provide leveled language in …

Student Desire To Stay In A Program: The Influence Of Faculty Caring And Cultural Identification With Faculty, Elizabeth Ann Cunniff

Dissertations

The Future of Nursing 2020-2030 report (National Academies of Sciences, Engineering, and Medicine, 2021) stated nurses should reflect the characteristics of the people they serve to ensure individuals receive culturally competent and equitable health care. Over the next decade and beyond, the U.S. population will become more racially and ethnically diverse, but the nursing workforce has not kept pace with the changing demographics (American Association of Colleges of Nursing, 2023). To increase diversity among nurses, nursing schools need more diverse graduates from prelicensure nursing programs, but attrition is greater among students with diverse racial, ethnic, and cultural backgrounds (Barbé et …

Fostering Resilience In Nurse Practitioner Practice: Development And Validation Of A Guide, Robyn L. Heiser

Capstones & Scholarly Projects

Nurse practitioners (NPs) are a significant part of the U.S. healthcare system providing high quality, safe, consistent care often in low access and rural settings. Nurse practitioners are increasing in demand due to a growing physician shortage and a changing patient demographic of aging patients and patients with increasing complex, chronic illnesses. Nurse practitioners experience chronic work stress from layered demands of their work and role. This challenges their resilience and, if not appropriately managed, could lead to negative consequences for patient outcomes, the well-being of the NP, and overall healthcare system. Applying interventions that could effectively and efficiently foster …

Designing A Culturally Relevant Lifestyle Modification Guide For Primary Care Providers To Improve Diabetes Management In The Hispanic Population., Jesusita Elvira Tafoya

Capstones & Scholarly Projects

Diabetes mellitus type II (DMT2) affects the Hispanic population in the United States at an alarming rate, contributing to elevated morbidity and mortality. This growing ethnic group is also disproportionately at risk for obesity and being at a lower socioeconomic status, both of which contribute to DMT2 severity and prevalence. The provision of culturally competent care in the primary care setting using evidence-based lifestyle modifications has the potential to improve DMT2 outcomes among this socioeconomically disadvantaged population. Thus, the expert opinions of eight primary care providers in the Pueblo, Colorado community were sought where half of the patient population identified …

Exploring Moral Distress And Reflective Debriefing As A Potential Intervention Among Intensive Care Unit Nurses, Tegan Camille Jones

Capstones & Scholarly Projects

Moral distress is recognized in the literature as a significant problem for nurses working in the intensive care unit (ICU). Moral distress occurs when one knows the right course of action but is unable to follow it due to team or organizational constraints. Moral distress may lead to physical and psychological symptoms resulting in burnout, job attrition, and a negative impact on patient care. While interventions for reducing moral distress among ICU nurses are limited in the literature, one potentially promising approach is reflective debriefing. This Doctor of Nursing Practice (DNP) scholarly project aimed to explore the intensity, frequency, and …

Exploring The Relationship Among Clinical Judgment, Academic Resiliency, Student Predictors, And Exam Remediation In Prelicensure Nursing Students Preparing For Next Generation National Council Licensure Examination [For] Registered Nurses, James Franklin Oberlander

Dissertations

As the field of nursing becomes increasingly more complex, nursing students are psychologically challenged as they progress through a program of study, prepare for the licensure examination, and enter professional practice. Identifying factors that influence student outcomes is necessary for faculty to effectively guide students toward successful completion of nursing school and passing the National Council Licensure Exam for Registered Nurses (NCLEX-RN). Along with academic and nonacademic demographic variables, the main objective of this exploratory, quantitative research study was to investigate the relationship between clinical judgement, academic resiliency, exam remediation, and NCLEX-RN first attempt pass rates. One hundred six senior, …

Lost In Interpretation: The Lived Experience Of Nurse Interpreters In The Clinical Setting, Byron Batz

Dissertations

The use of language interpreters in the health care setting constitutes a vital part of provider-patient communication but remains a relatively unexplored phenomenon. Registered nurses (RNs) are often called upon to serve as interpreters when linguistically diverse patients constitute a large segment of the patient population. That RNs serve simultaneously in an interpreter role – in addition to clinical and advocacy roles – is a complex facet of contemporary nursing practice in a diverse U.S. culture. The purpose of this qualitative descriptive study was to examine the lived experience of RNs serving as interpreters in health care institutions in Southern …

Exploring The Lived Experience Of Significant Other Caregivers Providing Care To Partners Surviving A Spinal Cord Injury, Lisa Ann Lumley

Theses & Dissertations

According to the World Health Organization, 250,000 to 500,000 people worldwide have suffered a spinal cord injury. Significant others may become caregivers responsible for meeting the needs of the dependent partner. The focus of this study is on significant other caregivers’ experiences providing care for partners after a spinal cord injury. The effects of stress from providing care may be detrimental to caregivers' psychological and physical well-being. Psychological distress, such as anxiety and depression in caregivers, is a significant public health issue that affects the quality of life for millions of individuals. There is a lack of studies focusing on …

The Effects Of Postpartum Hemorrhage Simulation, Kera Olson

Doctor of Nursing Practice Projects

Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality worldwide. Evidence supports the importance and impact simulation has had on preparation for postpartum hemorrhage. Preparation with hands-on education is imperative for a safe outcome during a real-life hemorrhage situation. Lack of frequent education and simulation can equate to negative outcomes for all involved. The purpose of this project was to increase exposure to a safe environment to explore knowledge and skills during a postpartum hemorrhage event. This quality improvement project surveyed postpartum nurses pre and post-mock postpartum hemorrhage simulation. The setting allowed for mistakes, discussion, and open …

Evaluating The Benefits Of Mindfulness Based Practices In The Hospital Setting: A Case For Mindful Communication Interventions For Nurses, Annie Kaplon

Mindfulness Studies Theses

Recent stressors, such as COVID-19, have provided new challenges for healthcare workers, especially nurses, and have contributed to the increase in burnout rates in the hospital setting. Therefore, relief in this space is critical. Ample research demonstrates that mindfulness-based interventions (MBIs) may help to improve well-being among healthcare providers more broadly. Literature supports that the practice of mindful communication, in particular, is helpful, not only in improving patient outcomes, but also in decreasing interpersonal stress among healthcare workers. This paper analyzes and synthesizes relevant studies, both qualitative and quantitative, and argues that mindful communication training improves the workplace environment for …

Nursing Perspectives On Intimate Partner Violence Screening In The Emergency Department, Justin Cabrera

Dissertations, Theses, and Capstone Projects

Using descriptive and quality descriptive (QD) analysis, emergency department nurses from around the country completed a modified version of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) tool to gain insight on their attitudes, knowledge, and preparedness about working with patient survivors of intimate partner violence (IPV) regarding their willingness to and comfort in engaging in IPV screening practices. In total, 1,523 responses were received from emergency department nurses currently or formerly in practice.

Findings show that there was no correlation between emergency department nurses’ education and training on IPV and willingness and comfort with IPV screening with …

Mandatory Child Abuse And Neglect Reporting Behaviors Among Registered Nurses In New Mexico: A Statewide Comparative Study, Ingrid Ann Wilson

Nursing ETDs

Child abuse and/or neglect (CAN) is a global problem. Although nurses are mandated CAN reporters, a lack of reporting has been an issue. New Mexico (NM) is faced with higher child poverty and CAN-related substance-abuse compared to other U.S. states. This quantitative study aimed to explore factors influencing intended/actual CAN reporting behaviors among NM registered nurses (RN)s, examine relationships of these factors, and compare differences in reporting behaviors between rural and urban locations. A survey to a sample of RNs (N=146) showed factors associated with CAN reporting intended behaviors were work status (r=.21, p < .05), cues to action (r=.20, …

Perspectives Of Home Care Nurses On Frailty And Resilience In Older Adults Living At Home, Lisa Foley

Seton Hall University Dissertations and Theses (ETDs)

The population of older adults is growing rapidly in the United States. As more people are living to an advanced age, they are often managing a multitude of chronic illnesses and disabilities while continuing to live at home. Frailty is a common condition that affects how one ages and the condition is associated with dependency and poor health outcomes. Resilience is considered to be a protective factor against health stressors that lead to frailty in older adults. Perspectives of home care nurses were obtained by semi-structured interviews which described how older adults live at home with frailty and demonstrate resilience. …

Utilizing A Reminder Tool To Improve Post-Hypoglycemia Recheck Rates On A Medical Surgical Unit., Laken Heitz

Doctor of Nursing Practice Papers

Diabetes is a growing epidemic with profound implications on the healthcare system. One of many possible complications is hypoglycemia, which is any value below 70 mg/dL. Inpatient hypoglycemia is a patient safety concern, and its treatment requires nursing adherence to strict protocols including a recheck within 15 to 30 minutes after treatment. However, evidence from the literature and project site demonstrated low rates of timely post-hypoglycemia rechecks. The purpose of this project was to provide education to all MIPS nurses regarding the utilization of a reminder tool for post-hypoglycemia rechecks. The intervention plan included reviewing the current hospital-wide hypoglycemia policy, …

Undergraduate Faculty Expectations Of New Graduate Nurses’ Entry-Level Competencies, Bridgette Lynn Bochner

Dissertations

This qualitative descriptive study sought to describe undergraduate faculty expectations of new graduate nurses’ entry-level competencies. By gaining valuable insight from nursing faculty, essential knowledge gained from this faculty perspective will benefit nursing students, nursing education, and all stakeholders in providing safe, quality care and establishing congruent entry-level competencies for new graduate nurses. Eleven faculty from the central and eastern portions of the United States participated in this study. In-depth interviews using open-ended questions were conducted, recorded, and transcribed by the researcher. A thematic analysis was conducted to identify recurring themes. The themes were validated by the participants using a …

Balancing Nurture And Rigour: Seeking Effective Support For Nursing Students In Distress, Marti Harder

The Dissertation in Practice at Western University

As higher educational institutions face a growing demand to graduate more nurses, and mental health and life stresses are recognized as increasing obstacles to student success, the timing is right for nursing programs to evaluate their traditionally rigorous program cultures. At Sunrise University in Western Canada, nursing students make up a large population seeking support services, and there is an increasing need for capacity building in faculty to support learners who are in distress. In this organizational improvement plan (OIP), I explore what can be enhanced or further developed to create more effective support for students who are in distress …

Shared Governance And Transition Into Practice: Impact On Work Engagement, Gudrun M. Reiter-Hiltebrand

Student Scholarly Projects

Practice Problem: High turnover rates, particularly in new graduate nurses, and poor organizational commitment and engagement negatively affect staffing, operational performance, and patient outcomes. A negative trend for nurse engagement indicators was noted in previous staff engagement surveys of this organization.

PICOT: The PICOT question that guided this project was: In transition-into-practice (TIP) nurses (P), how does the implementation of shared governance (I) compared with no shared governance participation (C), affect their engagement with the hospital (O) within eight weeks (T)?

Evidence: Literature has shown that nurse engagement is one of the nurse indicators positively affected by shared governance …

Evaluation Of Simulation On Medication Errors In The Pediatric Intensive Care Unit, Carrie Clark

Dissertations

Problem: Medical errors are the third leading cause of death in the United States, the most common medical error being medication error. Pediatric patients are at an increased risk of medication error due to medication dosage calculation and the use of frequent high hazardous drugs.

Methods: The quality improvement (QI) project implemented the use of descriptive observational design using retro and prospective data. The data was collected over a 4-week and 4-week period by gathering data via safety and environmental management survey (SEMS).

Results: The data gathered consisted of an increase in medication errors of 150%. The data collected yielded …

Improving The Mental Health Nursing Competencies Of Nurses Caring For Patients With History Of Substance Use Disorder In Long-Term Care Settings, Nancyver Lafleur-Omeler

Doctor of Nursing Practice Projects

Background

While nurses are often on the front lines of working with patients with a history of substance use disorders (SUD), most have limited training in this area. Nurses who work in Long Term Care (LTC) settings are often challenged to resolve the practical issue of needing more competency in caring for SUD patients. Horner et al. (2019) agreed that the deficiency of mental health knowledge and skills in healthcare workers is linked to decreased quality of care, which can diminish patient outcomes. This lack of competency must be addressed (Margoliese & Vandyck, 2019).

Purpose

The goal of this project …

Factors Influencing High Nurse Turnover In A Midwestern U.S.A. Community Hospital And A Proposal For Change, Deborah Mokeira Omagwa

Doctor of Nursing Practice Projects

Nurse turnover has become a universal problem in recent years, causing nurses to bear the burden of higher patient loads, working overtime hours, and dealing with unfavorable working conditions. Nurses sometimes feel they have no voice to fight for them while they struggle at the bedside to improve patient outcomes. The purpose of this project was to be a voice for the nurses to inform the hospital administration on data driven results on how nurse turnover can be reduced, with the goal that the proposed nurse retention strategies will be implemented in this community hospital.

This was a qualitative project …

The Lived Experience Of Using Opiates Among Young Adults, Catherine Mbewe

Dissertations, Theses, and Capstone Projects

The purpose of this research study is to explore the lived experience of using opiates, as described by young adults aged 18 to 25 years. Over the last 2 decades, opioid use disorders (OUDs) and opiate overdose deaths have increased dramatically in the United States. What used to be a problem primarily contained to minority groups in poor inner-city areas is now increasingly common in all races, genders, ages, and classes. There has also been an alarming increase in opiate use—including fentanyl, both legal and illegal—among young adults. While much of the literature has been focused on the opiate use …

Implementation Of Clinical Institute Withdrawal Assessment: Alcohol Revised (Ciwa-Ar) Education Program In A Crisis Stabilization Unit, Amanda Dehart

Doctor of Nursing Practice Final Manuscripts

Background: At this time the crisis stabilization Units do not currently utilize the Clinical Institute Withdrawal Assessment: Alcohol Revised tool with patients who may experience Alcohol Withdrawal Syndrome. Patients with alcohol use disorders have a high comorbidity rate with psychiatric disorders (Butterfield, et al, 2020). The Clinical Institute Withdrawal Assessment: Alcohol Revised or CIWA-Ar is currently the most widely used assessment tool in the psychiatric setting when assessing patients who may be experiencing Alcohol Withdrawal Syndrome (Pribék, et al, 2021) .

Purpose of Project: The purpose of this project is to measure pre and post -education knowledge of the registered …

The Dedicated Education Unit: Increasing Capacity And Confidence, Heather Marie Van Housen

Doctor of Nursing Practice (DNP) Projects

Background: In the American Association of Colleges of Nursing (AACN) 2020 annual survey, nursing schools turned away 66,274 entry-level applications to baccalaureate nursing programs in the United States due to a faculty shortage and clinical placement sites (AACN, 2021).

Local Problem: Hospitals need more qualified nurses to meet community needs. The need for clinical faculty and additional clinical placement sites disrupts the workforce pipeline through local nursing schools. A new approach to clinical education is needed to prepare more students for the growing complexities of independent nursing practice.

Methods: Dedicated Education Unit (DEU) implementation to expand pre-licensure nursing student clinical …

Improving Timely Sepsis Care Through Staff Education Within The Emergency Department, Jillian J. Abinader

Master's Projects and Capstones

Problem: A sepsis protocol and bundle has been implemented in an urban Emergency Department to help screen patients and treat sepsis efficiently and effectively. The benchmarks from the bundle are not being met consistently every month and are below the targeted 90%.

Context: A microsystem assessment and a gap survey sent out to nurses, helped determine that there is room to improve nurses’ knowledge and confidence about sepsis and the sepsis bundle workflow. Sepsis is one of the most expensive and burdensome conditions in U.S. hospitals. Literature supports staff education to improve sepsis bundle compliance.

Intervention: A video was created …

Educating Medical-Surgical Nurses In A Large Hospital Organization On Sepsis Bundle Elements, Christopher N. Guinto

Master's Projects and Capstones

Problem: Results from a voluntarily anonymous pre-survey about sepsis revealed that a majority of the seventeen nurses assessed themselves below an "expert knowledge '' level. The survey results present an opportunity to improve the nurses’ knowledge and confidence in nursing response and improve patient outcomes with sepsis.

Context: The quality improvement (QI) project was conducted on a medical-surgical unit in a large Northern California hospital.

Intervention: A QI team initiated evidenced-based practice research and created an educational sepsis handout for nurses to increase sepsis knowledge and confidence.

Measures: The self-assessment pre-survey would be compared to the responses from the post-survey. …

Implementation And Evaluation Of A Diabetic Education Program, Brianna Cole

Doctor of Nursing Practice Scholarly Project

The purpose of this project was to help create and evaluate a diabetes education program that was accessible to diabetic patients over the age of 18. This project was conducted through Enhanced Healthcare of the Ozarks clinic with the guidance and approval of the American Diabetes Association. There is currently one other diabetic education program available in Northwest Arkansas. The theme of this project was to provide education in individual and group settings regarding medication use, emergency situations, nutritional choices, and self-management techniques. These patients learned meal planning strategies, proper nutrition choices, functions of the body, self-management techniques, emergent situation …

Promoting Safety Through Advocacy And Practice: Nurse Input And Beliefs Regarding Hospital Fall Prevention Policies In The Inpatient Setting, Jimmy Milano

Doctor of Nursing Practice Scholarly Project

Throughout the evolving healthcare system, many issues in the hospital setting pose significant risk to patient safety and outcomes. Falls occur at detrimental rates that inevitably impact both the patient and the nurse. Of the several reasons one would choose to join the profession, nurses often seek the satisfaction of knowing the care they have provided impacted a patient, physically and spiritually. The healthcare system has allotted for variables in patient safety to promote safe outcomes and the reduction of fall risk, such as evidence-based practices and tools like cameras and assessments. However, the lack of nursing involvement in these …

A Lifestyle Modification Intervention In Hispanic Adolescents With Nonalcoholic Fatty Liver Disease, Brianne Miller

Evidence-Based Practice Project Reports

U.S. population studies have confirmed that the Hispanic population has the highest prevalence and the worst prognosis for non-alcoholic fatty liver disease (NAFLD) (Katz et al., 2021). The purpose of this evidence-based practice project was to implement a multicomponent, lifestyle modification intervention in Hispanic pediatric primary care patients to combat the disease process and sequela of NAFLD. The PICOT question for this project was: In Hispanic adolescents aged 10-21 with obesity and NAFLD (P), what is the effect of a multicomponent, lifestyle modification intervention (I), on alanine aminotransferase (ALT) (O), over a 12-week time period (T)? A comprehensive literature search …

The Importance Of Charting And Documentation In The Nursing Profession, Charlotte J. Bradshaw

Honors Capstones

Honors Capstone Abstract

Nursing is a profession that can take you to endless different directions, not just in the hospital. Some may decide to work in a clinic, a school, or even laser hair removal centers. Although the setting and workday are different, one thing remains the same: charting. Charting is an everyday, every patient requirement for all nurses. Although this is unarguably one of most important skills to learn before becoming a nurse, most nursing schools do not have a class dedicated specifically to charting. This can create many problems for newer nurses who lack the experience and knowledge …