Medicine and Health Sciences Commons^™

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 …

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 …

Effects Of Resilience Coaching On Behavioral Health Nurse Burnout, Dalila Franklin

Dissertations

Abstract

Background: Inpatient, staff nurse burnout negatively impacts nurses’ mental and physical health, hospital nurse retention and turnover, and patient care. The Stress First Aid for Health Workers program attempts to bolster resilience and subsequently reduce burnout among mental health nurses in this project.

Method: This quality improvement (QI) project was an observational pre-post survey design and was conducted on a cohort sample of inpatient, behavioral health nurses at an urban, mid-sized, Midwestern hospital psychiatric unit to assess personal, work-related, client-related, and overall burnout utilizing the Copenhagen Burnout Inventory (CBI) tool to quantitatively measure burnout pre- and three months post-implementation …

Implementing A D/Deaf Educational Module For Graduate Nursing Students, Brenda J. Pauley

Dissertations

Problem: Nurse practitioners lack knowledge and skills to effectively communicate with D/deaf individuals which potentiates risk for health disparities and gaps in care. Graduate nursing programs rarely incorporate D/deaf-focused education in their curriculums.

Methods: This descriptive quality improvement project implemented the first D/deaf-focused educational online module at a Midwestern university’s College of Nursing. A purposive sample of 38 BSN-DNP students enrolled in the Spring Intensive completed a pre- and post-education survey. Both surveys assessed students’ D/deaf perceptions through Lewis and Keele’s (2020) D/deaf and Hard of Hearing Interaction Beliefs Scale for Registered Nurses (DdHH-IBS/RN) and evaluated students’ knowledge through a …

Implementing A Standardized Nursing Communication Tool To Improve Inpatient Nursing Communication, Ashley D. Nator

Dissertations

Implementing a Standardized Nursing Communication Tool to Improve Inpatient Nursing Communication

Ashley D. Nator

B.S. Nursing, University of Missouri-St. Louis, 2018

A Dissertation Submitted to The Graduate School at the University of Missouri-St. Louis in partial fulfillment of the requirements for the degree

Doctor of Nursing Practice with an emphasis in Family Nurse Practitioner

August 2022

Advisory Committee

Cathy Koetting, PhD, DNP, APRN, CPNP, PMHS, FNP-C

Chairperson

Sarah Jackson, DNP, APRN, FNP-C

Amy Terbrock, MSN, PCCN, SCRN, RN

Copyright, Ashley D. Nator, 2021

Original: 08/2021 Revised: 09/2021, 10/2021, 04/2022

Abstract

Problem: Patient handovers occur among nurses more than 4,000 times …

Nursing Anxiety Self-Evaluation And Resiliency Methods, Dianne Deck

Dissertations

Abstract

Introduction: Nurses are stressed due to the demands of their job. This study aims to determine whether MICU nurses at a large Midwestern hospital would have reduced stress and anxiety after a 30-day meditation and exercise intervention.

Design and Methods: A quasi-experimental pre-post pilot study design was adopted. The convenience sample consisted of eight Medicine Intensive Care Unit (MICU) nurses in a large Midwestern urban tertiary medical center. Data collected included demographics, pre- post-Beck Anxiety Inventory Scale (BAIS), pre- and post-Single Item Stress Scale (SISS), and weekly diaries on exercise and meditation.

Results: The pre- post-SISS showed statistical significance …

Quality Improvement Competency Development For Correctional Nursing Leaders, Angela Chandler

Dissertations

Nurse leaders are often promoted with little to no leadership development. Lack of development is a leading cause of turnover. Leadership development is crucial to retaining qualified leaders and the National Academy of Medicine identified that quality improvement (QI) competency development for nursing leaders is critical to improved healthcare. To invest in leader development and improve QI competence, a structured, weekly, coaching intervention was used for four consecutive weeks to reinforce QI concepts and assist in development of a QI project plan for nursing leaders. The Beliefs, Attitudes, Skills, and Confidence in Quality Improvement (BASiC- QI) instrument was used before …

Predictors Of Engagement In Nursing Professional Practice: Transforming Organizational Culture In The Post-Covid Healthcare Environment, Jennifer Garnand

Dissertations

Cultivating the shared belief that individuals matter within an organization enhances the empowerment of staff and supports enthusiastic engagement in organizational efforts aimed toward a common mission, vision, and goals (McShane & Von Glinow, 2019). The nursing profession has been plagued by an unprecedented decrease in engagement and diminished job satisfaction, particularly following the prolonged tenure of the COVID-19 pandemic, leading to subsequent attrition amidst a staffing crisis. This quantitative predictive correlational study seeks to determine whether proactive and persevering characteristics, professional identity, and passion of nurses are predictors of engagement in a post-COVID healthcare environment. The research was based …

Remifentanil Patient Controlled Analgesia Use In Laboring Women: A Feasibility And Acceptability Study, Joshua Carr

Dissertations

Background/Purpose: Interest in remifentanil patient controlled analgesia (RPCA) as a treatment for labor pain has increased due to its unique pharmacodynamics and effectiveness on pain control among parturients. Despite its promise, RPCA remains infrequently used in the US. The purpose of this study was to 1) examine the implementation and acceptability of a new RPCA protocol in the labor and delivery ward of a mid-sized hospital, and 2) identify the attitudes and beliefs of healthcare workers in a real-world clinical setting.

Theoretical/Conceptual Framework: The holistic nature of Comfort Theory can account for the proposed mechanisms contributing to the …

When "First, Do No Harm" Fails: A Restorative Justice Approach To Workgroup Harms In Healthcare, Pedro L. Flores

Dissertations

In healthcare, workgroup mistreatment is a pervasive problem that begins during medical education (medical and nursing school) and becomes embedded in the “hidden curriculum of professionalism,” which dissuades and even punishes learners for talking about abuse they witness. Furthermore, the mistreatment of healthcare providers (HCPs) pervades all disciplines in the healthcare delivery chain due to a combination of cultural factors, systemic pressures, dysfunctional hierarchies, and leadership’s tolerance of intimidating and disruptive behaviors. Not surprisingly, 18% of U.S. HCPs have left the medical field since the start of the COVID-19 pandemic, and burnout, stress, anxiety, and increased workloads have been identified …

Minimizing Workplace Violence By Initiating An Evidence-Based Community Meeting, Olivia Gabrielle Foster

Dissertations

Problem: Workplace violence (WPV) in healthcare has become an epidemic demanding change. WPV is three to four times higher in the healthcare industry compared to other workplaces. For this project, WPV will be defined as any act of physical violence from a patient to a staff member. Community meetings are one evidence-based approach to decreasing WPV in psychiatric inpatient hospitals. Methods: This descriptive observational project compared data before and after implementing a targeted WPV community meeting, including unit rules, staff and patient expectations, a definition of WPV, and medication options available to reduce anxiety and irritability. This project …

A Descriptive Study Of Health-Related Risks And Outcome Differences By Loneliness Status In A Sample Of Older Veterans, Rachael Beard

Dissertations

There is a need to understand the influences and outcomes related to loneliness in veterans living with complex illness. Patients require self-care to manage complications and exacerbations associated with complex illness. Deficits in self-care result in negative health outcomes and drive resource utilization upward. The identification of potential factors related to self-care is important. Loneliness may be one factor that influences patients’ ability and desire to care for themselves. Descriptive correlational design was used to evaluate loneliness both as a predictor and outcome in veterans admitted to the hospital for three complex respiratory illnesses (heart failure, chronic obstructive pulmonary disease, …

Baccalaureate Nursing Students' Lived Experiences Of A Leadership Role During Clinical Practicum, Gisela E. Schmidt

Dissertations

Problem

Leadership is an essential component of professional nursing practice used in many aspects of the Registered Nurse (RN) role. Baccalaureate nursing (BN) programs have the responsibility of preparing graduating nursing students with leadership orientation and practice. Excellent professional preparation of RNs starts with their education during nursing school. The fast-paced and high-demand healthcare environment needs RNs who can be accountable for patient care that enables excellent patient outcomes and sound patient-centered care. Taking this into consideration, nursing educators are in a special position to promote nursing education which prepares their students with leadership education and training. The purpose of …

The Relationship Among Perfectionism, Perceived Stress, And Coping In Baccalaureate Nursing Students, Amanda Finley

Dissertations

Perfectionism in nursing students is an understudied problem that may affect student and workforce success. Perfectionism has been linked to increased stress and less effective coping styles, as well as depression, anxiety and other psychological alterations. However, it has rarely been studied in nursing students. Studying perfectionism in this population is important because it may increase the likelihood that new nurses will struggle with the stress of practice and it could be a significant factor in early career attrition. The purpose of this descriptive, correlational study was to gain a better understanding of the incidence of perfectionism in a nursing …

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 …

Impact Of Meaningful Recognition On Work Environment Perception Of Critical Care Nurses, Kristin Meinershagen

Dissertations

Problem: Absence of nursing staff recognition can lead to compassion fatigue, burnout, job dissatisfaction, and increased turnover rate resulting in high costs for hospitals. Meaningful recognition has been found to decrease compassion fatigue and reduce burnout. A meaningful recognition program was implemented over a 3-month period for staff nurses in an Intensive Care Unit (ICU) at a large midwestern, metropolitan hospital to determine its effect on nurse’s perception of work environment and turnover rate in the ICU.

Methods: This was an observational, descriptive, cohort design utilizing the AACN Healthy Work EnvironmentSurvey instrument for assessing results before and after implementation …

Dominican Nursing Students’ Self-Reported Mastery Of International Nursing Competencies, Wady Ramirez

Dissertations

The Dominican health care system has many challenges to meet the legal and the population’s health care expectations (La Hoz, 2018; United States Agency for International Development, 2013). The purpose of this study was to evaluate how well Dominican nursing students, who have completed their internship but not yet defended their final career project, assessed themselves against a set of international nursing competencies. In addition, the purpose was to explore any differences in their self-assessments based on whether these students completed their internship at public health care centers or not. Finally, the goal was to determine to what extent do …

Nitrous Oxide Use For Minor But Painful Pediatric Procedures, Samantha Kremer

Dissertations

Problem: Nitrous oxide (N₂O) is used for mild to moderate pain control and anxiolysis. Registered nurses (RN) as providers of N₂O administration may decrease the number of missed opportunities for pain control or anxiolysis. The purpose of this quality improvement initiative was to evaluate the type of procedures and rate of N₂O administration by providers, and cost difference between them.

Method: A descriptive, cohort-design for pediatric patients in the Imaging and Sedation Department between October through November of 2017 and 2018. Data was compared between physicians in 2017 and either a physician or RN …

Older Adults’ Implementation Of Discharge Instructions Following An Acute Care Hospital Stay, Brenda Miller

Dissertations

Discharge instructions are a self-care guide for patients after discharge from an acute care hospitalization. The discharge process starts on admission to the hospital and continues until discharged. Many patients rely on informal caregivers to provide support after a discharge. However, it is often unclear whether the patients or caregivers completely understand instructions provided during the discharge process. Key concepts related to how discharge instructions were implemented following discharge to home have been understudied from the patient’s and informal caregivers’ perspectives. Developing effective discharge instructions based on study findings may assist in reducing 30-day hospital readmission rates.
This study was …

The Use Of Clinical Decision Support To Improve Nursing Practice, Kathleen Klimpel

Dissertations

Healthcare information technology is solidly entrenched in most acute care hospitals but the need to demonstrate its positive impact on patient outcomes persists. Clinical decision support (CDS) is an informatics tool that is highly customizable to promote patient improvement activities. Despite its high potential, studies have had mixed results regarding the impact of CDS and it has not been widely studied in the realm of nursing practice. One aim of this dissertation was to analyze the concept of CDS in order to inform the examination of the relationships between CDS implementation and nursing interventions. The determining factors of nurses use …

Attitudes Of New Graduate Rns Regarding Their Readiness For Practice Before And After Hospital Orientation, Diane Young

Dissertations

The acuity level of patients continues to increase making it more vital than ever that new graduate Registered Nurses (RNs) be prepared to give safe, quality care when leaving their hospital’s orientation program (Spector et al., 2015). Today, new graduate RNs need orientation programs that will ensure a smooth transition into nursing practice. This involves the ability to apply higher-level knowledge and skills in everyday practice situations, thereby, maintaining quality care (Henderson, Ossenberg, & Tyler, 2015).

The purpose of this study was to identify differences between new graduate RNs’ opinions on readiness for practice, as measured by the Casey-Fink Readiness …

Simulation As Replacement For Traditional Clinical In Pre-Licensure Nursing Education: Outcomes Of Different Ratios Of Replacement Time For Traditional Clinical With Simulation, Tiffany Zyniewicz

Dissertations

The use of simulation in nursing education has grown over the last 30 years. The National Council of State Boards of Nursing National Simulation Study indicated that up to 50% of traditional clinical hours can be replaced with simulation at a 1:1 replacement ratio and produce the same outcomes. A review of the literature indicated that there is no standard replacement ratio for simulation time to traditional clinical time being used in pre-licensure nursing education in the United States. The purpose of this study was to explore the outcomes of utilizing a 1:1 simulation-to-traditional clinical time replacement ratio and a …

Implementing A Caps Simulation To Increase Nursing Education Practice Students’ Self-Awareness Of Attitudes And Beliefs About Poverty, Melissa Ehmke

Dissertations

Problem. The purpose of this project is to determine if college students who are currently in nursing school, will benefit from the addition of a poverty simulation to positively influence their self-awareness and individual-level beliefs and attitudes towards poverty, therefore being able to serve those in poverty fully and guide them to appropriate resources.

Methods. Bachelor of Science in Nursing (BSN) and Doctoral Nursing Practice (DNP) students participated in a three-hour Community Action Poverty Simulation (CAPS). A twenty-one item Attitude Toward Poverty Scale short form (ATPS) survey was completed pre and post-simulation participation.

Results. Significant improvements resulted in three of …

High School Seniors' Educational Experience Lnfluencing The Decision To Pursue A Career In Nursing, Ryan L. Rowe

Dissertations

Many high school students interested in nursing as an occupation choose to engage in a Career and Technical Education (CTE) program and subsequently progress through the exploration stage of Super’s Career Development Theory in a succinct, deliberate, and intentional manner. While CTE continues to serve as an educational option for many high school students interested in nursing, its value as a means for students to crystallize, specify, and implement the choice to pursue the high-wage, high-skill, and high-demand career of nursing is not understood to the extent possible. CTE is regularly overlooked as a viable educational option by high school …

Simulation Using A Standardized Patient To Measure Perception And Congruency Of Spiritual Care For A Veteran From Three Perspectives To Inform Nursing Education And Practice, Mary E. Desmond

Dissertations

Spiritual care refers to a purposeful process of helping another find meaning and purpose

in life through a mutual connection. Providing spiritual care is a professional nursing mandate, yet nurses report barriers in education and practice. Veterans want spiritual care to promote quality of life, and to cope with military experiences and chronic conditions. Patients report receiving less than desired spiritual care and nurses report infrequent provision of spiritual care. It is also unclear how congruent patients and nurses are in their perceptions of spiritual care. A spiritual care simulation and performance checklist was developed using a review of the …

Simulation Learning And Transfer To The Clinical Environment In Undergraduate Nursing Students, David A. Miles

Dissertations

Simulation learning is an integral component of many undergraduate nursing programs throughout the country. Experiential learning through simulation allows students to improve their cognitive, affective, and psychomotor skills. Some clinical experiences lack significant practice of clinical skills for students; including the inability to assume the role of the nurse. A recent literature review revealed a need to advance the understanding of simulation learning and transfer; with many questions still remaining unanswered. The aim of this study was to conceptualize the process by which simulation learning transfers to the clinical environment in undergraduate nursing students. Twenty-five, fourth-year traditional nursing students, who …

What Is The Process Of Relational Work Of The Nurse?, Daniela Terrizzi Defrino

Dissertations

The process of how nurses work in relationships to accomplish their work is presented in this dissertation. This study has made the relational work process of nurses explicit. While research demonstrates that increased nurse staffing is associated with better patient outcomes and with nurses experiencing less burnout and job dissatisfaction, the process is not explored in the empirical literature.

The research question was: “What is the process of relational work of the nurse?” Data collection and analysis conformed to the process of classical grounded theory. Interviews were face to face with 23 registered nurses working as direct care staff nurses …

Academic And Non-Academic Variables As Predictors Of Nclex-Rn Success Among Traditional Associate Degree Students At Southern Adventist University, Christine Moniyung

Dissertations

Problem

The School of Nursing at Southern Adventist University offers both Associate of Science and Bachelor of Science in nursing degrees. A majority of the students who sit for the NCLEX-RN are associate of science in nursing graduates. The pass rate dropped from 94.9% in 2010 to 88.8% in 2011. The pass rate went up to 93.3% in 2012, but dropped again by almost 5% in the following year, and to an all-time low of 76.5% in 2014.

Unlike most AS nursing program student populations in the nation, the majority of SAU students are young and considered traditional-age college students. …

Attitude, Subjective Norm, And Perceived Behavioral Control As Indicators For Nurse Educators’ Intention To Use Critical Thinking Teaching Strategies: A Structural Equation Model Analysis, Angerlita Yolanda Smith

Dissertations

Problem

Deficiencies in new nursing graduates’ ability to use critical thinking skills have been documented. Researchers have found that the continued use of traditional teaching methods and less student-centered approaches for critical thinking development has contributed to this problem. This particular issue has evoked much concern for institutions and organizations involved with the safe delivery of patient care. The purpose of this study was to examine (a) the relationship between the factors educator characteristics, attitude, subjective norm and perceived behavioral control in a hypothesized model that may influence nurse educators’ intention to use instructional methods that promote critical thinking in …

Onsite Integrative Clinics: Acupuncture, Positive Patient Outcomes, And Frequency Of Provider Office Visits, Sherry Shoemaker Phd

Dissertations

Purpose and Aims. There is limited information about outcomes of care, resource utilization, and associated costs for patients who receive acupuncture in integrative health settings. The purpose of this study was to address this gap through the following aims: To examine: (1) changes in patient pain levels pre/post acupuncture treatments; (2) relationships between receiving acupuncture treatments (number of treatments, length of time, select demographic factors, (age, gender), pain level pre and post acupuncture treatments; (3) relationships between number of treatments, length of time, age, gender, pain level (pre/post acupuncture treatments) and provider visits (pre/post acupuncture treatments); and (4) relationship between …