Medicine and Health Sciences Commons^™

Depression Screening In Poststroke, Shannah Lowe

Walden Dissertations and Doctoral Studies

Depression, a sequela of stroke, is underrecognized and underreported. The American Heart/Stroke Association estimated 1/3 of patients develop depression after a stroke. Depression after a stroke has negative influence on stroke recovery through decreased participation in rehabilitation, and increased morbidity and mortality. The American Heart/Stroke Association recommended that depression screening be conducted on stroke patient; however, there is a lack of guidance regarding the optimal time and tools for depression screening. The practice problem identified was the absence of depression screening in poststroke patients at the project site. The project question focused on identifying evidence-based approaches for depression screening in …

Relationship Between Post-Resuscitation Debriefings And Perceptions Of Teamwork In Emergency Department Nurses, Kerri Lyman

Walden Dissertations and Doctoral Studies

Emergency department nurses are faced with traumatic patient events while functioning as members of multidisciplinary teams. Critical incident debriefing has been shown to benefit health care professionals and patient clinical outcomes. The purpose of this quantitative correlational study was to examine the relationship between the use of formal post-resuscitation debriefings and perceptions of teamwork in emergency department nurses. The study also addressed the type and timing of debriefing to determine whether these factors impacted perceptions of teamwork. The nurse as wounded healer theory served as the theoretical framework. Data from the Nursing Teamwork Survey were collected from 68 emergency department …

Development Of A Tele-Healthcare Clinical Practice Guideline For Diabetic Patients, Kathy J. Montgomery

Walden Dissertations and Doctoral Studies

Lack of access to healthcare in rural communities has resulted in increased morbidity and mortality rates among diabetic patients. The problem identified in this project was the lack of access to healthcare among diabetic patients living in rural southeast Ohio. Tele-healthcare is a strategy that provides healthcare remotely and has been introduced into the rural setting and offers an appropriate healthcare delivery mode for the rural community. The purpose of the project was to develop a tele-healthcare clinical practice guideline, including smart phone applications, for the management of diabetic patients. An expert panel consisting of 2 advanced practice nurses in …

Improving Nursing Knowledge Of African American Heart Failure Self-Care Management, Sharnee Moore-Jervis

Walden Dissertations and Doctoral Studies

Heart failure is a complex chronic disease affecting 6.6 million people in the United States, with an annual cost of $39.2 billion per year. African Americans are at an especially high risk for poor outcomes and readmissions from heart failure complications, as they are 2.5 times more likely to develop heart failure than other ethnic groups. This disease requires a high level of patient self-care management, and evidence suggests that African Americans do not always receive culturally sensitive education, which can lead to suboptimal self-care practices. The practice-focused question for this educational program asked whether nurses of African American patients …

A Lifestyle Modification Toolkit To Increase Physical Activity Among Young Adults, Anthonia Ninikanwa Nwanna

Walden Dissertations and Doctoral Studies

Substantial decreases in physical activity have been observed between early to late adolescence in males and females, with decreases in levels of activity into adulthood. Physical inactivity among young adults leads to medical conditions such as Type 2 diabetes, stroke, ischemic heart disease, falls resulting in hip fractures, and depression later in life. Advanced Nurse Practitioners have a significant impact on the problem of physical inactivity among young adults through education to improve knowledge regarding physical activity participation. The focus of this project was to develop a toolkit on lifestyle modification as a resource for physical education teachers and nurses …

Staff Education: Hypertension Management For Adults In Primary Care Settings, Doris Adediwura Obaze

Walden Dissertations and Doctoral Studies

Management of hypertension and its complications requires health care providers to

understand the reason for developing the disease. Complications of hypertension (HTN)

are more prevalent when patient interventions are not consistently performed by staff. A

gap in staff knowledge regarding the management of patients with HTN was noted at an

outpatient clinic in the southwestern United States. A staff education project based on

the Eighth Joint National Committee (JNC-8) guidelines for HTN management was

developed to address the gap in knowledge. This DNP project sought to understand the

impact of an evidence-based staff education program in improving the knowledge of …

An Instructional Module For Nurses To Teach Patients With Gestational Diabetes Mellitus, Josephine Onyekachi Ollawa

Walden Dissertations and Doctoral Studies

Gestational diabetes mellitus (GDM) is a carbohydrate metabolism issue during pregnancy that is dangerous for mother and the baby. GDM occurs in 1 out of 3 diabetic women in 16.2% of live births. GDM knowledge and treatment practices among nurses were found inadequate when nurses’ effectiveness in treating a disease they have a shallow knowledge about (GDM) was investigated in the local medical facility. A GDM instructional module was applied and its effectiveness in promoting nurse’s use of GDM education as a treatment strategy tested. The total concept for knowledge and care, empowerment and the social cognitive theories grounded this …

Development Of A Nurse Residency Program In Perinatal Nursing, Elizabeth W. Roberts

Walden Dissertations and Doctoral Studies

Staffing turnover created a challenge for the women’s services department of a hospital in the southern United States, potentially compromising care for women and infants during childbirth. The gap in practice was the lack of a structured nurse orientation/residency program for nurses new to perinatal nursing, which requires specific competencies not learned at the prelicensure level of education. The guiding practice-focused question was whether a multidisciplinary team could develop a formal evidence-based perinatal nurse residency program that would meet the needs of on-boarding and support for the new nursing hires at this facility. A team of experienced nurses, which included …

Sleep Deprivation In The Intensive Care Unit: Lowering Elective Intervention Times, La Von Michelle Ross Purdie

Walden Dissertations and Doctoral Studies

Sleep deprivation is a multifactorial phenomenon, occurring frequently in the intensive care unit (ICU) and linked to adverse patient healthcare outcomes. The key practice question of this project focused on determining if retiming of routine laboratory and imaging testing outside of the designated “quiet time” can improve sleep quality among adult patients in the ICU. The purpose was to evaluate the effectiveness of implementing an evidence-based intervention to improve sleep quality in the ICU setting. The theoretical framework was the plan-do-study-act model, which offered a process for implementing a practice change and reevaluation of the intervention’s sustainability within the organization. …

Direct Care Staffs’ Experiences And Perceptions Of Person-Centered Care Training, Jennifer Miranda Strollo

Walden Dissertations and Doctoral Studies

Many long-term care (LTC) facilities within the United States have replaced the institutional model of care with one that accepts person-centered care (PCC) as the guiding standard of practice. Quality training ensures that direct care staff have the skills and the knowledge in the delivery of quality PCC. However, many nurses and nursing assistants have expressed the desire for further training in PCC practices to effectively deliver quality care. The purpose of this study was to explore the types and length of training and education provided based on the perceptions and experiences of direct care staff related to their implementation …

Impact Of Transitional Care Model On Readmissions Of Adults With Chronic Heart Failure, Sheila Delaine Stuckey

Walden Dissertations and Doctoral Studies

Chronic heart failure (CHF) is often associated with high morbidity, mortality, and increased health expenditures. The readmission rate of patients with CHF is approximately 30% within 30 to 60 days following discharge. This project examined the literature to identify best practices based on the use of the transitional care model (TCM) in the reduction of hospital readmissions among older patients with CHF. The review included articles that were published between 2015 and 2019, used a quantitative study methodology, were peer-reviewed, and written in English. Keywords used in the search were chronic heart failure, the transitional care model, and hospital readmissions. …

Effect Of Multiple Entry Levels Into Nursing Practice And Professionalism, Ogechi Abalihi

Walden Dissertations and Doctoral Studies

Entry into professional nursing practice in the United States occurs at varied education levels including a diploma, an associate degree, and a baccalaureate degree. These multiple entry levels into practice create a situation where academic preparedness for nursing practice varies, which may influence the professional behavior of nurses and, consequently, patient care and outcomes. The purpose of this quantitative comparative study, guided by Miller's wheel of professionalism in nursing, was to determine if there is a difference in the professional behaviors of associate degree prepared registered nurses (RNs) compared to the professional behaviors of baccalaureate degree prepared RNs. The Behavior …

Bedside Nurses' Perceptions Of Pursuing An Academic Career As Nursing Faculty, Suzanne Lynne Benfield

Walden Dissertations and Doctoral Studies

There is a nursing faculty shortage at a Mid-Atlantic associate degree nursing program. In response, program administrators have hired adjunct faculty with bachelor of science in nursing degrees (BSNs), hired full-time faculty with master of science in nursing degrees in areas other than education who also are not certified nurse educators, and reduced its minimum requirement for nursing faculty clinical experience. The nursing faculty shortage combined with the resulting gaps in practice are problematic because they may (a) negatively influence the program's ability to produce degreed nurses; (b) increase faculty workload; (c) decrease the quality of student education, which may …

Novice Nurse Respiratory Educational Component's Impact On Confidence And Knowledge, Peggy Lynn Cline

Walden Dissertations and Doctoral Studies

The hospital-based novice nurse is presented daily with complex patients with multiple coexisting morbidities, which demands increasing responsibility for evidence-based clinical decision-making to prevent adverse health outcomes and associated high health costs. Knowledge and confidence of novice nurses in a medical-surgical unit in the assessment and clinic management of the respiratory system was identified as a gap during onboarding of new nurses. The purpose of this doctoral staff education project was to determine whether a respiratory educational component added to a medical-surgical novice nurse's orientation would impact the respiratory confidence and knowledge of respiratory assessment and clinical management. Benner's nursing …

Evaluation Of A Postpartum Hemorrhage Protocol, Lori M. Davies

Walden Dissertations and Doctoral Studies

Postpartum hemorrhage is a leading cause of maternal death, yet many deaths related to hemorrhage might be prevented with early recognition and intervention. The birthing unit of a U.S. community hospital formed an interprofessional task force to plan and implement a postpartum hemorrhage protocol that would provide the obstetric team with the knowledge, skills, and tools needed for early identification and quick action when hemorrhage occurred. Lewin's model of change provided a framework for protocol implementation. The purpose of this doctoral project was to evaluate this quality improvement project. Secondary data internal to the organization were collected and analyzed to …

Development And Evaluation Of A Long-Term Care Skills Simulation Program, Tina Marie Gerovac

Walden Dissertations and Doctoral Studies

New graduate nurses often lack clinical skill competency. In a single year, a long-term care facility located in the midwestern region of the United States reported 25 clinical errors, each costing the facility approximately $10,000. Root-cause analysis revealed 85% of those errors were made by nurses in their 1st year of practice. The increase in clinical errors were attributed to insufficient clinical preparation prior to independent practice. A review of the current scholarly literature suggested simulation had demonstrated efficacy in the development and maintenance of clinical nursing skills and answered the practice-focused question: Development of a skills simulation program for …

Physical Activity And Dietary Interventions For Adolescent African Americans In Mississippi, Tanga Deson Hart Robinson

Walden Dissertations and Doctoral Studies

African American (AA) adolescents have higher rates of obesity than many other ethnic groups, which increases their risk for obesity-related diseases. Culturally sensitive obesity preventive interventions have been unsuccessful, resulting in a steady increase of obesity among AA adolescents. AA adolescents in the southern region of the United States are at a higher risk for obesity and physical inactivity; knowledge and understanding of causative factors remains limited. To identify the impact of programs, a systematic review of the literature focused on structured physical activity and/or dietary education interventions in Mississippi. The ecological framework was used to guide this study. The …

Nursing Knowledge On Pressure Injury Prevention In The Intensive Care Unit, Yanick Jacob

Walden Dissertations and Doctoral Studies

Over 60,000 hospital patients die each year from complications associated with hospital-acquired pressure injuries (HAPIs). Pressure-injury rates have increased by 2% within the past decade as life expectancy has also increased due to high cost in Medicare. Evidence shows that the incidence of pressure injuries (PIs) in healthcare facilities is increasing, with high rates of occurrence in intensive care units (ICUs). At the clinical site for which this project was developed, multiple in-services had been provided to staff regarding PIs, but uncertainty persisted about how knowledgeable the nurses were. This project, using the Academic Center for Evidence Star Model of …

Compassion Fatigue In Emergency Department Nurses, Michelle Candice Lawrence

Walden Dissertations and Doctoral Studies

Compassion fatigue (CF) is defined as a sudden onset of the inability to experience feelings or compassion for others that is triggered by a nurse's inability to separate his/her feelings of stress and anxiety associated with caring for patients who have suffered from a traumatic event. The practice problem addressed in this doctoral project was the lack of knowledge of emergency department nurses (EDNs) related to CF in the work setting, resulting in a negative impact on a nurse's ability to provide quality care to patients. The purpose of the project was to present an educational program on how to …

Basic Quality Care Blood Pressure Teaching Plan, Dorine A. Lynch

Walden Dissertations and Doctoral Studies

Hypertension (HTN) is a leading risk factor for cardiovascular disease complications, disability, and mortality. Delayed detection of HTN increases the risk of the patient developing heart disease, renal failure, and stroke, which are among the leading causes of death in the US. Educating healthcare providers is, therefore, necessary to ensure accuracy when measuring blood pressure (BP) to improve the likelihood of early detection and commencement of treatment. The BP teaching project involved the development of an evidence-based teaching program to educate nurses at an East Coast Veterans' Administration Center on the guidelines of measuring BP. The practice-focused question addressed whether …

A Staff Education Module For Depression Screening In Acute Care, Olufumilayo Sayo Onuoha

Walden Dissertations and Doctoral Studies

Depression is one of the most common mental health disorders in the United States. Although it can be treated, it may go unidentified for a long period of time. The World Health Organization (WHO) anticipates that, by 2020, depression will become responsible for more disabilities than a combination of other conditions, excluding heart conditions. The prevalence of depression among the general population is higher in patients who seek emergency healthcare services. The purpose of this project is to develop an evidence-based educational module for nurses to screen for depression in an acute care setting using the PHQ-2 and PHQ-9 depression …

Ambidexterity And Innovation In Chief Nursing Officers In The Healthcare Setting, Jennifer Wasilewski

Walden Dissertations and Doctoral Studies

Leaders in the healthcare setting are challenged with competing responsibilities as they seek to provide high-quality services, ensure the implementation of safety measures, and engage in workforce maintenance. Many researchers have described innovation as a strategic approach to organizational concerns and have noted a failure to implement innovative measures in healthcare. This study was an investigation of the impact of ambidexterity in healthcare leaders on innovation. The purpose of this quantitative study, guided by the ambidexterity theory of leadership for innovation, was to analyze the extent to which ambidextrous leadership characteristics of healthcare executives and chief nursing officers (CNOs) influence …

Clinical Resource Practice Scenarios To Mitigate Bullying, Sabrina Renea Brown - Oliver

Walden Dissertations and Doctoral Studies

Workplace bullying is repeated, aggressive action towards a victim, which especially affects new graduate nurses and can inhibit growth and lead to nursing burnout and staff turnover. The purpose of this Doctor of Nursing Practice project was to develop a clinical resource educational module. The case scenarios were developed using literature on workplace bullying and lateral violence. Clegg's circuits of power theory was applied to frame the organizational authoritative nursing power struggles that exist as a circular flow between different nursing group members, and the American Nurses Association (ANA) Practice Standards and Code of Ethics guided the assertive communication. The …

Education Program For Critical Care Nurses On Preventing Catheter-Associated Urinary Tract Infections, Olatunde Olatunji

Walden Dissertations and Doctoral Studies

Catheter-associated urinary tract infections (CAUTIs) are the most frequently reported hospital-acquired condition, affecting more than 560,000 patients each year. CAUTIs prolong hospital stays and increase health care costs, and they can result in patient morbidity and mortality. Nurses can be empowered by receiving education and knowledge to manage and identify urinary catheters that are not clinically indicated. The purpose of this project was to develop an education program on CAUTI prevention for critical care nurses using the teach-back method. The conceptual framework that guided this project was Knowles's adult learning theory. The theoretical model was based on 4 fundamental assumptions …

A Practice Guideline For Triaging Mental Health Patients In The Emergency Setting, Florence Nguh

Walden Dissertations and Doctoral Studies

Today's emergency departments (EDs) are challenged with increasing numbers of patients with behavioral health (BH) issues and associated management problems. Patients presenting in the ED are increasingly in need of BH services due to a lack of available services in the community. The implication is that ED staff are faced with conducting a comprehensive review of their systems and processes for BH care delivery to ensure that the needs of this population are safely met. Specifically, this DNP project addressed the lack of evidence-based screening tools for the ED triage area for patients with BH issues. The purpose was to …