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Walden University

Theses/Dissertations

2018

Articles 1 - 30 of 516

Full-Text Articles in Medicine and Health Sciences

Effects Of Cancer Staging On Maternal Coping And Mother-Child Communication Patterns Among Breast Cancer Survivors, Kevin Michael Lycke Jan 2018

Effects Of Cancer Staging On Maternal Coping And Mother-Child Communication Patterns Among Breast Cancer Survivors, Kevin Michael Lycke

Walden Dissertations and Doctoral Studies

Few researchers have examined the relationship between earlier stages of breast cancer and its effect on staging of the disease process and the co-occurring coping and communication patterns between mothers and their children. The purposes of this qualitative study with a multiple case study design were to examine (a) coping mechanisms that mothers used to manage the uncertainty of their breast cancer status and (b) the impact of early-stage breast cancer on communication patterns between mothers and their children. The Lazarus and Folkman theory of psychological coping and the McMaster family systems communication theory informed the conceptual framework for the …

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Transition Of Care Guideline For Reducing Heart Failure Hospital Readmission, Geeti Farrahi Jan 2018

Transition Of Care Guideline For Reducing Heart Failure Hospital Readmission, Geeti Farrahi

Walden Dissertations and Doctoral Studies

Heart failure (HF) patients are among the populations with the highest rates of hospital readmission within 30 days of discharge. Because of the 2010 Health Care Reform legislation, healthcare organizations are subject to financial penalty when a patient population exhibits excess readmissions. A significant reason for readmission of HF patients is a gap in the transition of care from hospital to home. The purpose of this doctoral project was to develop a practice guideline of best practices for transitioning HF patients from hospital to home. The transitional care model and care transitions intervention provided the theoretical underpinnings for developing this …

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Nursing Pain Management In An Emergency Room With Hallway Overflow, Zaida Ruiz Jan 2018

Nursing Pain Management In An Emergency Room With Hallway Overflow, Zaida Ruiz

Walden Dissertations and Doctoral Studies

Overcrowded emergency rooms (ERs) decrease the flow of nursing care creating a delay in nurse-administered pain management leaving patients in pain. The project-focused question asked if ER nurses felt that overcrowding in the ER led to inadequate pain management and if a clinical practice guideline (CPG) could be developed to promote effective pain management in the setting. Callista Roy's theory of human adaptation was used to guide the project. To prepare for CPG development, data from a simple random selection of 10 nurses who had worked in the ER for a minimum of 6 months was obtained from the practice …

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Low Health Literacy And Hpv Vaccine Uptake Of African American And Hispanic American Women, Peter Ntiamoah Jan 2018

Low Health Literacy And Hpv Vaccine Uptake Of African American And Hispanic American Women, Peter Ntiamoah

Walden Dissertations and Doctoral Studies

Cervical cancer incidence in the United States has declined for the past 40 years, yet the odds of developing cervical cancer is much higher among marginalized women, particularly African American and Hispanic American women. Although preventable through vaccination against the human papillomavirus (HPV) prior to infection, uptake and completion rates of the vaccine among African American and Hispanic American women are low. The purpose of the study was to determine if a significant relationship existed between the health literacy levels of African American and Hispanic American women, ages 18-26, and the low HPV vaccination uptake. The integrated behavioral model, which …

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Cultural And Environmental Determinants Of Dental Discoloration Among School-Aged Children In Nigeria, Ogbudu Gabriel Ada Jan 2018

Cultural And Environmental Determinants Of Dental Discoloration Among School-Aged Children In Nigeria, Ogbudu Gabriel Ada

Walden Dissertations and Doctoral Studies

Dental discoloration from fluorosis is a global public health problem. In Nigeria, 11.4% of the population is impacted by this disorder. Dental discoloration is caused by successive exposures to high fluoride concentrations during tooth development in utero and it is linked to the development of a variety of psychological and physiological problems, from dental aesthetics to a reduction in intelligence and skeletal changes. The purpose of this quantitative, cross-sectional study was to examine the cultural and environmental determinants of dental fluorosis in children in a rural community in Nigeria. A multilevel theoretical model was used to develop possible fluoride exposure …

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Chronic Care Management Services At A Clinical Medical Group, Sharon Guccione Jan 2018

Chronic Care Management Services At A Clinical Medical Group, Sharon Guccione

Walden Dissertations and Doctoral Studies

The purpose of this project was to design a chronic care plan using the chronic care management (CCM) framework to improve health services at lower healthcare costs. The practice-focused question explored whether the operationalization of the CCM model would impact progress toward the management of chronic illness for the target population of Medicare beneficiaries with 2 or more chronic illnesses in an urban acute care agency located in the western United States. The middle-range theory, logic rational plan model, Lewin’s change theory, and the CCM’s coordination care and collaborative care concepts were used to guide the project. Data were collected …

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Generational Homelessness In New York City Family Homeless Shelters, Deborah Johnson Jan 2018

Generational Homelessness In New York City Family Homeless Shelters, Deborah Johnson

Walden Dissertations and Doctoral Studies

Homelessness has been a problem in New York City (NYC) for decades. Part of the problem is children who grew up in the shelter system and then returned as adults, a phenomenon known as 2nd-generation homelessness. Literature indicates that no researchers have interviewed second-generation homeless adults about their experiences. The purpose of this study was to explore the experience of 2nd-generation homelessness from the perspective of homeless adults returning to the shelter system. The sample included 1 second-generation homeless adult and 10 case managers at Tier II homeless shelters. Interviews were conducted and data were analyzed using hand coding to …

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Improving The Care Of Patients With Urinary Catheters Through A Quality Improvement, Ashley Nicole Holmstrom Jan 2018

Improving The Care Of Patients With Urinary Catheters Through A Quality Improvement, Ashley Nicole Holmstrom

Walden Dissertations and Doctoral Studies

Catheter-associated urinary tract infections (CAUTI) significantly increases patient morbidity and mortality, length of stay, and organizational cost. In the 2 years prior to project implementation, the incidence of CAUTI increased by 15% in the local acute care, inpatient facility that served as the project site. Nursing leaders at the project site linked the increase in CAUTIs to a nursing knowledge deficit related to CAUTI prevention principles. The clinical question focused on the impact of CAUTI prevention staff training on the incidence of CAUTI, length of stay, and cost to the local acute care organization. After a review and critical appraisal …

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Spiritual Wellness As A Predictor For Moral Injury In Combat Veterans, Steve Zappalla Jan 2018

Spiritual Wellness As A Predictor For Moral Injury In Combat Veterans, Steve Zappalla

Walden Dissertations and Doctoral Studies

Many combat veterans face difficulties coping with their personal lives, relationships, and families when they leave the service and return to civilian life. Most studies examining the effects of combat on veterans focus on posttraumatic stress disorder (PTSD) as well as a collection of related consequences. Interest in the term moral injury of military veterans as a related mental health construct has grown. Researchers have investigated the effects of spiritual wellness of combat veterans. However, there is a paucity of counseling literature on the relationship between spiritual wellness and moral injury when combat veterans return to civilian life. Investigating the …

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Strategies Small Construction Business Managers Use To Reduce Safety Incidents In Their Organization, Peggy Ann Mcknight Jan 2018

Strategies Small Construction Business Managers Use To Reduce Safety Incidents In Their Organization, Peggy Ann Mcknight

Walden Dissertations and Doctoral Studies

Globally the construction industry struggles to prevent injurious and fatal safety incidents. The purpose of this single case study was to explore strategies used by construction business managers that had significantly reduced the occurance of safety incidents in a Northwest Ohio construction company. Data were collected from organizational records and interviews with 6 construction managers. The conceptual framework for this research was the concept of safety management systems. Data were compiled and organized, disassembled into fragments, grouped, and then interpreted for meaning. Methodological triangulation and member checking were used to enhance reliability and validity. Four themes emerged from the data: …

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Improving Outcomes For Congestive Heart Failure Patients, Diana Lee Collins Jan 2018

Improving Outcomes For Congestive Heart Failure Patients, Diana Lee Collins

Walden Dissertations and Doctoral Studies

Managing patients diagnosed with congestive heart failure (CHF) requires coordination with subspecialties and frequent outpatient monitoring. The lack of communication among health care providers and patients can result in a gap in practice when managing patients with CHF in the outpatient setting. Guided by the chronic care model, this quality improvement project was an initiative to develop and implement a 6-week self-care management program provided by nurse practitioners in an outpatient primary care practice. The goal of the project was to improve the day-to-day self-care management of patients with CHF and addressed the practice-focused question of whether a 6-week CHF …

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The Use Of Scorecards To Improve Documentation Of Obstetrical Blood Loss, Marilyn Cejka Steinberg Jan 2018

The Use Of Scorecards To Improve Documentation Of Obstetrical Blood Loss, Marilyn Cejka Steinberg

Walden Dissertations and Doctoral Studies

Obstetric hemorrhage is one of the most common causes of maternal morbidity and mortality. The measurement of quantitative blood loss (QBL) at delivery prevents clinicians from failing to recognize hemorrhage in healthy obstetric patients who initially compensate for excessive blood loss. The purpose of this project was to improve the compliance of labor and delivery nurses in a community hospital with consistent QBL measurement. Key theories that formed the basis for the project were Lewin's theory of planned change and homeostasis. The project question addressed was: Is the use of weekly scorecards to provide feedback to nurses with both blinded …

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Implementation Of A Diabetic Resource Toolkit In A Veterans Administration Emergency Department, Caroline Hairston Jan 2018

Implementation Of A Diabetic Resource Toolkit In A Veterans Administration Emergency Department, Caroline Hairston

Walden Dissertations and Doctoral Studies

Diabetes is the 7th leading cause of death in the United States. Uncontrolled diabetes and lack of self-care knowledge leads to increased emergency department (ED) visits, utilizing limited health care resources. The practice-focused question asked whether a patient-focused diabetic self-care toolkit could decrease the number of diabetes-related ED visits. The purpose of this project was to reduce the number of diabetes-related ED visits and was supported by the social cognitive theory. The sources of evidence included the facility's ED Information System (EDIS) data and a patient survey developed by the project lead. There were 149 participants (135 males and 14 …

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A Chronic Obstructive Pulmonary Disease Self-Management Packet To Reduce 30-Day Readmissions, Josette Askratni Jan 2018

A Chronic Obstructive Pulmonary Disease Self-Management Packet To Reduce 30-Day Readmissions, Josette Askratni

Walden Dissertations and Doctoral Studies

Chronic obstructive pulmonary disease (COPD) signifies a significant public health challenge that is both avoidable and treatable. There was no standardized education offered to the COPD population at the practice location. The scope of the project encompassed standardizing education by developing a self-management packet for the COPD patients. The goal of this project was to examine how the development of a standardized COPD self-management packet enhances the quality of care and strategizes reducing 30-day readmissions compared to nonstandardized delivery of education. Orem's self-care theory and Bandura's self-efficacy concept were used to explain the principle of self-management, while Rosswurm and Larrabee's …

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Development Of A Quality Improvement Program To Support Evidence-Based Nursing Practice, Heather Richards Jan 2018

Development Of A Quality Improvement Program To Support Evidence-Based Nursing Practice, Heather Richards

Walden Dissertations and Doctoral Studies

Nurses are expected to perform evidence-based practice (EBP) at the point of care (POC) to promote positive outcomes through the quality and safety of patient care. The struggle for nurses on the surgical digestive unit in a hospital to adopt EBP is the lack of access and knowledge to evidence-based research at the POC. The utilization of information technology is an innovated approach to providing access and knowledge for EBP at the POC to improve patient outcomes. The project was to develop a quality improvement program to improve nursing access and knowledge of EBP resources. The program was to identify …

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Improving Hand Hygiene In An Intensive Care Unit, Charles Chukwuemeka Njenje Jan 2018

Improving Hand Hygiene In An Intensive Care Unit, Charles Chukwuemeka Njenje

Walden Dissertations and Doctoral Studies

Health-care-associated infections (HCAIs) affect hundreds of millions of people worldwide, causing morbidity and mortality among hospitalized patients. About 2 million patients suffer from HCAIs in the United States, and it is estimated that 99,000 of them die each year. Studies have indicated that transmission of health-care-associated microorganisms occurs through contaminated hands of health care workers. Hand hygiene (HH) is the single most effective way to prevent health-care-associated infections, yet health care workers' hand hygiene compliance remains low. One factor responsible for poor compliance with hand hygiene guide-lines are lack of knowledge of good hand hygiene and lack of hand hygiene …

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Stress, Anxiety, And Depression: Role Of Campus Connectedness, Social Support, And Coping Among Nepalese Nursing Students, Priscilla Samson Jan 2018

Stress, Anxiety, And Depression: Role Of Campus Connectedness, Social Support, And Coping Among Nepalese Nursing Students, Priscilla Samson

Walden Dissertations and Doctoral Studies

High levels of stress, anxiety, and depression (SAD) can adversely influence physical health, psychological well-being, and academic and clinical performance of nursing students. Numerous studies have identified the factors associated with SAD; however, a paucity of empirical research addresses the relationship of SAD with campus connectedness (CC), perceived social support (PSS), and coping. The purpose of this quantitative cross-sectional study, guided by Lazarus and Folkman's theory of stress, coping, and adaptation, was to determine the prevalence of SAD and examine its relationship with CC, PSS, and coping among undergraduate nursing students of Nepal. Survey research was conducted using depression anxiety …

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Causes Of Recidivism Among Mentally Ill Prerelease Offenders From The Perspective Of Former Correctional Mental Health Professionals, Rina Desiree Deneice Bradley Brown Jan 2018

Causes Of Recidivism Among Mentally Ill Prerelease Offenders From The Perspective Of Former Correctional Mental Health Professionals, Rina Desiree Deneice Bradley Brown

Walden Dissertations and Doctoral Studies

The move toward reducing the prison population was driven by an increase in the number of reentry programs that focused on the needs of the offender, such as the provision of stable housing, employment, education, and sustaining strong familial bonds. While the literature supported these areas as being effective in reducing recidivism, there was no consensus that they were effective for offenders with mental illness (OMI). The purpose of this qualitative study was to analyze the impact of prerelease services for the OMI population from the perspective of former correctional mental health professionals who provided these services. The research questions …

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Coping With Sickle Cell Disease Using Cognitive Behavior Therapy, Helen Alexander Jan 2018

Coping With Sickle Cell Disease Using Cognitive Behavior Therapy, Helen Alexander

Walden Dissertations and Doctoral Studies

This project focused on identifying the best evidence available on the use of cognitive behavior therapy (CBT) for pediatric patients and families with sickle cell disease (SCD) to improve their coping skills with pain management. This resulted from an identified gap in nursing practice regarding psychosocial support for this subset of hospitalized pediatric patients. The practice-focused question was whether there was evidence in the literature on the use of CBT techniques to improve parental coping skills with children who have chronic and life-threatening illness that could be utilized with sickle cell disease. The theory of stress and coping guided the …

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Initiating Kangaroo Care In The Neonatal Intensive Care Unit, Karen Stadd Jan 2018

Initiating Kangaroo Care In The Neonatal Intensive Care Unit, Karen Stadd

Walden Dissertations and Doctoral Studies

Kangaroo care (KC) is a cost-efficient method to increase infant-parent bonding and neonatal health outcomes worldwide. Despite evidence supporting KC in critically ill infants, nursing perceptions regarding patient safety and interrupted work flow continued to impede practice in the local high-tech neonatal intensive care unit (NICU). Their current policy failed to address the 2-person transfer method recommended for safe practice. In addition, both staff and parents lacked training and education regarding the benefits and feasibility of KC. This doctoral project aimed to decrease practice barriers and promote earlier and more frequent KC by developing and integrating an evidence-based clinical pathway …

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Developing Neonatal Gavage Tube Guidelines To Decrease Feeding Intolerance, Elizabeth Demeester Webster Jan 2018

Developing Neonatal Gavage Tube Guidelines To Decrease Feeding Intolerance, Elizabeth Demeester Webster

Walden Dissertations and Doctoral Studies

A nutritional method commonly used to deliver feedings to premature infants is the use of a gavage tube. To measure for any undigested breastmilk or formula, a gastric aspirate is checked prior to the next feeding. There is a gap in practice as to what to do if these aspirates signify feeding intolerance. The project question centered on identifying evidence-based guidelines in the literature that would help to define best practices related to feeding intolerance of gavage-fed infants. The Johns Hopkins Nursing Evidence-Based Practice model and the Appraisal of Guidelines Research and Evaluation provided the frameworks for gathering and evaluating …

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The Impact Of Interprofessional Collaboration On Diabetes Outcomes In Primary Care Settings, Charette Coleman Deloach Jan 2018

The Impact Of Interprofessional Collaboration On Diabetes Outcomes In Primary Care Settings, Charette Coleman Deloach

Walden Dissertations and Doctoral Studies

Inadequate interprofessional collaboration (IPC) and communication among health care professionals are associated with medical errors and mortality. Guided by the theory of goal attainment and the chronic care model, a systematic review was conducted to explore the evidence related to whether interprofessional collaborative primary care can have a positive effect on health outcomes for patients living with diabetes (PLWD). The systematic review followed the Joanna Briggs Institute method for systematic reviews and results were complied with the PRISMA evidence-based minimum set for reporting. Data were analyzed to identify if IPC positively impacted the health outcomes of PLWD, as evidenced by …

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Smoking Cessation Education For Acute Care Nurses, Dawn Garcia-Brinker Jan 2018

Smoking Cessation Education For Acute Care Nurses, Dawn Garcia-Brinker

Walden Dissertations and Doctoral Studies

Tobacco use among veterans is significantly higher than among members of the general population. The purpose of this quality-improvement project was to increase acute care staff members' knowledge and confidence in using tobacco cessation interventions to increase quit rates among the inpatients of a veterans' hospital in the midwestern region of the United States. An evidence-based, standardized Tobacco Tactics Toolkit was developed and implemented, and a 6 sigma method guided the quality improvement process to define, measure, analyze, improve, and control the tobacco-cessation education initiative. The reach, effectiveness, adoption, implementation, and maintenance framework was used to ensure that evidence-based interventions …

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Enhancing Urinary Catheter Skills Among Clinically Practicing Nurses, Arvella Derisa Battick Jan 2018

Enhancing Urinary Catheter Skills Among Clinically Practicing Nurses, Arvella Derisa Battick

Walden Dissertations and Doctoral Studies

Catheter-associated urinary tract infections (CAUTIs) contribute to increased patient length of stay and health care costs. The literature has shown that one plausible cause of CAUTIs is improper Foley catheter insertion techniques among nurses. The purpose of this project was to answer the project-focused question that asked if there was a difference in nurses' practice skills following an educational intervention involving aseptic Foley insertion. Benner's novice-to-expert theory was the conceptual model for the study. Nurses from a college nursing program were asked to demonstrate Foley catheter insertion on a simulation model, and their technique was evaluated using a standardized checklist. …

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Advanced Practice Nurse Intervention And Heart Failure Readmissions, Tanesha Kemble Jan 2018

Advanced Practice Nurse Intervention And Heart Failure Readmissions, Tanesha Kemble

Walden Dissertations and Doctoral Studies

Heart failure (HF) is one of the main reasons for hospitalizations and readmissions. A local hospital collaborated with a skilled nursing facility (SNF) in 2012 with the goal of reducing systolic HF readmissions. This collaboration consisted of having an Advanced Practice Nurse (APN) who specializes in cardiac care follow up with all patients discharged from the hospital to the SNF with a diagnosis of systolic HF. The practice-focused question for this project addressed whether early follow-up and continuity of care by a cardiac APN would decrease hospital readmission within 30 days in patients with systolic HF who are discharged to …

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Workplace Bullying From A Nurses Perspective, Dawn Reid White Jan 2018

Workplace Bullying From A Nurses Perspective, Dawn Reid White

Walden Dissertations and Doctoral Studies

Bullying has long been associated with school children. In recent years, however, more attention has been paid to the bullying that has reached beyond the playground and into the workforce. One population facing this problem is staff nurses. To date, no one has found an effective way to address workplace bullying in the healthcare field, nor have effective methods been found for retaining trained nurses affected by this problem. The focus of this dissertation was on understanding nurses' lived experiences and how nurses decided to remain in their current working position despite these problems. Taking a phenomenological approach and using …

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A Clinical Practice Guideline For Pain Management In The Post Anesthesia Care Unit, Susan Mogan Jan 2018

A Clinical Practice Guideline For Pain Management In The Post Anesthesia Care Unit, Susan Mogan

Walden Dissertations and Doctoral Studies

Ineffective pain management in the post anesthesia care unit (PACU) increases patients' risk of adverse effects including decreased mobility, infection, chronic pain, depression, cardiopulmonary complications, increased length of stay, insomnia, fatigue, and overall decrease in quality of life. The PACU in a community hospital did not provide an evidence-based pain management guideline for nurses treating postoperative patients, resulting in nurses' concerns about providing pain management. The purpose of this project was to translate evidence on pain management into an evidence-based guideline for improved nursing practice in a PACU. Evidence was obtained from a detailed literature search using multiple databases and …

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Reducing Home Health Copd-Related 30-Day Hospital Readmissions Using Telehealth Technology, Steven Eric Stammer Jan 2018

Reducing Home Health Copd-Related 30-Day Hospital Readmissions Using Telehealth Technology, Steven Eric Stammer

Walden Dissertations and Doctoral Studies

Chronic obstructive pulmonary disease (COPD) is a collection of chronic conditions that results in irreparable lung damage and stress to patients. COPD also has considerable financial impacts on health care entities due to frequent hospital readmissions of COPD patients. The Centers for Medicare and Medicaid Services penalize care entities for 30-day hospital readmissions. Many rehospitalizations attributed to COPD are due to exacerbations, often preceded by physiologic and emotional changes that can be monitored, allowing action to be taken to prevent readmissions. The practice problem for this quality improvement project explored whether the use of remote home monitoring of COPD patients …

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Reducing Clabsi Rate Among Icu Patients, Rita L. Walker Jan 2018

Reducing Clabsi Rate Among Icu Patients, Rita L. Walker

Walden Dissertations and Doctoral Studies

Approximately 55% of intensive care unit (ICU) patients require the use of a central venous catheter (CVC). CVCs are often an essential component of care; however, CVCs can create avenues for pathogens to enter the bloodstream and cause a central line-associated bloodstream infections (CLABSI), which can lead to increased mortality and morbidity, prolonged length of stay, increased cost of care, decreased patient satisfaction, and increased workload. In 2017, the CLABSI rate at the project site was 4.3 per 1,000 catheter days as compared to the national rate of 0.8 per 1,000 catheter days. Based on Piaget's theory of constructivism, a …

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Comparing A General And Transitional Registered Nurse Orientation To Facilitate Quality Improvement, Kathryn R. Cortes Jan 2018

Comparing A General And Transitional Registered Nurse Orientation To Facilitate Quality Improvement, Kathryn R. Cortes

Walden Dissertations and Doctoral Studies

Most hospitals orient new graduate nurses and experienced nurses in the same generalized orientation programs. To address the cost of orientation to specialty units, a pediatric hospital developed a tailored transitional residency orientation program for experienced nurses. The purpose of this project was to describe, compare, and evaluate the existing generalized orientation program and the transitional orientation program to determine how the orientations differed in structure, process, and outcomes. Donabedian's model assessing quality of care services and Benner's novice-to-expert theoretical framework served as guides in evaluating the orientation outcomes. Qualitative data about residency classroom time, preceptor selection and time, mentor …

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