Delirium And Staff Injury, John Olague Jr

Master's Projects and Capstones

Abstract

Problem: From April 2021 to January 2022 there were 17 cases of reported patient aggression and staff injury due to patients in the hyperactive state of delirium. In a stroke/tele unit, diagnosis of delirium was delayed due to subjective assessment from the confusion assessment method (CAM) tool. This delay allowed patients to reach the hyperactive state of delirium which poses a threat to patient and staff safety. An objective form of assessment for delirium was needed on this stroke/tele unit.

Context: Through a microsystem assessment and strengths, weaknesses, opportunities, and threats (SWOT) analysis, stakeholders in this performance improvement plan …

Impact Of Montessori-Based Dementia Programming On Engagement And Affect Of Older Adults With Dementia, Meredith S. Sheppard

Master's Projects and Capstones

The COVID-19 pandemic has profoundly impacted the Adult Day Services program and Adult Day programs across the country. As the Adult Day Services program transitions to an in-person format, goals within the organization include developing appropriate programming, increasing group size, and keeping clients entertained. The framework guiding this quality improvement project is Montessori-Based Dementia Programming ® (MBDP). This project aims to increase client engagement, decrease client anxiety, and decrease staff workload. This will be measured by a self-developed staff workload survey, the Menorah-Park Engagement, and the Affect rating scale. Implementation of MBDP at the Adult Day Center did not meet …

Frailty Determination And Responsiveness In Left Ventricular Assist Devices, Sarah Schroeder

Theses & Dissertations

Frailty, the state of being vulnerable with susceptibility to decreased age-related physical reserve, is found in 56-79% of adults with end-stage HF receiving durable left ventricular assist device (dLVAD) therapy. Frailty increases risk of adverse events, including increased mortality in the dLVAD population, but less is known about depression, quality of life (QOL), cognition and frailty responsiveness. Therefore, we aimed to describe and compare frailty (5-Meter Walk Test, 5MWT), depression (Patient Health Questionnaire-9, PHQ-9), quality of life (EQ5D Visual Analog Scale, EQ-5D VAS) and cognition (Trailmaking B) from pre- to 12-months post-dLVAD We also compared demographics, clinical characteristics, and post-dLVAD …

Esp In Nursing: Building Communicative Competence For Internationally-Educated Nurses, Sami Vuong

Master's Projects and Capstones

The nursing shortage in the United States has been an ongoing issue due to nursing burnout and retirement. Together with the COVID-19 pandemic, it has further exhausted the healthcare system’s resources and healthcare providers. In order to sustain the healthcare system in society, a large number of internationally educated nurses (IENs) have been transferred to work in the United States. As a result of different nursing practices, cultures, and communication styles, many IENs experience language and cultural barriers at work. Difficulty in communication influences the quality of patient care provided, which can lead to negative health outcomes for patients and …

Improving Nursing Staff Knowledge For Management Of Geriatric Patients With Confusion In The Emergency Department, Kareem G. Carter

Master's Projects and Capstones

Problem: Staff knowledge of effective management of confusion in geriatric patients (>65yo) may be limited and inconsistent with the current goal of establishing a geriatric-friendly Emergency Department (ED) Model of Care. Suboptimal management of this patient population can result in prolonged ED stays, which increases the cost to the hospital and the patient (Han & Wilber, 2013).

Context: An Emergency Department at a large Bay Area urban hospital hopes to obtain Geriatric Emergency Department Accreditation (GEDA) through the American College of Emergency Physicians (ACEP).

Interventions: Create a simplified checklist for nursing staff using mnemonic devices to …

Evidence-Based Selection Of A Fall Risk Assessment Tool: A Program Evaluation Review, Lindsey Adams

Student Scholarly Projects

Fall prevention strategies are a consistent topic of discussion for healthcare regarding patient safety, as patient falls are costly to the patient and the organization. This project uses the CDC Framework for Program Evaluation to assess the fall prevention policy of a local hospital system, with particular emphasis on the fall risk assessment tool, Hester Davis. This project also explores the risks and benefits of adopting an alternative fall risk assessment tool, predictive analytics. Predictive analytics uses electronic health record (EHR) data analysis to provide a highly individualized patient fall risk score based on a large variety of patient and …

Evidence-Based Best Practice For Transitions Of Care: A Policy Review On Medication Reconciliation Standards, Lovelyn Chizoba Ogbennah

Student Scholarly Projects

Practice Problem: Medication reconciliation (MR) is crucial in care transitions among healthcare facilities. Developing evidence-based discharge planning strategies, improving communication, optimizing electronic health record intelligence interoperability, and stakeholder engagement will promote a better transition process for patients and healthcare providers.

PICOT: The PICOT question that guided this project was: In an urban-based adult skilled nursing facility, how does an evidence-based structured review, and revision of current MR policy and procedures, compared to the existing MR policy, affect the clarity of the process for communication between clinicians during transitions of care over a 10-week review cycle?

Evidence: Fifteen …

Addressing Obstacles In Following Prescribed Medication Regimens In Patients With Type 2 Diabetes Mellitus, Cristina Sarro

Doctor of Nursing Practice

Background. Type 2 diabetes is the ninth leading cause of death in the United States. Micro/macro vascular complications are common in diabetes. Purpose. To implement an evidence-based protocol addressing obstacles for patients with type 2 diabetes in following their prescribed medication regimens to reduce glycosylated hemoglobin levels. Evidence. Failure to follow treatment plans increases diabetes complications. Perceptions and complexities of treatment plans, side effects of therapies, and cost contribute to patients not taking their medications as prescribed. Goals. To increase the number of patients with type 2 diabetes who follow their prescribed medication regimen and reach their targeted glycosylated hemoglobin. …

The Lived Experience Of Losing Employment After Diagnosis With Dementia: A Phenomenological Analysis, Susan K. Blaine

Doctoral Dissertations

The purpose of this study was describing the experiences of people with dementia (PWD) who lose their employment after diagnosis with dementia, but sooner than originally planned. A phenomenological approach based on tenets of Maurice Merleau-Ponty was used. Six telephone interviews were conducted, with participants sharing their experiences. Transcripts were transcribed verbatim, and subsequently analyzed via a hermeneutical analysis approach. Themes were identified within and between transcripts, considering the contextual grounds of Merleau-Ponty’s phenomenology: body, others, time, and world, and the contextual ground of participants’ experience: the stigma of dementia. An overarching, central theme of “still working” was identified across …

Factors Impacting Organ Transplant Outcomes, Katelyn Grubich

Nursing | Senior Theses

Organ transplants are crucial to the survival of those on the receiving end. With medicine advancing, so has transplantation. Health care providers are becoming more aware of the strategies necessary to prolong the transplanted organ and how to obtain better outcomes. Heart, lungs, kidney, liver, pancreas, and some where more than one organ are involved, are the types of organ transplants performed.

Providing patients information will allow them to be a part of their treatment and can help to ease their anxiety knowing what is being performed and what can be expected. Health care providers must ensure that patients and …

Perceived Quality Of Senior Care In An Assisted Living Facility Following The Outbreak Of Covid-19, Kaylie Hill

Theses/Capstones/Creative Projects

The COVID-19 pandemic has posed a monumental obstacle to the healthcare field in terms of severely reducing the number of healthcare workers. Among the many industries affected by staffing shortages are assisted living facilities (ALFs), in which residents are dependent on care staff for daily assistance. This study sought to investigate whether long-term residents of ALFs perceive a difference in the quality of their care under the circumstances of the pandemic as opposed to those of pre-pandemic times. Semi-structured interviews were facilitated with 10 long-term residents who have been residing in an Omaha ALF since prior to the outbreak of …

Physical Activity, Daily Step Counts And Functional Ability In Older Adults: Using Nhanes Database, Chunfang(Maggie) Chen

Doctoral Dissertations

Maintaining functional ability and independence are essential in the healthcare of older adults. Physical activity(PA) has been acknowledged as effective and economical health promotion strategies in older population. However, the amount of PA needed to maintain functional ability in older adults remains unclear. This investigation used PRISM Dose-response Curves Stimulation Variable slope model to explore the relationships between the amount of PA and functional ability in community-dwelling young-old, middle-old and old-old age group adults. ANOVA analysis was used to examine the relationship between functional ability and self-perceived active level changes compared to 10 years ago. NHANES 2005-2006 older participants datasets …

Toolkit For Screening Older Adults Desiring To Age In Place In Independent Living, Sister Raymond Marie Labonte

Seton Hall University Dissertations and Theses (ETDs)

The world is experiencing an increase in the aged population. This increase stimulated the popular theme of aging in place. Much time, effort and research have been channeled into exploring this model as an alternative to assisted living or skilled nursing settings for senior citizens worldwide. Elders desire to age in place. Current, recent, and decades old literature identifies this preferential option of the elderly and supports the need to develop plans and tools to assist elders to be able to successfully age in place. This quality assurance project is the venture to create both a congregate living community and …

Improving Hypertension Self Management In African American Men, Elizabeth C. Felix

Electronic Theses and Dissertations

Hypertension is a cardiopulmonary condition linked to genetic, environmental, and social factors. Left untreated, it can lead to fatal conditions such as heart disease. In the United States, African Americans experience disproportionately high rates of hypertension, earlier onset of symptoms, greater severity, and higher related mortality rates. African Americans also statistically have more difficulty self-managing their hypertension than other demographics. The aim of this project was (a) to identify, define, and measure perceived barriers to self-management of hypertension among African American men and (b) to target these barriers and increase patient engagement through personalized intervention plans. The researcher recruited 24 …

Efficacy, Acceptance, And Feasibility Of Virtual Reality For Chronic Pain Relief In Older Adult Veterans Residing In Long Term Care, Valicia Philibert

Dissertations, Theses, and Capstone Projects

Older adults residing in Long-Term Care (LTC) have a high prevalence of chronic pain. Pain management strategies have primarily focused on pharmacological approaches, but with physiological changes associated with aging, this population is at an increased risk for adverse effects from prescribed medications. More research is needed on innovative non-pharmacological interventions in the LTC setting. This study examined the feasibility, acceptance, and preliminary efficacy of Virtual Reality (VR) for chronic pain among older adult veterans in LTC. In this quasi-experimental, 12 older adult participants living with chronic pain in a long-term care facility received two sessions of VR. Pain intensity …

Trends In Health Outcomes Before And After Long Term Care Federal Regulations Limited Antipsychotic Medication Use: A Secondary Data Analysis, Karen Robson

Electronic Theses and Dissertations

Trends in resident falls did not significantly change, although trends in serious injury from falls declined ten years after regulations restricted antipsychotic medications in long-term care facilities. Trends in functional and continence status worsened after the regulations were implemented.

Improving Moisture Associated Skin Damage In A Veteran Unit, Beverly Chen

Master's Projects and Capstones

Problem: Moisture-associated skin damage (MASD) has always been a problem, regardless of the setting is an I.C.U., Med-Surg, or long-term care. Evidence suggests prevalence rates can range from 5.2% to 46%, depending on the facility. The highest rates of incontinence-associated damage (IAD) occurred in long-term acute settings (Kayser et al., 2019).

Context: The veterans of the Community Living Center (CLC) have an increased risk for skin breakdown. Currently, of the fifteen residents, six residents (40%) have MASD, two of which have chronic MASD (13%). MASD can be a common occurrence for adults with limited mobility or cognitive diseases. MASD may …

Development Of A Fall Prevention Bundle With Evidence-Based Tools For Hospitalized Adults, Kelly A. Tirone

Master's Projects and Capstones

Problem

One million hospitalized people fall annually in the United States, and up to a third are preventable.

Context

Data from an acute care hospital show one medical-surgical unit reported eight patient falls in 2021, two causing major harm that reached sentinel event criteria.

Interventions

A Clinical Nurse Leader (CNL) leveraged the unique CNL skill set and characteristics of Human-Centered Leadership to engage in horizontal leadership, injury prevention, and team coordination through authentic human connection. The team leveraged documentation for improved fall risk communication. Unavoidable disruptions hindered other planned interventions.

Measures

Outcome measures observe for total fall count and the …

Addressing Anxiety In Hospitalized Adults Using A Music Intervention, Raina M. Rochon

Student Scholarly Projects

Practice Problem: The practice problem is anxiety related to hospitalization among adults in an acute care setting. Increased anxiety can lead to other issues while hospitalized including disruptive behaviors.

PICOT: The PICOT question that guided this project was: In hospitalized medical-surgical adults (P), how does the implementation of a music intervention as an adjunct to standard distraction techniques (I) compared to standard care (C) affect symptoms of anxiety as observed by the rate of behavior de-escalation team calls (O) within eight weeks (T)?

Evidence: There were five systematic reviews, four systematic reviews with meta-analysis with high level of …

Myasthenia Gravis, Rebecca Wheeler

Nursing Student Class Projects (Formerly MSN)

Myasthenia gravis (MG), a neuromuscular and autoimmune disorder, is not completely understood by clinicians and scientists. The primary cause is thought to be anti-Acetylcholine receptor antibodies that attack the neuromuscular junction, causing destruction of post-synaptic junctional folds and blockade of the receptor. This causes frequent weakness and fatigability of voluntary muscles, making activities of daily living difficult for those living with MG. Although it is not an incredibly prevalent disease, the incidence is increasing in the United States due to better testing and diagnosis. Treatments are available, including cholinesterase inhibitors that raise the concentration of Acetylcholine at the neuromuscular junction …

Evaluating Mindfulness On Loneliness In An Older Adult Population, Jessica Tieskoetter

Dissertations

Problem: Loneliness is a widespread public health concern and has negatively impacted mortality and health outcomes among older adults. This quality improvement project’s purpose was to evaluate mindfulness on loneliness and quality of life among adults aged 65 years and older, participating in a weekly befriending socialization program.

Methods: A descriptive cohort design was utilized to assess loneliness pre-and post-implementation of a mindfulness telephone line over three months. A convenience sample of 22 older adults enrolled in a befriending socialization program was used. The Iowa Model of Evidence-Based Practice framework was applied to guide the implementation of a practice change …

Preventing Falls Using Evidence-Based Interventions In A Long-Term Care Facility, Pibi Bouda

Dissertations

Falls and fall-related injuries are common and significant health issues among older adult patients living in Long-Term Care (LTC) facilities, especially those with memory impairment. The current quality improvement (QI) project aimed to educate staff members and implement a structured 4 Ps hourly rounding (HR) protocol on an LTC facility pilot unit in Missouri. The project was implemented in a memory care unit housing older military veterans patients in a large metropolitan area of Missouri. The project question that guided the intervention was: In older residents living in a memory care unit of an LTC facility, what is the impact …

Palliative Care Screening For Persons Living With Dementia In A Nursing Home, Shanika S. Pruitt

Dissertations

Problem: Dementia is rapidly increasing as the people of the world mature and life expectancy increases. As the world ages and the prevalence of dementia increases, nursing home placement will and is the most sought place for care of this population. Dementia is under recognized as a terminal illness and palliative care is underutilized for nursing home residents with advanced symptoms of dementia.

Methods: This quality improvement (QI) initiative utilized a prospective, descriptive design. The Palliative Care Screening for the Elderly tool was administered to a purposive sample of persons living with dementia residing in the nursing home. Qualitative data …

Comprehensive Pain Assessment For Veterans In Long-Term Care., Christopher Jenkins

Doctor of Nursing Practice Papers

Background Literature supports the need for comprehensive pain assessment (CPA) in long-term care facilities. CPAs provide valuable information for facility providers and health care staff to intervene appropriately regardless of cognitive ability. Without the use of such tools, pain can go undertreated or ignored for this underserved population causing undue suffering and poor quality of life. Chronic pain perpetuates an endless cycle of immobility, falls, injury, functional decline, and eventual death for this population.

Purpose: A CPA was implemented, evaluated, and integrated into the care processes in a long-term care facility for veterans

Method: The IHI improvement model with a …

An Evidence--Based Intervention: Use Of Visual Aids For Patient Education During Bedside Team Rounding, Kristin Clifford, Shay Gruber

Nursing DNP Projects

Abstract Purpose: To increase patient health literacy and satisfaction in hospitalized adult medical-surgical patients through an evidence-based provider intervention (advanced practice providers, APPs, or physicians, MDs) adding visual aids to current verbal patient education methods during daily bedside team rounding (BTR).

Strength of Evidence: A literature review resulted in 15 studies meeting inclusion criteria including two meta-analyses, three randomized control trials, two quasi-experimental studies, five systematic reviews, two descriptive studies, and one clinical practice guideline. Evidence revealed the addition of visual information to verbal and written education methods significantly improves patient knowledge, understanding, and recall of health information and increases …

Correlates Of Health Literacy And Perceptions Of Burden Among Caregivers Of Persons Diagnosed With Chronic Illnesses, Mubarak Aldawsare

Dissertations

Background/Rationale: Greater attention is needed on factors effectively supporting caregivers because poor well-being of caregivers can hamper overall patient outcomes. Lack of awareness of caregiver burden has implications for healthcare systems globally. Caregivers may encounter various levels of burden as a result of providing long-term care to individuals diagnosed with one or more chronic illnesses. Caregivers with inadequate health literacy are more likely to experience feelings of uncertainty, and as a result, caregiver burden. Little is known about the impact of the health literacy of caregivers on the level of burden when providing care to individuals with complex care …

Fall Risk Assessment And Intervention To Reduce Fall-Related Injuries And Hospitalization In Older Adults, Pittawat Emerson

Doctor of Nursing Practice Final Manuscripts

Falls among older adults is a major issue that has become a leading cause of injuries and deaths. This study is an evaluation of fall-risk assessment using the Stopping Elderly Accidents, Deaths & Injuries (STEADI) tool and physical activity intervention in older adults aged 65 and above during their annual wellness visits to reduce fall-related injuries and hospitalizations. The results showed a reduction of fall-related injuries by up to 11.8% after the 12-week intervention. Patients with moderate-to-high fall risk saw a decrease in injury by 12.9%. Patients with moderate-to-high fall risk scores saw a decrease by 12.9%, from 25.9% to …

Phenomenological Study Of The Lived Experience Of New Graduate Nurses Caring For Hospitalized Patients Living With Dementia, Geline Buenconsejo

Dissertations

Title. Phenomenological Study of the Lived Experience of New Graduate Nurses Caring for Hospitalized Patients Living with Dementia.

Purpose. This study explored new graduate nurses’ lived experiences in caring for hospitalized patients living with dementia.

Background. The first twelve months of transitioning from student to professional nurse in acute care settings are the most stressful, emotionally challenging, and mentally exhausting for new nurses striving to apply newly acquired skills into practice. Some of the most challenging patients for nurses to care for are hospitalized patients living with dementia (PtLWD). With the projected increase in the number of patients with dementia …

Early Integration Of Palliative Care With Curative Oncology Treatment For Patients With Advanced Cancer: Implications For Clinical Nursing Practice, Rhea Rughani

Honors Projects

Palliative care, though clinically established to improve health-related quality of life measures for patients with advanced illness, remains underutilized and largely limited to end of life care. This project aims to inform oncology nursing practice through the analysis of literature supporting the early integration of palliative care with standard curative oncology treatment for patients with clinically advanced cancer. Informed by relevant research, clinical practice guidelines, and improved specialty palliative care training, oncology nurses and nurse practitioners are ideally situated to advocate for and initiate early palliative care integration, to holistically improve the standard approach to complex cancer care.

Transitioning Eating Practices Of Older Adults, Michelle Lajoy Jackson

Dissertations

Purpose: The purpose of this descriptive qualitative study was to explore what factors may have influenced the transition of an individual older adult’s eating practices over a lifespan and the impact participants perceived those factors currently had upon their nutritional health in older adulthood.

Background: The older adult population is recognized as one of the fastest growing populations in the United States. One of many growing concerns for this population is the impact of dietary practices on the morbidity and mortality of this aging population. There is limited research to date that has explored the transitioning of appetite …