Digital Commons Network^™

Barriers To The Influenza Vaccination In Veterans, Zina Floyd

Walden Dissertations and Doctoral Studies

Influenza is the eighth leading cause of death in the United States, accounting for 56,000 deaths annually and leading to an average of more than 200,000 hospitalizations every year. Adults 65 years of age and older account for 50% to 60% of influenza-related hospital admissions and an estimated 90% of influenza-associated deaths occur in people age 65 and older. During the 2011 to 2012 influenza season, approximately 50 % of veterans between 45 and 70 years of age refused the influenza vaccine within the metro-area outpatient Veteran Administration (VA) facility in Atlanta, Georgia. The aim of this project was to …

Assessing Spirituality Among Hospice Patients: A Phenomenological Study Of Hospice Nurses, Isabel Esther Kaufman

Walden Dissertations and Doctoral Studies

The shift in health care and nursing philosophy and practice from a holistic approach to a highly technological, cure-oriented approach has been attributed to effective pharmaceuticals made to prolong life. Recently medical professionals have shifted their focus to a combination of spiritual healing and medicine. Hospice care in particular have taken a key interest in integrating spirituality within their health care. The problem is that due to the complications in defining spirituality and appropriate training and education of spirituality within nursing curriculum, assessing patients' spiritual distress may be difficult for many hospice nurses which may be at a loss when …

Fall Prevention Quality Initiative: Implementation Of A Unit Safety Champion (Usc), Susan Lynn Rednak

Walden Dissertations and Doctoral Studies

The literature supports that a Unit Safety Champion (USC) may reduce falls among hospitalized patients. The purpose of this project was to determine if the implementation of a USC would assist in reducing falls on an acute unit in an urban hospital environment. The frequency of patient falls on the unit was collected from the hospital's quality department 3 months before and 3 months after the implementation of the USC. The average number of falls for 3 months before implementation was 5.0 per month (SD = 2.65) and involved a total of 15 individual patients. The average number of falls …

Evidence-Based Mentorship Program: Overview, Review Of Evidence, And Approach, Elizabeth Villanueva

Walden Dissertations and Doctoral Studies

Nurses comprise the largest segment of the healthcare workforce. Adequate numbers of

nurses help to ensure sufficient and safe nursing care in all settings. The current nursing shortage poses a barrier to optimum nursing care, and the nature of recruitment and retention of nurses has generated research interest because of its association with the labor shortage. The purpose of the project was to develop a nurse mentorship program for possible adoption by a northern state correctional facility. Goals are to aid recruitment and improve retention of nurses in the facility. This quality improvement project was informed by Jean Watson's theory …

The Effects Of A Concept-Based Curriculum On Nursing Students' Nclex-Rn Exam Scores, Patricia Allen Edwards

Walden Dissertations and Doctoral Studies

The Institute of Medicine and the National League of Nursing have called for curricular reform that promotes high first-time pass rates on the National Counsel of Licensure Examination for Registered Nurses (NCLEX-RN). A campus in the southeastern region of the United States implemented a concept-based curriculum; however, the effect on the first-time NCLEX-RN pass rates was unknown. The purpose of this comparative study was to determine if the concept-based curriculum improved student scores on the NCLEX-RN. Dreyfus' model of learning guided this study because of the andragogy tenets, which in turn supported the concept-based curricula. The research questions examined the …

Provider-Initiated Condom Education, Hiv, And Stds Among Older African American Women, Natasha Hall

Walden Dissertations and Doctoral Studies

Older African American (AA) women are at increased risk for HIV and STDs. The purpose of this quantitative study was to examine the influence of provider-initiated condom use education on condom use among unmarried, heterosexually active AA women aged 50 and over using the constructs of self-efficacy and attitudes of the health belief theoretical model. The relationships between provider education on condom use, condom use self-efficacy, condom use attitudes, and actual condom use were tested individually, and provider education on actual condom use was tested after controlling for condom use self-efficacy and attitudes among 95 study participants recruited primarily from …

Implementing An Evidence-Based Educational Module On Nurses' Role On Management Of Postpartum Hemorrhage, Stella Motanya

Walden Dissertations and Doctoral Studies

Postpartum hemorrhage is the second leading cause of maternal death in the United States. According to American College of Obstetricians and Gynecologists, postpartum hemorrhage is an obstetric emergency. Between 2012 and 2013, a medical facility reported 369 postpartum hemorrhages, a 4.7% increase from previous years. It is important to address this practice issue because postpartum hemorrhage can lead to maternal mortality. The purpose of this project was to increase staff nurses' awareness and knowledge of their role on the management of postpartum hemorrhage. The outcome of the project paper was implementation of an educational module on postpartum hemorrhage at this …

Alarm Safety In A Regional Neonatal Intensive Care Unit, Piper Probst

Walden Dissertations and Doctoral Studies

Alarm fatigue is a practice problem that applies to hospitalized patients and the nurses who care for them. Addressing alarm fatigue is important to promote alarm safety and to decrease the risk of patient harm or death. The purpose of this study was to decrease alarm fatigue and improve alarm safety in a regional neonatal intensive care unit (RNICU). Guided by the conceptual model for alarm fatigue and alarm safety, this study addressed whether or not alarm management protocols designed to decrease false and nuisance alarms in the physiological monitoring of neonates improve alarm safety via decreased alarm burden and …

Moving From Productivity To Professional Value Model Of The Hospital-Based Registered Nurse, Crystal Maree Billings

Walden Dissertations and Doctoral Studies

There is a gap between organizational commitment to professional value of the nurse and the achievement of quality outcomes. This study explored the relationship between the productivity model and the professional value (PVS) model of the hospital-based registered nurse (RN). It was essential to understand how to measure nursing's contribution to patient care as a means to promote patient care outcomes. The current professional nursing dynamic provides an unprecedented opportunity for nurses to achieve their highest professional potential through increased demonstration of advocacy and accountability for the central tenets of nursing. The intent of this project was to explore the …

Development Of Mentors To Facilitate Evidence-Based Practice In A Nurse Residency, Susan Annette Breit

Walden Dissertations and Doctoral Studies

Evidence-based practice has resulted in better patient outcomes, higher patient satisfaction, and effective patient-centered care. Leadership of a large teaching hospital determined that new nurses lacked the education and experience to design and implement an evidence-based project at the bedside, which was an expected outcome for completion of the established nurse residency program. The purpose of this project was to develop a design-only project in which Masters of Science in Nursing-prepared mentors were added to the residency program to establish the required evidence-based project. A mentor workshop was developed to guide the mentors in this role using Benner's novice to …

Promotion Of The Hospital's Patient Portal, Courtnie Jones Burrell

Walden Dissertations and Doctoral Studies

The Centers for Medicare and Medicaid Services wanted to ensure that electronic health records were used in a meaningful manner to improve coordination and quality of patient care. In 2011, the federal government began offering monetary incentives to help healthcare facilities and providers adopt technology that supported patient access and increased their ability to manage their own health. The hospital where this project took place encouraged patients’ involvement in their health by providing a patient portal, yet the public has underutilized it. The purpose of this project was to develop an evidence-based strategy for future implementation at the hospital that …

The Effects Of The Night Shift On Nursing Staff Of An Inpatient Hospice Facility, Carolyn Dopson Horton

Walden Dissertations and Doctoral Studies

The night shift environment in an inpatient hospice facility is unique in care and relegates challenging situations for the nursing staff. Using the Parse methodology, the purpose of this project was to explore the challenges faced by inpatient hospice facility night shift nursing staff in providing a continuum of care for dying patients and their families. Nine night shift hospice nurses participated in 45-60 minute interviews. The interviews were conducted in a hospice quiet room or a designated place of comfort for the participant, which allowed for dialogical engagement. The interviews were unstructured with open-ended questions about lived experiences. The …

Visual Arts And Chronic Pain: Thematic Analysis To The Artistic Statements Of Visual Artists, Susan Beth Janicke

Walden Dissertations and Doctoral Studies

The relief of pain is an essential element of nursing practice. Nursing has begun to successfully use art to assess and reduce pain among hospitalized children, surgical patients, and oncology patients. Structured art projects have been used to provide distraction from pain and patient drawings have allowed nurses to assess pain. This project employed grounded theory and thematic analysis to uncover significant concepts in the artists' statements. The Roy adaptation model and Saunders' total pain theory provided the project theoretical framework. The artistic statements and the art of chronic pain patients were examined using thematic analysis to identify recurrent themes. …

Interdisciplinary Bedside Rounding: Patient Satisfaction With Nursing Communication And Decreased Hospital Readmissions, Luanne Parks

Walden Dissertations and Doctoral Studies

There is a lack of quality communication among health care professionals and patients in the hospital setting, which can negatively impact patient satisfaction and increase hospital readmission rates. Interdisciplinary bedside rounding (IBR) is a method of rounding that uses direct communication and discussion of the patient at the bedside, and the use of IRB may improve the quality communication among health care professionals and patients. The purpose of this program outcomes evaluation project was to evaluate whether IBR increased patient satisfaction with nursing communication and if IBR decreased hospital readmission rates. The Iowa model of evidence-based practice provided a framework …

Can Nurse-Facilitated Support Groups Foster Self-Awareness?, Althea Lenore Phillips

Walden Dissertations and Doctoral Studies

Students with learning disabilities (LDs) represent 9% of students attending college, and college administrators must comply with a large number of federal requirements outlining the provision of educational services for students with LDs, including offering support groups. Nurse-facilitated support groups, held within the university setting, could provide effective social support, increasing likelihood of college success among students with LDs. The purpose of this project was to develop a plan for implementing nurse-facilitated support groups for students with LDs within the student health services (SHS) department at a university designed to improve their coping skills on personal, social, and academic levels. …

Relationship Between Stress Burden And Perceived Support Among Elderly Male Spousal Caregivers, Stephanie Fitzsimmons Sexton

Walden Dissertations and Doctoral Studies

As older couples age, often one partner becomes more competent and able to care for the other, in which case they are able to remain in their homes. In one township in the northeastern United States, the caregiving role had a significant effect on the lives of elderly men who care for their wives. The purpose of this quantitative project study was to determine the relationship between perceived stress burden and perceived level of social support services and between perceived stress burden and use of support services by elderly male spousal caregivers residing in active adult communities. Watson's theory of …

Nursing Faculty Perceptions Of And Responses To Student Incivility, Lori Linn Theodore

Walden Dissertations and Doctoral Studies

Student incivility has become a problem in nursing schools around the country. Researchers have noted that uncivil behavior that goes unaddressed may compromise the educational environment. Nursing faculty have differing standards about uncivil behavior; thus, students experience inconsistencies in approaches to incivility. The purpose of this mixed-methods explanatory study was to explore nursing faculty experiences with, understandings of, and responses to student incivility. The conceptual framework was Clark's continuum of incivility and the conceptual model for fostering civility in nursing education. Descriptive analysis of the level and frequency of uncivil behaviors of nursing faculty members (17 full-time and 15 part-time), …

The Role Of Nursing Practice In Promoting Sleep During Brain Injury Rehabilitation, Jill Massengale

Walden Dissertations and Doctoral Studies

During hospitalization, sleep can be interrupted or even elusive. It has been established that quality sleep is essential in neural repair. Previous research has indicated that many nurses are unaware of the impact of sleep disturbance on brain injury recovery and do not understand how to promote sleep in the neurorehabilitation setting. The purpose of this project was to determine whether educational intervention would influence nurses' knowledge and attitudes toward sleep. Benner's (2001) novice to expert theory provided a framework for the project. With the collaboration of a neuropsychologist, this study produced a sleep knowledge and attitudes instrument. Pulmonary sleep …

Impact And Prevention Of Psychiatric Polypharmacy In The Elderly, Rose Cordelia E Onyekwe

Walden Dissertations and Doctoral Studies

Adequate medication management is a focus of effective care that is often overlooked in caring for adults with comorbid psychiatric and physical conditions, especially in patients who are treated by multiple care providers and have a variety of health issues at the same time. The purpose of this project was to develop evidence-based policies and practice guidelines to reduce polypharmacy in elderly patients in a rural outpatient psychiatric clinic. Bandura's self-efficacy theory was used to inform the project for its value in assessing motivation, capacity for self-regulation, and perceptions of individual ability. An interdisciplinary team of stakeholders explored best practices …

Student Perceptions Of Effective Learning Strategies For National Council Licensure Examination Preparation, Lori Jean Johnson

Walden Dissertations and Doctoral Studies

The purpose of this study was to examine efficacious instructional strategies that the New England Community College (NECC) nursing program could implement in the curricula to improve National Council Licensure Examination Registered Nurse (NCLEX-RN) first-time pass rates. Effective strategies from students and nursing program faculty had used were investigated. Such strategies support student nurses in their efforts to succeed on the first administration of the exit examination. The rationale for this study and resulting project was that they could improve NCLEX-RN first-time pass rates and positively impact the local hiring of qualified nurses. Guided by Knowles's adult learning theory, key …

Care Transition Gaps: Risk Identification And Intervention, Michael Howard Jongsma

Walden Dissertations and Doctoral Studies

Hospital readmissions related to chronic heart failure (CHF) are costly, widespread, and often avoidable. Patient education that includes diagnosis, causes, medications, diet, exercise, and exacerbation warning signs has been shown to reduce the number of CHF readmissions. The purpose of this study was to use risk stratification to identify CHF patients at high risk for 30-day readmission. Once a high-risk CHF patient was identified, nursing interventions would be triggered to reduce readmissions and close the gaps in the continuum of care following acute care admission. Transitions of care theory was used as the framework for this project. The methodology had …

Cultural Competence Education For Care Coordinators, Wendy Janet Renault

Walden Dissertations and Doctoral Studies

Aboriginal people bear a burden of health disparities when compared to non-Aboriginal people in Canada. To date, traditional health-related programs to address these disparities have not been effective. Compounding this problem, the Aboriginal people have also reported dissatisfaction with the healthcare system and the relationships they experience with healthcare providers. However, the literature supports that when providers employ cultural competence in their practice, there is a possibility for improved relationships with patients. Using critical social theory as a framework, the purpose of this project was to conduct a 1-hour class on cultural competence for care coordinators and nurses in a …

Recent Graduates' Perspective On The Efficacy Of Nursing Simulation Laboratory Experiences, Holli Sowerby

Walden Dissertations and Doctoral Studies

It has become progressively difficult to find suitable clinical placement for nursing students. To help meet this need, local schools of nursing are turning to high-fidelity simulation manikins to substitute for clinical experience. There is a lack of research that explores recently graduated nurses' perceptions about the efficacy of simulation experiences. Guided by the constructivist theory, this qualitative case study identified how recent RN graduates viewed simulation experiences and whether associate's-degree RN program graduates and bachelor's-program RN graduates viewed simulation differently. Nine recent graduates participated in individual face-to-face interviews. The data were coded and grouped into 5 major themes in …

Critical Care Nurses' Perceptions Of Their Knowledge And Self-Efficacy About Providing End-Of-Life Care, Mary Kathryn Gaffney

Walden Dissertations and Doctoral Studies

Most nurses receive limited formal education regarding end-of-life (EOL) care, which affects their ability to meet dying patients' needs. Guided by Bandura's social learning theory, this explanatory correlational study examined the relationships between critical care nurses' personal and professional characteristics and their perceived knowledge and self-efficacy when providing EOL care at an academic medical center. Convenience sampling was used to recruit participants from the eligible adult, pediatric, and neonatal critical care nurses for this study. The 67 participants completed the End-of-Life Professional Caregiver Survey (EPCS) to assess EOL care knowledge and self-confidence. Total EPCS scores revealed only moderate levels of …

Automated Medication Dispensing Cabinet And Medication Errors, Marie Helen Walsh

Walden Dissertations and Doctoral Studies

The number of deaths due to medical errors in hospitals ranges from 44,000 to 98,000 yearly. More than 7,000 of these deaths have taken place due to medication errors. This project evaluated the implementation of an automated medication dispensing cabinet or PYXIS machine in a 25-bed upper Midwestern critical access hospital. Lewin's stage theory of organizational change and Roger's diffusion of innovations theory supported the project. Nursing staff members were asked to complete an anonymous, qualitative survey approximately 1 month after the implementation of the PYXIS and again 1 year later. Questions were focused on the device and its use …

Communication Skills Of Novice Psychiatric Nurses With Aggressive Psychiatric Patients, Rose Moss

Walden Dissertations and Doctoral Studies

Communication Skills of Novice Psychiatric Nurses with Aggressive Psychiatric Patients

by

Rose L. Moss

MS, University of Hartford, 1996

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

March 2015

The transition from novice nurse to a competent psychiatric staff nurse is often associated with major communication challenges, primarily when caring for aggressive patients. Guided by Peplau's theory, this quantitative study assessed the communication skills of novice psychiatric nurses (N = 25) who worked 24 months or less in the state psychiatric hospital with aggressive psychiatric patients. Additionally, certain demographic data …

Nurse-Physician Communication Tools To Enhance Use Of Nursing Evidence-Based Protocols, Tochi Onyenwe Ubani

Walden Dissertations and Doctoral Studies

Nurse-Physician Communication Tools to Enhance use of Nursing Evidence-Based Protocols

by

Tochi Onyenwe Ubani

MSN, Walden University, 2011

BSN, Chamberlain College of Nursing, 2009

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

February 2015

In the current health care environment, consumers are demanding collaboration among clinicians even when traditional attitudes minimize nurses' input on the direction of clinical care. Compounding this problem is that nursing practices have not always been derived from randomized clinical trials, but instead from personal experiences. The purpose of this study was to explore the perceptions …

Meaningful Use Of Electronic Medical Recording To Improve Diabetic Treatment Compliance Of American Diabetic Association Treatment Standards, Tamara Ann Parrish

Walden Dissertations and Doctoral Studies

Diabetes affects approximately 10% of the American population with an annual expenditure of approximately $174 billion dollars. The utilization of electronic medical records (EMR) combined with the meaningful use (MU) initiative may ensure that diabetic patients receive the recommended preventative care. Dorthea Orem's self-care deficit theory and the transtheoretical model of behavior change was utilized to design this quality improvement project. Medical professionals at a small private practice received education on American Diabetic Association (ADA) treatment standards and how to use the EMR system to track patients receiving the recommended diabetes care. The project question examined the effectiveness of provider …

The Effect Of Evaluating A Quality Improvement Initiative On Reducing Hospital Transfers Of Nursing Home Residents, Denise Eileen Jarboe

Walden Dissertations and Doctoral Studies

The Effect of a Quality Improvement Initiative on Reducing Hospital Transfers of Nursing Home Residents

by

Denise Eileen Jarboe

MSN, Walden University, 2010

BS, University of Maryland, 1981

Project Study Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

February 2015

Nursing homes (NH) in the 21st century provide skilled healthcare services for resident populations who are older, frailer, and often suffering from multiple incurable chronic medical conditions. Nurses practicing in this setting must be keen observers and effective communicators with the ability to recognize and report subtle changes in health status …

Improving Perceptions Of Menopause With An Educational Tool About Non- Pharmacologic Menopause Symptom Management, Megan Larsen

Doctor of Nursing Practice (DNP) Practice Innovation Projects

The time period surrounding menopause, or perimenopause, often is associated with many symptoms that are unpleasant and life changing for women. These symptoms, which occur in up to 70% of perimenopausal women, can negatively impact quality of life. There is little information available about how a woman can proactively reduce her menopause symptoms naturally, and many are unable to utilize pharmacologic methods. The literature review included in this paper reveals several different non-pharmacologic treatment methods that are supported by peer reviewed research, including: relaxation and stress reduction, ingestion of soy nuts, acupuncture, lifestyle behavior changes, and exercise. It has been …