Digital Commons Network^™

Design And Implementation Of A Sustainable, University-Based, Emergency Medical Response Service, Octavia A. Mandel Struve

Doctor of Nursing Practice (DNP) Projects

Collegiate-based emergency medical services (EMS), designed primarily to provide pre-hospital basic life support and emergency services, are venues by which nurses and other healthcare professionals, with an understanding of community health and social network issues, can maximize health promotion objectives for university and college campus communities. These EMS systems also provide vital support to city and county emergency services and promote positive community relationships with neighboring areas. They can provide excellent opportunities for students to develop critical skills for success in the healthcare and business world. The sustainability and vibrancy of collegiate-based EMS systems are primarily related to impact, benefit …

A Novel Psychotropic Risk Assessment To Enhance Medical Management Of Patients With Behavioral And Psychological Symptoms Of Dementia, Nancy C. Trego

Doctor of Nursing Practice (DNP) Projects

There is growing evidence and concern documenting the risks of antipsychotic use, and psychotropic medication burden in general, for older adults with behavioral and psychological symptoms of dementia (BPSD). Yet nearly 25 percent of all long term care residents take antipsychotics for behavioral disturbances associated with dementia as “off-label” use, despite their modest efficacy and FDA black box warnings (CMS, 2013). Expert consensus calls for non-pharmacological strategies as the first line treatment, yet some patients with BPSD may require a combination of non-pharmacological interventions and pharmacological treatments for symptom reduction (AGS, 2011). The relief of debilitating symptoms aims to improve …

Motivational Interviewing Education For San Mateo County’S Adolescent Healthcare Providers: Focus On Healthy Diet And Physical Activity, Emilie J. Gruhl

Doctor of Nursing Practice (DNP) Projects

Motivational interviewing has been endorsed by San Mateo County as an evidence-based effective form of behavior change counseling. Eighty percent of pediatric healthcare providers in San Mateo County have been trained in motivational interviewing, however 70% of the providers use it less than 50% of the time. The goal of this project was to reeducate the adolescent providers of San Mateo County in motivational interviewing with an emphasis on individualized training and feedback, directed toward healthy diet and exercise. Results of the quality improvement project showed an average 2.5-point increase in provider confidence on a zero to ten-point scale, and …

Influence Of A Palliative Care Protocol On Nurses' Perceived Barriers To Palliative Care And Moral Distress, Christina Cavinder

Evidence-Based Practice Project Reports

The World Health Organization (2013) states palliative care for children should begin at diagnosis which may even occur prenatally. Neonatal palliative care is variable due to the high technological, curative environment in the newborn intensive care unit, and the uncertain prognoses of infants born at the edge of viability. The purpose of this EBP project was to determine the influence of establishing a neonatal palliative care protocol on nurses’ perceived barriers to palliative care and moral distress. Corley’s Moral Distress theory and Stetler’s Model were used as guides for the framework of the project. The protocol, based on guidelines supported …

A Novel Method For Assessing Medication-Related Adverse Outcomes In A Community Hospital, Christopher M. Patty

Doctoral Projects

The use of medications for hospitalized patients is universal, and unfortunately medication-related adverse outcomes are common. The accurate assessment of medication-related harm in hospitalized patients is foundational to the development of an effective hospital medication safety program. Every hospital has its own unique "fingerprint" of harm, accurate determination of the nature of medication-related harm specific to each hospital is necessary to facilitate prevention of that harm with specific and effective interventions. This project has provided a community hospital with its first systematic methodology for assessing medication-related harm. The methodology is adapted from that used in a recent national-level study.

Several …

Nurses' Perceptions Of Structural Empowerment: A Practice Review Process Pilot, Andrea M. Lee-Riggins

Doctoral Projects

Nurses are professionally and morally obliged to monitor and evaluate nursing practice via active participation in review mechanisms that are designed to promote patient safety and care delivery, thereby improving patient care quality (American Nurses Association [ANA], 1988, 2001, 2004; O'Rourke, 2006). The purpose of this Doctor of Nursing Practice (DNP) project was to develop, pilot, and evaluate a nurse practice review process with frontline nurses within Fresno Heart & Surgical Hospital (FHSH), a small specialty hospital, affiliated with Community Medical Centers (CMC) in Fresno, California. A nurse practice algorithm was subsequently developed and structural empowerment was assessed with the …

Primary Care At Home: Nurse Practitioners' Perceptions And Practices, Tonya Bragg-Underwood

Doctor of Nursing Practice Technical Reports

Background: Primary care at home is not a new idea, but rather a reinvention of an old and almost forgotten practice. Today, only 1% of primary care visits are provided in a home setting; despite the increasing aging homebound population in the United States. Current primary care at home research relates improved patient outcomes with primary care at home visits. Primary care at home is reemerging in the United States, but currently is not generating many positive reviews. There is a gap in the current primary care at home literature regarding nurse practitioner home visit practices and perceptions. Methods: A …

Pediatric Asthma Telemonitoring: Literature, Theory, And Application To Practice, Erin Christine Shankel

DNP Projects

Asthma is one of the most prevalent and costly chronic diseases faced by Americans today. It is marked by inflammation and hyperresponsiveness of the airways which fluctuates, often unpredictably, in response to triggers. As such, it causes particular challenges symptom management, especially on the part of the patient who is tasked with dealing with these frequent fluctuations for months at a time between regularly scheduled health care appointments. This is further complicated when the patient is a child, and symptoms must be interpreted and managed second-hand by a caregiver. Uncertainty about how to manage symptoms, as well as minimization of …

The Effect Of Patient Education On Anxiety Levels In Patients Receiving Chemotherapy For The First Time, Sarah Garcia

Evidence-Based Practice Project Reports

Cancer affects approximately 1.5 million people every year throughout the United States.Comprehensive care that includes psychosocial aspects is important to help patients effectively adapt to their diagnosis and treatment plan. Improper prevention and management of anxiety can lead to poor psychosocial outcomes, dissatisfaction with care, and decreased adherence to treatment. Current evidence suggests that education is effective at helping reduce anxiety in patients receiving chemotherapy for the first time. The purpose of this evidenced based practice project was to determine if nurse-led patient education regarding chemotherapy side effects, side-effect management, and orientation to the infusion center was effective at decreasing …

Effects Of An Osteoporosis Educational Intervention: Knowledge And Self-Efficacy Of Prevention In Young Adult Collegiate Females, Valerie A. Bollenbacher

Evidence-Based Practice Project Reports

Osteoporosis is a silent and potentially debilitating chronic illness. In 2012, the CDC reported that 4.5 million women over the age of 50 were diagnosed with osteoporosis in the United States. Within the next 20 years, 41 million women worldwide are projected to have osteoporosis. The annual financial burden of osteoporosis is estimated to be 19 billion dollars. The objective of this evidence-based practice project was to answer the clinical question: In young adult collegiate females, how does an osteoporosis educational intervention compared to current education effect osteoporosis knowledge and self-efficacy of osteoporosis prevention over a one-month time period? The …

The Use Of Stress Reduction Techniques In Nursing Education, Jennifer S. Bauer

Evidence-Based Practice Project Reports

Stress is a complex phenomenon that has significant effects on students which may disturb their physiological, psychological, and spiritual health and well-being. Nursing students have been identified to be at high risk for stress during their education. Stress can arise from new clinical experiences, academic load, and personal stressors (Jones & Johnston, 2006). This increase in stress can lead to the student’s inability to assimilate and learn within the classroom and clinical settings. A review of the literature provided evidence that reported a positive relationship between guided imagery and a decrease in stress and anxiety. This evidence-based practice (EBP) project …

The Effect Of Patient Reminders On Osteoporosis Screenings, Billie-Ann Black

Evidence-Based Practice Project Reports

Osteoporosis is characterized by reduction of bone mass and compromised bone strength, resulting in an increased fracture risk. Since a reduction of bone mass has been shown to be predictive of future fracture risk, prevention strategies target screening those patients at risk for decreased bone mass by using bone mineral density (BMD) dual energy x-ray absorptiometry (DXA) scans. Current national guidelines recommend that all women 65 years and older undergo BMD testing using central DXA every two years. Despite these recommendations, women age 65 years and older still do not participate in this screening. Greater rates of osteoporosis screening could …

Effects Of A Parish Based Heart Healthy Education Program, Kristin A. Kilinski

Evidence-Based Practice Project Reports

Cardiovascular disease is the leading cause of mortality and morbidity in the United States. Some risk factors for cardiovascular disease can be modified which include: diet; physical activity; smoking; hypertension; diabetes; and weight. Various national programs, such as “Go Red for Women” and “Let’s Move,” have been implemented to address this growing epidemic. Community programs are needed as an adjunct to these national initiatives. Thus, a parish based cardiovascular disease educational program would provide for a unique socially and spiritually supportive environment for education at the community level. Research findings indicate that parish based educational programs are effective in increasing …

The Effects Of Education On Cardiovascular Disease Knowledge, Lauren A. Ostrowski-Winkler

Evidence-Based Practice Project Reports

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality for adults in the United States. The three main risk factors for the development of CVD include hypertension, high cholesterol, and tobacco use; these factors are largely prevented or reduced through lifestyle modifications. Researchers indicate that knowledge of CVD mortality has been linked with individual action to reduce one’s CVD risk. Researchers have also indicated that segments of our underserved society, particularly those with the highest CVD mortality rates, are also the least knowledgeable about CVD and their own personal risk. These risk factors were a concern within the …

Dopaminergic Genetic Contributions To Obesity In Kidney Transplant Recipients, Ashley Grimes Stanfill

Theses and Dissertations (ETD)

Background: Kidney transplant recipients are a population who experience a high likelihood of gaining a significant amount of weight (between 6 and 13 kilograms) during the first year after transplantation. However, not all kidney transplant recipients gain weight. Studies have found little difference in physical activity and nutritional intake among those who do and do not gain weight. Immunosuppressant medications have also not been shown to play a substantive role in post-transplant weight gain. Additionally, although some studies have shown that age, gender, and race can influence weight gain, this information does not fully capture the observed variance. These observations …

Screening Asymptomatic Women For Cardiovascular Risk, Kathryn Nelson-Murphy

Evidence-Based Practice Project Reports

Cardiovascular disease (CVD) has long been recognized as a significant health problem in the U.S., and is the leading cause of preventable death in women, collectively causing about one death per minute (Caboral, 2013). A myriad of modifiable risk factors including dyslipidemia, hypertension, smoking, obesity, and type II diabetes are associated with 80-90% of CVD morbidity and mortality. Despite sobering statistics, valid risk prediction screening tools, and national preventive guidelines, adequate screening in clinical practice settings is sadly deficient. An evidence-based practice project was designed and implemented at a large OB/GYN practice in southern Ohio to address this identified gap …

Results And Lessons Learned From A Nurse Practitioner-Guided Dementia Care Intervention For Primary Care Patients And Their Family Caregivers, Richard H. Fortinsky, Colleen Delaney, Ofer Harel, Karen Pasquale, Elena Schjavland, John Lynch, Alison Kleppinger, Suzanne Crumb

Articles - Patient Care

Older adults with dementia care needs often visit primary care physicians (PCPs), but PCP dementia care limitations are widely documented. This study tested the value of employing a nurse practitioner (NP) with geropsychiatric expertise to augment PCP care for newly and recently diagnosed patients and family caregivers. Twenty-one dyads received the NP intervention; 10 dyads were controls. Outcomes included patient neuropsychiatric symptom and quality of life changes, and caregiver depression, burden, and self-efficacy changes. Intervention acceptability by patients, caregivers, and PCPs was determined. No outcome differences were found; however, the NP intervention was deemed highly satisfactory by all stakeholders. Patients …

Online Learning: Advantages And Challenges In Implementing An Effective Practicum Experience, Maureen M. Mitchell, Cheryl Delgado

Nursing Faculty Publications

Executing an effective clinical practicum experience for distance learners requires systems to be in place to ensure that all students receive a quality clinical experience and meet course and program objectives. Key to achieving these successful outcomes is recognizing and overcoming the challenges involved in designing graduate practica for Master of Science in nursing candidates. A systematic approach is presented for consideration.

The Effect Of A Group Lifestyle Coaching Model On Hba1c And Psychosocial Constructs In Low-Income Patients With Type 2 Diabetes, Lillian Tryon, D.N.P.

Faculty Works

The epidemic of diabetes and its complications is concerning, and new approaches need to be explored for fostering better patient outcomes in a cost effective way. This exploratory study examined the effectiveness of a group coaching model on glycemic control, diabetes knowledge, diabetes empowerment, and diabetes self-management compared to usual care or participation in a 90-minute diabetes education class. A convenience sample of 34 patients with type 2 diabetes mellitus was recruited at a clinic providing services to the uninsured. Participants self-selected into the coaching group (n= 12), class group (n = 10), or control group ( …

Promoting Behavior Changes In Patients With Type 2 Diabetes Through Shared Medical Appointments, Shonda Lanette Williams

Doctoral Projects

Diabetes Mellitus (DM) is a chronic disease that affects many individuals in the United States. It was reported that a total of $245 billion is spent annually on both direct and indirect health care costs associated with the treatment of diabetes and diabetic related complications. Diabetes related complications can be prevented or delayed if proper education is done and individuals are willing to practice positive behavior changes and self-manage their disease. The purpose of this doctoral capstone project was to promote behavior changes in patients with diabetes through diabetes self-management education (DSME) in shared medical appointments (SMAs).

This project was …

An Evaluation Of The Effectiveness Of Providing Foot Care Education In A Rural Clinic Setting, Gloria Green-Morris

Doctoral Projects

Diabetes is one of the most frequently diagnosed metabolic disorders and is currently at pandemic magnitude. Approximately 1.4 million adults are diagnosed with diabetes each year. According to the American Diabetes Association (2011), the numbers of diagnoses will more than double by 2030. Because of the high prevalence of diabetes, the perceptions of risk factors and healthy behaviors are important. A good understanding of written and verbal healthcare instructions, healthcare accessibility, and socio-economic status have a direct effect on patient health outcomes and the overall health of the population (Jovic-Vranes, Bjegovic-Marinkovic & Marinkovic, 2009).

Diabetic foot complications are common concerns …

Bridging The Gap: Understanding, Anticipating, And Responding To The Needs Of Student Veterans In A Bachelor Of Science In Nursing Program, Larry Michael Stowers

Doctoral Projects

The passage of the Americans with Disabilities Act Amendment Act (ADAAA) of 2008 and the Post-9/11 Veterans Assistance Act of 2008 have afforded veterans the opportunity to pursue post-secondary education. Since October 2001, over 2 million American men and women in uniform have deployed in support of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). While thousands of returning combat veterans take advantage of recent legislation that helps pay for their education, they face new challenges in the classroom. This nation’s veterans represent a group of diverse individuals who bring different experiences, thus different perspectives than traditional college-aged students. …

The Wright Tool Kit: Qsen Competency Integration In An On-Line Rn-To-Bsn Program, Ann M. Stalter, Patricia Martin, Ximena Chrisagis, Deborah Lee Ulrich, Kathy J. Keister

Nursing Faculty Publications

Colleges across the nation are working to transform nursing education and to integrate QSEN competencies into program curricula.

Successful Aging In The United States And China : A Theoretical Basis To Guide Nursing Research, Practice, And Policy., Valerie Lander Mccarthy, Hong Ji, Jiying Ling

Faculty and Staff Scholarship

Successful aging is an idea gaining increasing attention given the exponential growth in the older adult population. Criteria and definitions within multiple disciplines vary greatly in Western literature, with no consensus on its meaning. Moreover, sociocultural, economic and political differences between the Western view of successful aging and its use in China – with the world’s largest older adult population – add to the confusion. Similarities and differences in the meaning of successful aging in the United States and China are examined and the potential for a common definition that is useful to nursing in both countries is explored. Using …

The Experience Of Latino Parents Of Hospitalized Children During Family Centered Rounds, Lisa Ann Walker-Vischer

Doctoral Projects

Problem: Hospitalization of a child is stressful. The parental role is altered and parents have a primary need to receive timely information. Family centered rounds (FCR) provide a mechanism to exchange information and facilitates shared decision making with the medical team while parents advocate for their child's needs. FCR has been linked to increased satisfaction and improved outcomes. A recent study suggests that Latino parents have a suboptimal experience related to language barriers and a lack of empowerment. The purpose of this study is to describe the experience of Latino parents of hospitalized children during FCR in a public safety …

Pilot Study: Avoiding Readmissions Of Heart Failure Patients Across Transitions Of Care, Analiza Baldonado

Doctoral Projects

Background: A major problem facing the U.S. healthcare system is avoidable hospital readmissions. Patients with Heart Failure (HF) face variety of barriers to health care and are at higher risk for readmissions. To address this problem, evidence-based interventions focused on safe transition from hospital to home are needed.

Methods: A quality improvement pilot project was implemented to evaluate the feasibility of evidence based interventions in preventing avoidable readmissions. The project setting was in a 900 bed health care system. The descriptive statistical methods were means and frequencies. The Transition Coordinator (TC) enrolled a convenience sample of 30 participants. The evidence …

Limited Association Between Perceived Control And Health-Related Quality Of Life In Patients With Heart Failure, Teesta Banerjee, Kyoung Suk Lee, Steven R. Browning, Claudia Hopenhayn, Susan C. Westneat, Martha J. Biddle, Cynthia Arslanian-Angoren, Jo-Ann Eastwood, Gia Mudd, Debra K. Moser

Epidemiology and Environmental Health Faculty Publications

Background: Perceived control has been suggested as a modifiable factor associated with health-related quality of life (HRQOL). However, the relationship between perceived control and HRQOL has not been evaluated in patients with heart failure (HF). The purpose of this study was to determine whether perceived control independently predicts HRQOL in HF patients. Methods: A total of 423 HF patients were included. Hierarchical linear regression was performed to determine the independent association of perceived control to HRQOL after controlling for covariates. Results: Higher levels of perceived control were associated with better HRQOL in univariate analysis. However, this relationship was strongly attenuated …

Endoscopic Pancreatic Pseudo-Cyst Drainage, Judith Dorsam Rn

Patient Care Services / Nursing

No abstract provided.

A Multi-Disciplinary Team Approach To Quality And Efficiency In The Total Knee Arthroplasty Patient, Lori Anne Wittner Bsn, Rn, Cnor

Patient Care Services / Nursing

No abstract provided.

ผลของโปรแกรมส่งเสริมการรับรู้สมรรถนะแห่งตนต่อพฤติกรรมการฟื้นฟูสภาพ ของผู้ป่วยกระดูกขาหักที่ได้รับการผ่าตัดใส่โลหะยึดตรึงภายใน, นันทยา เสนีย์, สุนิดา ปรีชาวงษ์, วรวรรธน์ ลิ้มทองกุล

Journal of Nursing Research, Innovation, and Health

วัตถุประสงค์: เพื่อศึกษาผลของโปรแกรมส่งเสริมการรับรู้สมรรถนะแห่งตนต่อพฤติกรรมการฟื้นฟูสภาพ ของผู้ป่วยกระดูกขาหักที่ได้รับการผ่าตัดใส่โลหะยึดตรึงภายใน\n \nรูปแบบการวิจัย: การวิจัยแบบกึ่งทดลอง\n \nวิธีดําเนินการวิจัย: กลุ่มตัวอย่าง คือ ผู้ป่วยกระดูกขาหักที่ได้รับการผ่าตัดใส่โลหะยึดตรึงภายใน เข้ารับ การรักษาในหอผู้ป่วยศัลยกรรมกระดูก โรงพยาบาลศูนย์ตรัง คัดเลือกกลุ่มตัวอย่างตามสะดวกตาม คุณสมบัติที่กําหนด จํานวน 50 คน โดยผู้ป่วย 25 คนแรก เป็นกลุ่มควบคุม และ 25 คนหลัง เป็นกลุ่ม ทดลอง จับคู่กลุ่มตัวอย่างทั้งสองให้มีคุณสมบัติคล้ายคลึงกันในด้าน เพศ อายุ และระดับการศึกษา กลุ่มทดลองเข้าร่วมโปรแกรมส่งเสริมการรับรู้สมรรถนะแห่งตนในการฟื้นฟูสภาพ ส่วนกลุ่มควบคุมได้รับ การพยาบาลตามปกติ เครื่องมือที่ใช้ในการทดลอง ได้แก่ โปรแกรมส่งเสริมการรับรู้สมรรถนะแห่งตน ซึ่งนําแนวคิดการรับรู้สมรรถนะแห่งตนของ Bandura (1997) มาประยุกต์ใช้ในการจัดกิจกรรมจํานวน 4 ครั้ง โดยใช้เวลาในการทดลองทั้งหมด 8 สัปดาห์ เครื่องมือเก็บรวบรวมข้อมูล ได้แก่ แบบสอบถามพฤติกรรมการฟื้นฟูสภาพของผู้ป่วยกระดูกขาหักที่ใส่โลหะยึดตรึงภายใน ตรวจสอบความตรงเชิงเนื้อหา โดยผู้ทรงคุณวุฒิจํานวน 5 คน มีดัชนีความตรงเชิงเนื้อหา เท่ากับ .87 และมีค่าสัมประสิทธิ์แอลฟ่า ของครอนบาค เท่ากับ .88 วิเคราะห์ข้อมูลโดยใช้สถิติทดสอบค่าที (Independent t-test)\n \nผลการวิจัย: คะแนนเฉลี่ยพฤติกรรมการฟื้นฟูสภาพของผู้ป่วยกระดูกขาหักที่เข้าร่วมโปรแกรมส่งเสริม การรับรู้สมรรถนะแห่งตนสูงกว่ากลุ่มที่ได้รับการพยาบาลตามปกติ อย่างมีนัยสําคัญทางสถิติที่ระดับ .05\n\nสรุป: โปรแกรมส่งเสริมการรับรู้สมรรถนะแห่งตนสามารถเพิ่มพฤติกรรมการฟื้นฟูสภาพของผู้ป่วย กระดูกขาหักที่ได้รับการผ่าตัดใส่โลหะยึดตรึงกระดูกภายในได้ จึงควรนําไปเป็นแนวทางในการดูแลผู้ป่วย กระดูกขาหักที่ได้รับการผ่าตัดใส่โลหะยึดตรึงภายใน และใช้เป็นมาตรฐานในการดูแลผู้ป่วยตั้งแต่ระยะ แรกหลังการผ่าตัดใส่โลหะยึดตรึงภายใน\n