Digital Commons Network^™

The Determinants Of A Nurse's Discretionary Decision To Respond To Situations That Place Patients At Risk For Safety Events But Requires A Response That Is Beyond The Scope Of Nursing Practice, Kathy Baker

Theses and Dissertations

A nurse’s contribution to patient safety in regards to early detection of issues in the clinical setting is undisputed (Redman, 2008). If these patient situations require a response that is beyond the scope of nursing practice, in most instances nurses are not sanctioned to intervene without physician consultation (Gaba, 2000). The evidence in the nursing literature does suggest that some nurses exercise professional discretion and are, at times, making the decision to initiate interventions independently (Benner, Hooper-Kyriakidis, & Stannard, 1999; Hutchinson, 1990; Tiffany, Cruise, & Cruise, 1988). The focus of this inquiry was to examine the determinants of a nurse’s …

Facilitating The Staff Nurse's Role In Creating A Culture Of Care On An Obstetrical Care Unit, Laura Struve Hanson

Theses and Graduate Projects

The art of caring is foundational to the nursing profession, but too often nurses prioritize care for others above care for themselves. Nurse self-care and peer care are integral in the creation of a unit culture of care. This project introduces a new nursing practice model based on Jean Watson's caring theory and Caritas Processes to guide staff nurses on an obstetrical unit in creating a culture of care for self and peers. The practice model relies on nurse courage, intentional collaboration, and creativity to uniquely integrate the Caritas Processes into professional practice. This progression fosters the emergence of holistic …

Introducing Integrative Medicine At The Bedside To Patients With Post-Traumatic Headache Pain, Melissa E. Allard

Theses and Graduate Projects

The use of integrative medicine is growing, and the nursing profession has a responsibility to meet the changing needs of patients. This paper describes a model of nursing for delivering integrative medicine practices at the bedside to persons suffering with post-traumatic headache pain related to traumatic brain injury (TBI) and is grounded in Katherine Kolcaba's Comfort Theory. A patient is best served when the holistic principles of integrative medicine are facilitated by a nurse who is centered and able to introduce these modalities with positive intention. The goal of the practice model is to provide the foundation for nursing to …

Advancing A Culture Of Safety Through The Creation Of A Unit-Based Safety Team, Lynda K. Carr

Theses and Graduate Projects

Hospitals are challenged to create a strong culture of safety within their organization to eliminate harm to patients. This paper describes a project to advance a culture of safety on a cardiovascular acute care unit at an urban hospital through the creation of a unit-based safety team. Based on the premise that patient safety is a local phenomenon, the rationale for the project is to aim interventions at the unit level where they will have the greatest impact. Four key steps in creating an effective unit-based safety team are highlighted: team member selection, team development, enacting interventions, and evaluating interventions …

Response To And Recovery From Endotracheal Suctioning In Preterm Infants Using Routine Versus Four-Handed Care, Sharon Cone

Theses and Dissertations

Neonatal Intensive Care Units have experienced profound advances in technology and treatment modalities over the last two decades. Infants born at the edge of viability are now surviving despite prolonged hospitalizations. These infants born preterm are prone to a high degree of stress from life sustaining and routine interventions. Much focus has been directed toward addressing noxious environmental factors such as noise, light, and infectious disease; however, little has been done to examine the stress experienced by the professional caregiver who work in these environments. Environmental press theory, which focuses on the interplay between human beings and their surroundings, is …

Caring For A Preterm Infant During The First Six Months Post Nicu Discharge: A Mother’S Perspective, Lois Phillips-Pula

Theses and Dissertations

Overview There are numerous studies in the current literature focusing on the intense emotions experienced by parents, following the birth of a preterm infant, (i.e., born prior to 37 weeks gestational age [GA]). Research findings have helped us understand the fear and anxiety they feel while attempting to navigate the neonatal intensive care unit (NICU) environment. What happens in those early weeks and months at home after discharge, however, is surprisingly absent from the literature. It is well known that preterm infants are readmitted to the hospital during the first few months after discharge at a rate of 10% - …

A Bridge To One World: An Indigenous Wisdom-Based Approach To Designing A Transcultural Patient Family Advisory Council, Julie Lundberg

Theses and Graduate Projects

As health care organizations face increasing challenges to accommodate diverse patient populations amid growing concerns of persistent health disparities, there is urgent need to better understand and listen to diverse, unique patient experiences. This paper describes the design and implementation of a transcultural Patient Family Advisory Council (PFAC) as a concrete step towards ensuring that the voices of culturally diverse patients and families are effectively engaged to improve the patient experience at a large, Midwestern healthcare organization. Storytelling, ritual and dialogue provide a wisdom-based approach to the design of a Bridge to One World practice model grounded in Leininger's Culture …

Care Of Self: How Reiki Is Used By Nurses To Reduce Stress On An Acute Care Unit, Leann Olson

Theses and Graduate Projects

As the nursing shortage escalates and patient acuity levels continue to rise, nurses can expect to experience increased stress and burnout. Indeed, studies show that job dissatisfaction among nurses today is widespread. Finding ways to reduce the stress, improve job satisfaction, and retention is important not only for nurses, nursing units, and organizations, but also for patients. This paper describes a nursing practice model that was developed to reduce stress and burnout among nurses in an acute care unit of a large urban hospital. The model uses the energy therapy of Reiki and is guided by Martha Rogers' Science of …

Creating A Healing Environment In The Intensive Care Unit, Elissa Egbers

Theses and Graduate Projects

The intensive care unit (ICU) can be a very stressful environment. Patients are critically ill and require constant monitoring. Indeed, high tech care in the ICU environment includes multiple factors that may impair the patient's ability to sleep and rest. The purpose of this paper is to describe a practice model that is conducive to patient healing in an intensive care unit in a large urban hospital. This practice model is significant to patients, families, and nursing staff and is based on Florence Nightingale's Environmental Model of Nursing and her thirteen canons. This paper describes the potential implementation of the …

Living With Hiv: Views Through The Blog, Linda Eastham

Theses and Dissertations

The purpose of this qualitative descriptive study was to develop a greater clarity of how HIV infected individuals live and work within the sphere of HIV infection as represented through unsolicited, personal narratives posted on blogs. Existing, single author, personal blogs were identified via a search engine. Blogs were defined as the blog author's postings and all responses, whether written by the blog author or a reader respondent. Inclusion and exclusion criteria were developed to respect indicators of bloggers' intentions for privacy, e.g., blogs which required a password were excluded. A total of 14 blogs met inclusion criteria. Actions to …

Healthcare Acquired Infection Risk And Toothbrush Contamination In The Icu., Michelle Frazelle

Theses and Dissertations

Healthcare acquired infections (HAIs) are a complex and multi-factorial problem associated with high morbidity, mortality, and cost. Toothbrushes (TBs) may be at risk for contamination with potential pathogenic microorganisms (PPMs) from the patient care environment or autoinnoculation from the patient. We focused on three PPMs: multiply resistant Staphylococcus aureus (MRSA), vancomycin resistant Enterococcus (VRE), and Acinetobacter. Specific aims were to (1) describe environmental factors associated with TB contamination in the ICU; (2) describe the relationship between TB contamination and oral colonization in critically ill adults.

Understanding Mothers Of Late Preterm Infants, Brenda Baker

Theses and Dissertations

The experience of becoming a mother is a personal and social experience influenced by individual characteristics, friends and family, and the infant. The journey to become a mother encompasses concepts of maternal competence and responsiveness. The purpose of this study was to examine maternal competence and responsiveness to the infant in mothers of late preterm infants compared to mothers of full term infants. The conceptual model for this work was based on the work of Reva Rubin describing maternal identity and role development. Maternal competence and responsiveness are components of maternal role and are influenced by social support, maternal self-esteem, …

Caring, Interaction, And Active Teaching Strategies: Factors That Contribute To The Success Of The Associate Degree Nursing Student, Penelope Sue Logsdon

Dissertations

This exploratory study examined successful associate degree nursing students’ perceptions regarding the importance of caring by the nursing faculty, nursing faculty/student interaction, and faculty use of active teaching strategies. Participants completed a researcher developed survey instrument that measured both the importance and frequency of the caring, interaction, and active teaching strategies. The survey instrument measured six demographic factors and 30 statements regarding caring, interaction, and active teaching. Participants rated the statements for both importance and frequency on a four-point Likert scale. Five community and technical college associate degree nursing programs participated in the research with a total of 270 successful …

Caring Minds, University Of Texas Health Science Center At Houston School Of Nursing

Caring Minds

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Are Nursing Students’ Clinical Skills Competency And Self-Confidence Levels Improved Via Video Ipods? A Randomized Controlled Pilot Study, Margaret M. Hansen Edd, Msn, Rn

Nursing and Health Professions Faculty Research and Publications

Background: Mobile technologies allow students the opportunity to enhance learning while away from the traditional classroom setting. However, educational outcome research is lacking in the use of mobile health (m-health) applications in healthcare professional practice development.

Objectives: The aim of this pilot study was to discover whether male and female urinary catheter insertion videos delivered via iPods increases students’ skills competency and self-confidence levels.

Methods: A prospective replicated study including second year, semester two, undergraduate nursing student participants (NSP) (N=16) was conducted: nine control participants (no video iPods) and seven intervention participants (video iPods). Nursing students attending a mandatory skills …

Call-Shift Fatigue And Use Of Countermeasures And Strategies By Certified Registered Nurse Anesthetists, Ramona M. Domen Phd, Crna

Dissertations

Purpose: The purpose of this study was to examine whether Certified Registered Nurse Anesthetists (CRNAs) experience fatigue during call and to assess their use of fatigue avoidance strategies (practices that prevent fatigue) and fatigue countermeasures (practices that decrease fatigue) to mitigate its effects. Method: Using a cross sectional descriptive survey design, data were collected from a randomly selected sample of 323 practicing CRNAs who worked call shifts. Data analysis: Data were analyzed using descriptive and multivariate statistics. Results: The sample was fairly evenly distributed with slightly more female respondents, 55% (n = 179). Fifty four percent worked a weekday call …

Military Sexual Trauma Exposure And Heart Rate Variability Outcomes In Female Veterans, Elizabeth Ann Davis Lee

Theses and Dissertations (ETD)

Area of Investigation and Hypothesis: Decreased heart rate variability (HRV) has been used as a predictor of cardiac and all-cause mortality. Studies have documented decreased HRV in a variety of conditions, including posttraumatic stress disorder (PTSD), depression, age, coronary artery disease (CAD), diabetes mellitus (DM), and tobacco use but improvement with beta blocker (BB) treatment. No prior study evaluated the relationship between military sexual trauma (MST) exposure and HRV outcomes. The hypothesis of this study was that female veterans exposed to MST would have lower time domain HRV measures than a reference cohort reporting non-exposure. Methods and Procedures: Electronic medical …

The Effect Of Safety Climate, Teamwork, And Sustainable Motivation On Nurse Job Satisfaction And Intent To Stay, M'Lynda Owens

Nursing Theses and Dissertations

Nursing is a hazardous occupation, and occupational safety in healthcare, particularly hospitals, is gaining attention. The Institute of Medicine (2003) ranked hospitals in the top five industries for occupational injuries and illness. This study explored the relationship between sustained motivation in nurses as depicted by their perceptions of workplace safety climate, teamwork climate, and autonomy and their job satisfaction and intent to stay at their current jobs. Sustained motivation was manifested as the ability of the nurses to consistently and persistently attend to routine activities such as actions to ensure safety. Over one-third (36%) of the variance in sustained motivation …

The Utilization And Effectiveness Of The Hesi E(Square) Exit Exam As A Graduation Requirement Toward Increasing Nclex-Rnrtm Pass Rates In Baccalaureate Nursing Programs, Debra Henline Sullivan

UNLV Theses, Dissertations, Professional Papers, and Capstones

Due to a desire to better prepare BSN students for the Nurse Council Licensure Examination for Registered Nurses (NCLEX-RN^® ) and to increase first-time pass rates, nursing programs across the US are using predictive testing to implement policies that require students to pass a standardized exit exam to graduate (National League for Nursing, 2010). Evolve Learning Systems owned by Elsevier, Inc. offers such an exit exam named the HESI E ² , which recommends a benchmark score to predict success on the NCLEX-RN^® . To offset an expected decrease in NCLEX-RN^® pass rates due to recent changes …

Impact Of Home Hospital Program On Empowerment And Professional Practice Behaviors, Marcille Jo Jorgenson

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this study was to evaluate the impact of a Home Hospital Clinical Placement program on professional behaviors of nursing staff within the Home Hospital and professional behaviors of baccalaureate nursing students enrolled in the Home Hospital Clinical Placement program. The study used a conceptual model developed and tested by Manojlovich (2003).

The study was a non-experimental, cross-sectional design to compare selected attributes between students enrolled in a Home Hospital Clinical Placement and students enrolled in a traditional clinical placement and between registered nurses with high levels of teaching interaction with home hospital students and registered nurses with …

Professionalism And Social Networking: Can Patients, Physicians, Nurses, And Supervisors All Be ‘Friends’?, Joy Peluchette, Katherine Karl, Alberto Coustasse, Philip Rutsohn, Dennis Emmett

Management Faculty Research

This study examines the use of Facebook by certified nurse anesthetist students. Our results showed that, contrary to expectations, most were neutral about faculty, physicians, and supervisors viewing their Facebook profiles but expressed concerns about patients seeing such information. Many (30%) of our respondents had observed unprofessional content posted on the social network sites of their classmates including: intoxication or substance abuse, profanity, sexually suggestive photos or comments, and negative work-related comments. A vast majority indicated they would accept a ‘friend’ request from their supervisor and a physician but not a patient. Surprisingly, about 40% had initiated a ‘friend’ request …

Factors Which Influence The Use Of Active Learning Strategies By Nursing Faculty, Deborah Lowell Shindell

UNLV Theses, Dissertations, Professional Papers, and Capstones

Nursing education is facing a crisis. Anachronistic teaching methods are no longer keeping up with the needs of new graduates entering practice. Despite a body of knowledge which supports the use of active learning in higher education, nursing faculty continue to rely on lecture as their primary pedagogical approach. Previous study of the use of research products in clinical nursing practice identified systematic factors such as characteristics of the communication of research findings and characteristics of the organization form the greatest barrier to use. This study discovers if these same barriers face nursing educators.

Using Roger‟s Theory of Diffusion of …

Nursing Students' Lived Experiences Surrounding Medication Administration, Sally Nan Morgan Phd

Dissertations

Medication errors are abounding and the complexity of medication administration creates an environment where health care providers are at risk for making errors. This environment includes nursing students learning medication administration. Coupled with a rigid, protocol-driven pedagogy, nursing students may be placed in a learning experience counterproductive to accuracy. Previous studies have focused on causes and perceptions of medication errors looking for the delineation between safe and unsafe practice. In doing so, past research may have narrowed the path of discovery needed to diminish medication errors. In addition, research regarding the lived experience of nursing students while they are learning …

Women's Cognitive Appraisals Of Their Birth Experience As Predictive And Maintaining Factors Of Postpartum Posttraumatic Stress Symptom Severity, Lauren Carr Spooner

Dissertations

Empirical support has accumulated for evidence of posttraumatic stress symptoms following approximately 30% of childbirth experiences (Olde, van der Hart, Kleber, & van Son, 2006). Researchers have suggested that there is a complex relationship among predisposing, precipitating, and maintaining factors that impact postpartum PTSD (Slade, 2006). Anxiety, perception of support, and negative cognitions are such factors that have been shown to significantly correlate with PTSD symptoms (Foa & Rothbaum, 1998; Olde et al., 2006; Soet, Brack, & Dilorio, 2003), but have not been studied together in relation to PTSD associated with traumatic birth. The current study controlled for trait anxiety …

Nurses Information Appraisal Within The Clinical Setting, Heather D. Carter-Templeton

Theses and Dissertations (ETD)

Information appraisal is foundational to information literacy, a necessary skill to support evidence-based practice. Little discussion in nursing literature exists regarding how nurses appraise information. If nurses lack information appraisal skills they cannot safely and effectively apply evidence in practice. Furthermore, if nurses at all levels are to engage in evidence-based practice, information appraisal in the clinical setting must be understood. The research study used an interpretive description design to define and describe the process of information appraisal in the clinical setting. Participants of this study represented a stratified purposeful sample of 44 registered nurses employed at a regional medical …

A Study Of Expressed Emotion In Psychiatric Nurses And Its Relation To The General Role And Effects Of Emotions In Nursing, Lauren A. Buck

Senior Honors Theses

Nurses play a vital role in the health and care of a patient. Through that care, the nurse has the ability to improve the patient’s experience or ruin it. A vital component influencing the care provided are the emotions the nurse displays toward her coworkers, patients, and patients’ family members. The emotions of a nurse may positively or negatively impact a patient. The studies that examine the impact of the nurse’s emotions on patient’s outcomes are varied and few. The communication and emotion of nurses are likely to impact their care and, from that, the patient’s outcome; however, there is …

Creating A Self Learning Module For Nurses Caring For Patients Undergoing Angioplasty And Receiving Anticoagulation Therapy, Stacy Incardone

Nursing Masters

Nurses in the Cardiac Catheterization Lab (CCL or commonly referred to as the Cath Lab) play a critical role in the delivery of high quality care to their patients. Being knowledgeable and current on evidence based practice is the key to being an effective and efficient nurse. Every year there are annual competencies that nurses must demonstrate to prove that they are capable of performing these patient tasks independently. These annual competencies are institution and unit specific and may include tasks such as demonstration of inserting an intravenous catheter, drawing a blood specimen from an arterial line, and reading and …

Job Stress, Mentoring, Psychological Empowerment, And Job Satisfaction Among Nursing Faculty, Catherine Emily Ebersole Chung

UNLV Theses, Dissertations, Professional Papers, and Capstones

The National League for Nursing (NLN) endorses mentoring throughout the nursing faculty career trajectory as the method to recruit nurses into academia and improve retention of nursing faculty within the academy (NLN, 2006). One way mentoring assists faculty is by easing socialization to the culture of the employing institution and decreasing faculty stress (Lewallen, Crane, Letvak, Jones, & Hu, 2003). Mentoring can also be a facilitating factor of an individual's psychological empowerment. Academia is an environment able to foster psychological empowerment, a state in which faculty may be self-directed, highly productive, confident, and find a meaningful connection to their work …

Methodological Quality Of Quantitative Nursing Lesbian, Gay, Bisexual, And Transgender Research From 2000 To 2010, Michael Johnson

UNLV Theses, Dissertations, Professional Papers, and Capstones

Lesbian, gay, bisexual, and transgender (LGBT) people constitute one of the largest underserved populations in any nursing setting. Despite the large LGBT populations, very little nursing research has been conducted on these populations. Nurse researchers have recommended that nursing researchers end the silence on LGBT research. To accomplish this, the methodological rigor of LGBT nursing research must be evaluated and improved upon. Currently, no literature examines the methodological quality of quantitative nursing LGBT research. Using a cross-sectional design, it was the purpose of this study to evaluate the methodological quality of quantitative nursing LGBT research from 2000 to 2010 using …

Effects Of Voluntary Public Reporting On The Nurse Sensitive Measures Of Falls And Falls With Injury In Hospitals: A Massachusetts Perspective, Patricia Noga

Graduate Doctoral Dissertations

Background: Interest and efforts in the health care industry to be transparent by collecting and publicly reporting performance measures about healthcare quality and cost has increased in recent years. The National Quality Forum (NQF) endorsed a set of 15 national quality measures for nursing-sensitive care that could be used for public accountability and quality improvement, including measures of patient falls and falls with injury. Patient falls have been among the largest category of reported incidents in hospitals, and are a serious concern for healthcare leaders and healthcare team members. In 2006, Massachusetts hospitals began voluntarily publicly reporting the nurse sensitive …