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A Study Of Registered Nursing Students’ Perceptions Of Confidence In Providing Quality Nursing Care To Patients With Alzheimer’S Disease Or Other Dementia, Louanne E. Harto

Doctor of Education (Ed.D)

There are currently millions of persons living with Alzheimer’s disease or other dementia; a number that will rise as the older adult population increases. Patients with Alzheimer’s disease or other dementia who are admitted to the acute care hospital for a physical problem may not receive the same standard of care as those persons without a cognitive impairment. The purpose of this study was to explore the perceptions of students in a prelicensure registered nursing program regarding their confidence to provide patient-centered nursing care to patients with cognitive impairment, specifically Alzheimer’s disease or other dementia. This quantitative study used a …

I Survived The Icu: Post-Intensive Care Syndrome From Patient And Nursing Perspectives, Catherine Bynum

Undergraduate Honors Theses

Excerpt from Introduction

After a head-on collision with a drunk driver, Kathy Torpie had a long road to recovery ahead of her. After three weeks in the intensive care unit (ICU), sedation, and mechanical ventilation, she was left with a set of symptoms coined Post-Intensive Care Syndrome (PICS) (Torpie, 2005). PICS is defined as “a condition that encompasses new or worsening impairments in the patient’s physical, cognitive, or mental status arising after critical illness and persisting beyond the acute hospitalization” (Makic, 2016, p. 172). With technological advancements, ICU survival rates are on the rise. Now that survival has increased, it …

Inter-Sensory Perception Model: Integrating The Sixth Sense In Providing Nursing Care, Ponnambily Jobin Ms, Rajeswari Siva Dr, Sudha R, Hema V. H Ms

Manipal Journal of Nursing and Health Sciences

Introduction: In 21st century, nursing profession is enriched with many theories. However, there exists a wide gap between knowledge and implementation of nursing care. Aim: The paper explains causes of this gap and addresses a solution using a conceptual model titled “Intersensory perception in nursing care ‘under empirical concept’ open your sixth sense in addition to five traditional senses.” Methods: A qualitative case study design was used for testing the conceptual model. Results: The paper classifies the different modalities of sensing, adds one more nontraditional sense (auto thermoception) to five traditional senses and depicts how general sensory perception can be …

Implementation Of Donor Human Milk In A Newborn Nursery: A Quality Improvement Initiative To Increase Exclusive Breast Milk Feeding, Emily Bombard

DNP Scholarly Projects

Background: At the site of this quality improvement project, exclusive breast milk feeding rates before discharge from a newborn nursery were behind benchmark goals. The aim of this project was to improve exclusive breast milk feeding rates by implementing a Pasteurized Donor Human Milk (PDHM) Program for breastfeeding newborns requiring medically indicated supplementation. The study site was a Level I newborn nursery of a 20-bed, labor, delivery, recovery, and postpartum unit within a 100-bed community hospital (i.e., the agency).

Methods: This retrospective pre-post cohort study used the Plan, Do, Study, Act (PDSA) framework for rapid cycle change to assess the …

An Inpatient Rehabilitation Interprofessional Care Pathway For Traumatic Hip Fracture: A Pilot Quality Improvement Project, Sarah Plante

DNP Scholarly Projects

Background: Each year over 300,000 older adults are hospitalized for hip fracture. The impact of the cost of hip fracture on the US health care system is estimated to be as high as $9 billion, with the typical cost of a hip fracture episode around $30,000. Formalized pathways have been developed and successfully utilized for many patient presentations, including hip fracture, in the acute setting. Although this research is important to the comprehensive care of the elderly hip fracture patient, very little research exists that outlines evidence-based best-practice for patients in the post-acute recovery period.

Purpose: The primary aim of …

Identifying Rates, Barriers And Facilitators For Hpv Vaccines In Children Ages 11-14 In A Kentucky Primary Care Clinic, Sarah J. King

DNP Projects

Background: Among all of the pediatric vaccinations recommended by the CDC, the HPV vaccination has consistently had lower adherence rates than the goal set by Healthy People 2020. The CDC recommends that adolescents start receiving the human papillomavirus (HPV) vaccine at the ages 9-11 to provide protection against certain strains of HPV that can cause cancer. The goal is to administer the HPV vaccine before the adolescent would be exposed to the virus. However, there has been much resistance and non-adherence to the HPV vaccination. Purpose: The purpose of this study was to identify the current rates of HPV vaccination …

Depression, Thanu Abraham

Senior Honors Theses and Projects

Depression is one of the most prevalent mental health disorders in the United States. Anyone can be diagnosed with depression at any point in life. The objective of this paper is to explore depression within special populations. This paper will be sectioned into five different chapters. Chapter I will discuss what depression is. Chapter II will examine depression in adolescents. Chapter III will explore postpartum depression. Chapter IV will discuss geriatric depression. Chapter V will explore the relationship between depression and cardiovascular disease. Each section will contain extensive research within its topic. Although depression drastically impacts one's life, only half …

Developing A Predictive Model For Prostate Cancer Screening Intent, Quentin E. Moore

Theses and Dissertations--Nursing

African Americans bear a disproportionately high burden of cancer incidence and mortality in this country. The purpose of this dissertation was to investigate factors associated with African-American men, who are incarcerated, making informed health decisions about participation in prostate cancer screening, as well as exploring factors that reduce modifiable risk factors for cancer. The United States incarcerates more people per capita than any country in the world and African American men are overrepresented in the U.S. prison system

This dissertation is composed of three manuscripts. The first paper reviews the current literature about the factors that influence African-American males in …

Reproductive Autonomy: The Context Of Pregnancy Intention, A Global To Local Approach, Hartley C. Feld

Theses and Dissertations--Nursing

Globally, in low and middle-income countries 4 out of every 10 pregnancies is reported to be unintended. Having an unintended pregnancy increases the risk of maternal and infant morbidity and mortality, preterm birth, low birth weight, and decreases rates of breast-feeding. The United States (U.S.) consistently has some of the highest rates of preterm birth, infant and maternal mortality of all high-income countries and 45% of all pregnancies in the U.S. are reported to be unintended. The etiology of these outcomes and their relationship to pregnancy intention are complex and multifactorial, but we know this disproportionately effects women living in …

Factors Associated With Taste Perception And Dietary Consumption Patterns In Individuals With Or At-Risk For Cardiovascular Disease, Jennifer L. Smith

Theses and Dissertations--Nursing

Excessive intake of sodium, sugar, fats, and other unhealthy dietary patterns significantly contribute to cardiovascular disease (CVD) risk and, among those with diagnosed CVD, to deleterious outcomes. Taste perception is one of the most important factors influencing dietary intake and there are many factors that can alter it such as medication and genetic variations. Yet there has been relatively little research on influences of taste perception on self-management of CVD and CVD risk.

The purpose of this dissertation is to examine the association of various factors and taste perception in order to add to our understanding of what may or …

Social Support, Relationship Quality, And Self-Care Behaviors In Patients With Heart Failure, Majdi Mohammad Rababa

Theses and Dissertations--Nursing

The purpose of this dissertation was to examine the associations among social support, gender, relationship quality, and self-care behaviors in patients with heart failure (HF). Specific aims were to: 1) compare the psychometric properties of the 12-item and the 9-item European Heart Failure Self-Care Behavior Scale (EHFScBS) when used to measure self-care behaviors in patients with HF in the United States; 2) determine whether gender moderated the association between perceived social support and daily sodium intake in patients with HF; and 3) determine whether a patient’s gender and relationship with the primary family caregiver (spousal or non-spousal) moderated the association …

Reference Notes For Palliative Care Consultation, Robert F. Johnson

Open Textbooks

The interprofessional health care specialty of palliative care employs holistic evaluation and person-centered communication in the care of people with life-threatening illness. Palliative care clinicians are consulted for one or more of the following reasons:

• Symptom assessment and management
• Assistance with making difficult decisions about continued use or withdrawal of life-sustaining interventions
• Communication for planning the most appropriate care setting to meet person/family goals for end-of-life care
• Assessment of suitability and eligibility for hospice care

This resource is a compilation of previously published documents and tools useful to palliative care clinicians in preparing for and conduction these consultations. In addition, …

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

Walden Dissertations and Doctoral Studies

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

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

Walden Dissertations and Doctoral Studies

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

Implementation Of A Standardized Approach To Diabetes Education, Stacey Williams Porter

Walden Dissertations and Doctoral Studies

The Centers for Disease Control and Prevention (CDC) report that Type 2 diabetes

mellitus (T2DM) is a serious health issue affecting over 24 million Americans. Adults with T2DM are 2 to 4 times more likely to experience complications of the disease such as heart disease and stroke. Efforts are needed to control the condition and prevent the complications. At a local community hospital in the southeast United States, a 2-year assessment revealed over 10,000 patients admitted with diabetes or diabetes-related complications. Staff nurses at the site were responsible for diabetes self-management education for T2DM patients at discharge; however, no standardized …

Increasing Referrals Of Hospitalized Obese Patients, Tammy Elaine Cabrera

Walden Dissertations and Doctoral Studies

The rate of obesity continues to rise in the United States and globally, placing populations at

increased risk of obesity related conditions, such as diabetes, hypertension, heart disease, cancer,

and other disease states. Literature review shows that there have been many different methods

utilized to halt obesity's progression, however rates continue to increase. The United States

Preventative Services Task Force (USPSTF), American Heart Association (AHA), and other

agencies recommend obesity screening and counseling at every patient encounter, but most

hospitals do not have a current obesity policy in place to accomplish this task. The purpose of

this project is to …

A Structured Weight Loss Program To Combat Obesity In Women, Tara English

Walden Dissertations and Doctoral Studies

Rates of obesity and the associated comorbidities continue to increase for women in the United States. Despite information available, efforts at weight loss are often unsuccessful because women lack integral knowledge of how to approach the various components essential for weight loss. This doctoral project was created to address the practice question of whether obesity can be reduced through a step-wise weight loss program that identifies essential elements to reduce weight in menopausal age women. Guided by the information-motivation-behavioral skills model, this project led 17 volunteer participants from a Northwest, Florida primary care clinic through 6 weeks of protocols supplemented …

Implementation Of A Physical Activity Group At A Community Mental Health Center: A Pilot Quality Improvement Project To Reduce Depressive Symptoms In Adolescents With Major Depressive Disorder, Nancy Gallagher

DNP Scholarly Projects

Major Depressive Disorder is a debilitating illness that affects millions of Americans, including adolescents. The majority of adolescents with Major Depressive Disorder (MDD) do not receive treatment. There may be a variety of reasons for this including stigma, access to care, and potential adverse reactions. People suffering from MDD are known to be at high risk for suicide. Lack of treatments adds the risk of suicide for adolescents with MDD. Identifying and implementing treatment options that are more acceptable and accessible are of the utmost importance. Although there is limited research regarding exercise/physical activity, depressive symptoms, and adolescents with MDD, …

Educating Primary Care Nurses On Phosphorus Management In Chronic Kidney Disease Patients, Lilian Somuah

Walden Dissertations and Doctoral Studies

Fifteen percent of adults in the United States have been diagnosed with chronic kidney disease (CKD). CKD is the slow, progressive, and irreversible loss of kidney function. The most effective means of controlling CKD is by managing dietary phosphorus intake. It is important that staff nurses be educated about effective patient education tools to improve dietary phosphorus management. The purpose of this project was to educate primary care nurses about phosphorus management in CKD patients through the introduction of the phosphorus pyramid as a visual tool. The project sought to understand if an educational intervention regarding phosphorus management in CKD …

A Patient-Centered Approach To Diabetes Education In A Rural Clinic, Paul Okpuzor

Walden Dissertations and Doctoral Studies

Type 2 diabetes mellitus (T2DM) is a heterogeneous metabolic disease impacting more than 8.3% of adults in the United States. Diabetes-related care accounts for more than 11% of all patient care expenditures. The purpose of this project was to identify the primary concerns of members of the T2DM patient population in an underserved clinic in rural southcentral United States and to make recommendations for a staff diabetes education program to address these concerns. Orem's theory of self care outlined the importance of educating and supporting patients in their efforts to manage their own healthcare. Knowles's assumptions of how adult's learn …

A Community Oriented Solution To Access To Care, Margaret Louise Thornell

Walden Dissertations and Doctoral Studies

Access to primary health care services is a significant issue for many communities seeking to improve the health of their populations. This single case study describes the 12-year journey of 2 adjoining rural counties in 2 states towards meeting the primary and specialty care needs of the uninsured and underinsured population. Data were triangulated using historical documents, first-person interviews, and health utilization data. The community leadership moved through various models including a free clinic and a university-sponsored health center before finally establishing a federally qualified health center, which now serves 40,000 citizens in these counties. The site is now hosting …

Increasing Medication Adherence In Hypertensive Patients With Million Hearts® Health Literacy Program, Tammy Ross

Walden Dissertations and Doctoral Studies

Healthy People 2020 identified hypertension (HTN) as a controllable risk factor to prevent cardiovascular disease and stroke. Adhering to regular antihypertensive (AHT) medications improves outcomes in patients diagnosed with HTN by controlling blood pressure, reducing hospital visits, and promoting patient wellness. Medication adherence occurs when prescribed medicine regimens are utilized by the patient as directed to manage illness or disease, as evidenced by patients receiving medications at their pharmacy. The practice-focused question for this quality improvement project asked whether implementation of health literacy tools from Million Hearts® HTN Control: Action Steps for Clinicians, increased medication adherence as evidenced by regular …

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

Walden Dissertations and Doctoral Studies

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

A Nurse-Led Evidence-Based Quality Improvement Program On Childhood Obesity Prevention, Ana Flor Rasonabe Ciocson

Walden Dissertations and Doctoral Studies

The increased prevalence rate of childhood obesity in Saudi Arabia is a nationwide health issue. The doctoral project was instituted in the pediatric out-patient clinic (POPC) of a tertiary university hospital in Riyadh, Saudi Arabia. Child obesity clinic and clinical practice guideline (CPG) for primary prevention were not available in the pediatric outpatient clinic with a high incidence of newly diagnose obese children. The focus of this doctoral project was to improve the clinical nursing practice of POPC nurses through the adoption of CPG on primary prevention of childhood obesity. The knowledge translation into action framework provided a summary of …

Program To Prevent Subsequent Fragility Fractures, Kathleen Jean Forti-Gallant

Walden Dissertations and Doctoral Studies

One out of 2 women and 1 out of 5 men over age 50 will sustain a fragility fracture (FF) in their lifetime. The risk of a 2nd FF increases dramatically after the 1st fracture and can lead to pain, disability, and mortality. Despite the evidence that secondary prevention programs are effective, the local facility did not have a formal mechanism to address this need. The purpose of this project was to design a program for secondary prevention of FFs and to address the need for a program for secondary FF prevention that was sustainable locally. The program was designed …

A Practice Change In Adult Obesity Primary Care, Jasmine Tinsley

Walden Dissertations and Doctoral Studies

The rate of obesity in American adults has increased dramatically over the last decade. Obesity has reached epidemic proportions and demands attention to reverse the current trend. This project was developed to evaluate a quality improvement initiative implemented in 2016 to address the problem of obesity in a rural southeastern primary care clinic setting where underserved populations are treated. The quality improvement (QI) initiative was developed using the plan-do-act-check model and the evaluation of the initiative was the focus of the current project. The project question asked if a quality improvement initiative for weight loss monitoring and counseling could improve …

Hand Expression With Lactation Support: Effect On Self-Efficacy And Breastfeeding Duration, Florence Omekara

Walden Dissertations and Doctoral Studies

Breastfeeding is the best infant feeding method, and breastmilk has many immunological and anti-inflammatory properties that protect babies against illnesses and diseases. It protects the health of the mother and saves society substantial economic costs, as demonstrated in many studies. Studies show that if 90% of U.S mothers breastfed for 6 months, up to $13 billion in healthcare costs could be saved. Despite the health and economic benefits of breastfeeding, most women stop breastfeeding before 6 months postpartum, which falls short of the recommendations of the World Health Organization, U.S. Surgeon General, and American Academy of Pediatrics. This study explored …

Development Of A Scholarly Educational Intervention To Improve Inpatient Diabetes Care, Sharon.Hasfal Hasfal

Walden Dissertations and Doctoral Studies

Advanced practice providers (APPs), consisting of nurse practitioners and physician assistants, face many challenges in the provision of evidence-based practice in their management of hospitalized adult patients with diabetes. Some of the barriers faced by APPs at a Northeast acute care facility are poor communication between disciplines, lack of confidence in initiating insulin, limited understanding of the management of insulin and the insulin pump, and insufficient treatment of the hospitalized patient with diabetes that aligns with current clinical guidelines for the management of inpatient hyperglycemia. This quality improvement project focused on the development of an evidence-based theory supported educational intervention …

Discharge Calls And Avoiding Hospital Readmissions, Wanda Lee Cassavettes

Walden Dissertations and Doctoral Studies

Hospital readmissions are disruptive and costly for patients and hospitals. As hospital discharge instructions are a key nursing responsibility, this project implemented a nurse follow-up phone call intervention within 12-48 hours of patient discharge from an indigent care facility in the Great Lakes region of the United States. The project was designed to understand whether follow-up phone calls from nurses that clarified discharge instructions, symptom management, and medications would be associated with decreased readmission rates within 30 days post-discharge among chronic care patients. The theoretical framework was the health belief model, which proposes that the patient's knowledge of illness severity, …

The Effect Of Lactation Consultation On The Duration Of Breastfeeding In New Mothers: A Systematic Review, Jillian Leiter, Jennifer Naegeli, Lilyana Walkley

Williams Honors College, Honors Research Projects

In the United States, 3.978 million babies were born in the year 2015 (U.S. Department of Health & Human Services, 2016). Statistics show that less than 25% of newborns in the United States are breastfed for half of the recommended time by The American Academy of Pediatrics. There are many benefits to breastfeeding, but babies are not receiving these benefits. This systematic review identifies, reviews, and critically appraises the evidence regarding the effect of lactation consultation on duration of breastfeeding in new mothers. Literature was retrieved from CINAHL and Google Scholar. Each study was vetted based on criteria to fully …