Digital Commons Network^™

Evidence-Based Pulmonary Rehabilitation Reduces Hospital Readmissions In Adults With Copd, Christiana Otuwa

Walden Dissertations and Doctoral Studies

Many patients are affected by chronic obstructive pulmonary disease (COPD), a progressive lung disease that obstructs air flow, resulting in dyspnea and inability to carry out daily activities. Despite optimal pharmacological management, COPD patients make frequent emergency room visits and are hospitalized due to exacerbations of COPD. Literature has suggested that pulmonary rehabilitation (PR), a nonpharmacological treatment, could help to decrease the symptoms that lead to illness exacerbation, hospital readmissions, and decreased quality of life in patients with COPD. The purpose of the project was to increase the quality of life and reduce admission rates for patients diagnosed with COPD …

Early Detection Of Neonatal Abstinence Syndrome By Neonatal Intensive Care Unit Nurses, Ebele Oraka

Walden Dissertations and Doctoral Studies

Neonatal abstinence syndrome (NAS) is a public health concern that is increasing in the United States due to the use of illicit drugs by pregnant women, which exposes the fetus to these substances. NAS results in increased infant morbidity and prolonged stay in the hospital, which can lead to increased cost of care. The inability of the nurses to care for at-risk infants can lead to inconsistent NAS scores, which can affect the infant's care treatment. The project examined the effectiveness of educating the neonatal intensive care unit (NICU) nurses on the correct use of the modified Finnegan Neonatal Abstinence …

Non-Nursing Courses' Impact On Nclex-Rn Pass-Rates In Associate Degree Nursing Programs, Nicole A. Garner

Walden Dissertations and Doctoral Studies

Nurse educators make decisions regarding the inclusion or exclusion of non-nursing courses in a curriculum. The current literature lacks research regarding which courses have the most impact on first-time nursing licensing examination pass-rates. The purpose of this quasi-experimental study was to investigate if there is a specific combination of courses that enhance first-time licensing examination pass-rates, using 161 randomly selected accredited associate degree nursing programs. General systems theory applied to nursing education was the framework for the study. ANOVA and independent t-tests were used to address the questions of non-nursing courses or discipline-specific set of non-nursing courses' impact on first-time …

Development Of A Staff Education Module On Adolescent Obesity, Deborah Ann Stallworth

Walden Dissertations and Doctoral Studies

Adolescent obesity is a growing health concern in the United States due to its increasing prevalence and comorbidities that can reduce longevity and increase morbidity. Advanced practice nurses (APNs) providing care in school-based health centers (SBHC) located in marginalized communities are uniquely positioned to work with adolescent students challenged with obesity. The management of adolescent obesity requires advanced skills and knowledge to promote healthy lifestyles, prevent obesity, and to directly address the many factors that contribute to the condition. The purpose of this project was to develop an education program for APNs to prepare them to work with students in …

Barriers To Daiy Blood Glucose Self-Monitoring In Type 2 Diabetes Mellitus, Sylvain N. Tientcheu

Walden Dissertations and Doctoral Studies

Routine blood glucose monitoring by patients with Type 2 diabetes mellitus (T2DM) is needed for effective management of T2DM; however, 75% of monitoring logs are returned incomplete during monthly provider follow-up appointments. As a result, effective management of the patient's medical condition is limited. To better understand the reasons for noncompliance, a quality improvement project (QIP) was initiated between July 01, 2017 and September 30, 2017, to identify barriers that prevented patients from self-monitoring of blood glucose (SMBG). No formal assessment of the patients' responses had been done, and, as a result, the deidentified, qualitative responses from the QIP were …

Evaluation Of The Effectiveness Of An Established Glycemic Monitoring Program In A High School Setting For Adolescents With Type I And Type Ii Diabetes Mellitus, Tabatha Lee Obeda

Walden Dissertations and Doctoral Studies

Adolescents with Type I and Type II diabetes need to monitor blood glucose and food intake, administer insulin, and participate in activities including physical education during school hours to maintain glycemic control. Glycemic management programs (GMPs) exist for the improvement of diabetes management during school hours. The purpose of this project was to evaluate a GMP in a school system in a rural area in the Southeastern United States. The goal was to determine if the existing GMP met objectives and to make recommendations for continuation, revision, or discontinuation of the GMP. The logic model provided the basic framework for …

Adherence To The Icu Liberation Abcdef Bundle Improves Patient Outcomes In The Icu, Jennifer Sweeney

Walden Dissertations and Doctoral Studies

Delirium is a frequent complication of intensive care unit (ICU) admissions manifesting as acute confusion with inattention and disordered thinking. Patients in the ICU who develop acute delirium are more likely to experience long term disability and mortality. The purpose of this doctoral project was to evaluate an existing organizational quality improvement project to guide recommendations on improving care in the ICU. The practice-focused research question was: Does improving adherence to the ICU Liberation ABCDEF bundle for patients admitted to the ICU decrease incidence of delirium compared to outcomes prior to implementation? The Program Logic Model served as a framework …

Using Diabetes Self-Management Education To Enhance Adolescent Transition, Jessica Adkins

Walden Dissertations and Doctoral Studies

Type 1 diabetes is a long-term diagnosis, the prognosis of which is directly related to the patient's ability to self-manage the disorder. Adolescents are not currently taught how to manage diabetes; instead, parents and educators expect self-management to be more of a learned behavior from their parents. The purpose of this project was to create a quality improvement plan which the regional pediatric diabetes center study site could implement to improve adolescent glycemic control. Orem's self-care theory was used as theoretical framework for the design and evaluation of the project. The practice-focused question for this doctoral project was: Can a …

Chronic Disease And Injury Prevention Programming For Canada's Indigenous Population, Nicole Blackman

Walden Dissertations and Doctoral Studies

Local public health units in the province of Ontario, Canada, are often the primary source of health promotion and health education resources, but many do not provide programming specific to the Indigenous population. As of January 2018, modernization of the Ontario Public Health Standards requires public health units to work with the Indigenous population in providing culturally appropriate programs and services. The practice question guiding the capstone project was to determine what chronic disease and injury prevention programs exist that are culturally appropriate for the Indigenous population. The purpose of this project was to do an environmental scan and compile …

A Staff Education Project And Screening Tool To Identify Calciphylaxis, Janice Pennington

Walden Dissertations and Doctoral Studies

Calciphylaxis is a deadly disease seen primarily in patients with end stage renal disease. Literature indicated that improved patient outcomes are seen with routine screenings. Many dialysis providers lack fundamental knowledge that would enable early identification of calciphylaxis in patients with renal disease. The purpose of this project was to design a screening instrument and develop a staff education program that would transform calciphylaxis management by promoting early identification and treatment of the disease. Knowles's theory of andragogy was used as the theoretic framework for the project. Dialysis center staff (n = 26) participated in the education. The number of …

The Impact Of Diabetes And Obesity In The African American Population, Andrea Lynette Swails

Walden Dissertations and Doctoral Studies

Within the 21st century, Type II diabetes has emerged as a public health crisis. African Americans and Hispanic Americans have the highest rates of Type II diabetes and obesity compared to European Americans. The purpose of this DNP project was to teach medical assistants (MA) to provide self-management of diabetes and obesity for the African American population in the local clinical setting. An educational tool kit for health providers was developed to guide the educational project. The chronic care model was used to guide the development of the educational toolkit. A pretest posttest design was incorporated into the educational program. …

The Effects Of Hourly Rounding On Patient Safety And Satisfaction, Renee Allatzas

Walden Dissertations and Doctoral Studies

The clinical practice problems addressed by the DNP project were the low patient satisfaction scores and the high number of falls on a hospital neurological step-down unit. The purpose of this project was to improve the Hospital Consumer Assessment of Healthcare Providers and Systems score on one patient satisfaction question and decrease the number of patient falls by implementing hourly rounding, using a script related to patient comfort and toileting needs. The scripted questions were expected to increase the satisfaction of patients and decrease unassisted falls due to increased attention to patient pain and positioning and timely help with toileting …

Health-Related Quality Of Life Of Older Adults In Costa Rica As Measured By The Short-Form-36 Health Survey, Esmeralda Valdivieso-Mora, Mirjana Ivanisevic, Leslie A. Shaw, Mauricio Garnier-Villarreal, Zachary D. Green, Monica Salazar-Villanea, Jose Moncada-Jimenez, David K. Johnson

College of Nursing Faculty Research and Publications

Objective: To test the validity of a common measure of health-related quality of life (Short-Form-36 [SF-36]) in cognitively healthy older adults living in rural and urban Costa Rica. Method: Confirmatory factor analysis was applied to SF-36 data collected in 250 older adults from San Jose and Guanacaste, Costa Rica. Results: The best fitting model for the SF-36 was an eight first-order factor structure. A high correlation between the Mental Component Summary and Physical Component Summary scores was found. Region differences indicated that rural dwellers perceive a poorer health-related quality of life compared with the urban group. Discussion: Costa Rican older …

Exploring The Preparedness Of Novice (Student) Paramedics For The Mental Health Challenges Of The Paramedic Profession: Using The Wisdom Of The Elders, Lisa Holmes

Theses: Doctorates and Masters

This study investigates the preparedness of novice (student) paramedics for the mental health challenges of the paramedic profession and identifies the coping strategies used by veteran paramedics to successfully meet these challenges. The lived experience of veteran paramedics is utilised to provide this important assistance.

Initially, two surveys were developed and administered to 16 course coordinators and 302 students of the 16 accredited undergraduate degree paramedicine courses across Australia and New Zealand, to identify the perceived need (for preparation) within the curriculum. In addition, the anticipations, confidence and fears of novice (student) paramedics, course coordinators and veteran paramedics were also …

Lifestyle Health Behaviors Of Nurses And Midwives: The ‘Fit For The Future’ Study, Lin Perry, Xiaoyue Xu, Robyn Callagher, Rachel Nicholls, David Sibbritt, Christine Duffield

Research outputs 2014 to 2021

Nurses and midwives (nurses) are the principle role models and health educators for the wider population. This study sought to identify the health-related behaviors of the nursing workforce of New South Wales (NSW), Australia, compared to contemporary recommendations for healthy living and to the Australian general population, matched by gender and age. An electronic cross-sectional survey delivered in 2014–2015 recruited 5041 nurses through the NSW Nurses and Midwives Association and professional networks. Validated health behavior measures were collected and compared to Australian National Health Survey data. Compared with younger nurses, older nurses reported greater adherence to fruit and vegetable guideline …

Effects Of An Alcohol Education Program On Improving Knowledge, Attitudes And Satisfaction Of Registered Nurses Caring For Patients Undergoing Alcohol Withdrawal, Luis Medina

Seton Hall University DNP Final Projects

Managing and caring for patients who are undergoing alcohol withdrawal presents challenges for nurses in an inpatient setting. These challenges are influenced by factors such as negative attitudes, lack of knowledge and poor satisfaction. The purpose of this quality improvement initiative was to determine whether the effects of implementing an alcohol educational program would improve knowledge and satisfaction while reducing negative attitudes. This program implemented education on alcoholism, alcohol withdrawal and the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) monitoring tool which would be incorporated into the everyday practice of nurses caring for patients undergoing alcohol withdrawal. The …

Psychometric Testing Of The Healthy Eating And Physical Activity Self-Efficacy Questionnaire And The Healthy Eating And Physical Activity Behavior Recall Questionnaire For Children, Jane Lassetter Phd, Rn, Christopher I. Macintosh, Mary Williams, Martha Driessnack, Gaye Ray, Jonathan Wisco

Faculty Publications

Purpose: The purpose of this study was to develop and assess the psychometric properties for two related questionnaires: the Healthy Eating and Physical Activity Self-Efficacy Questionnaire for Children (HEPASEQ-C) and theHealthy Eating and PhysicalActivity Behavior RecallQuestionnaire for Children (HEPABRQ-C). Design andMethods: HEPASEQ-C and HEPABRQ-C were administered to 517 participating children with 492 completing. Data were analyzed to evaluate for reliability and validity of the questionnaires. Results: Content validity was established through a 10-person expert panel. For the HEPASEQC, item content validity index (CVI) ranged from 0.80 to 1.00. The CVI for the total questionnaire was 1.0. AllHEPASEQ-C items loaded on …

Improving Obesity Management In Primary Care, Jeffrey M. Waddell

Doctor of Nursing Practice Scholarly Project

This project examined how advanced practice nurses (APNs) manage overweight and obesity in primary care. Not only were their general attitudes and beliefs toward overweight and obesity explored, but their beliefs about the treatment and management of obesity were also examined. The APNs’ knowledge and current practice with managing obesity in the primary care setting were evaluated. This project went on to examine the APNs’ awareness and utilization of clinical practice guidelines in managing overweight and obesity. Finally, the study asked about the perceived impact of a website designed to provide guidance managing obesity based on the American Association of …

Improve Readmissions And Patient Satisfaction Scores With A Revised Discharge Education Plan, Michele M. Hughes

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Problem: Payers of health insurance are tracking key performance measures and are limiting payments to hospitals. With this threat to financial reimbursement hospital systems have increased emphasis on tracking and improving outcomes. The purpose of this project is to reduce all-cause 30-day readmissions and improve patient satisfaction scores in the care transitions domain after a total hip or total knee replacement by revising the discharge materials and education.

Method: The total joint replacement discharge education materials were revised to address the common causes of readmissions. The documents were reformatted to improve literacy level, readability, and patient learning. Nurses were educated …

Gerontological Community-Academic Partnership For An Msn Internship, Francine Serafin-Dickson

Doctor of Nursing Practice (DNP) Projects

The growing population of older adults beckons nursing education to evolve and prepare the future nursing workforce with skills and knowledge to coordinate care for the community-dwelling older adult (gerontological) population. The purpose of this project is to develop, implement, and evaluate academic partnerships with agencies serving community-dwelling older adults for the Master of Science in Nursing (MSN) Clinical Nurse Leader (CNL) students. The formation of Community-Academic Partnerships (CAP) offers the opportunity for an experiential learning internship in combination with a gerontological curriculum. The curriculum is integrated into the CNL role courses and internship, focusing on person-centered interactions with older …

Assessment Of Falls Protocol Use On Medical-Telemetry Units, Fanny Ku

Master's Projects and Capstones

Purpose: The purpose of this quality improvement project is to identify a root cause analysis for an increase in falls at a large, metropolitan hospital and implement interventions designed to reduce the incidence of falls on the medical-telemetry unit.

Background: Falls, regardless of severity, may inflict irreparable consequences on patients, families, and hospitals. Approximately 20-30% of falls result in physical or emotional harm, including minor bruises, emotional trauma, and fractures (“Falls,” 2004). When falls occur, hospitals are generally responsible for all costs incurred from the sentinel event, and do not receive re-imbursement from insurances for services provided. In the large, …

Maternal Life Course Adversity: The Intersection Of Psychosocial And Biobehavioral Adaptive Response In Pregnancy, Crystal Modde Epstein

Theses & Dissertations

The link between life course adversity and adverse health outcomes is well established, particularly early life adversity (ELA). There is also evidence that the physiologic adaptations associated with stress, depression and ELA can be transmitted intergenerationally via long-term set-point changes within the maternal hypothalamic-pituitary-adrenal axis (HPA). It is unknown how the type and timing of maternal stress and adversity influences HPA regulation during pregnancy and whether maternal coping attenuates this relationship. Manuscript 1 was an integrative review of studies examining the association between maternal ELA and HPA regulation during pregnancy. In manuscripts 2 and 3 the findings of the dissertation …

Sexual Health Education In New Mexico Public Secondary Schools, Elizabeth Dickson

Nursing ETDs

Previous research has shown that comprehensive sexual health education (SHE) can significantly reduce risky sexual behavior and can increase protective behavior in adolescents. While an important component for all adolescents, this is particularly important for adolescents at high risk for adverse health outcomes, such as unplanned adolescent pregnancy and sexually transmitted infections. The aims of this descriptive study were to explore the content and delivery of SHE in New Mexico and to describe influences on decisions pertaining to implementation of state SHE policy. The social ecological model (SEM) was used as a theoretical framework to better understand levels of influence …

Developing Ostomy Educational Tools To Decrease Hospital Length Of Stay, Morgan Whitmore

Master's Projects and Capstones

A quality improvement project “Developing Ostomy Educational Tools To Decrease Hospital Length Of Stay” is aimed at reducing length of stay (LOS) for patients undergoing elective ostomy surgery from the current twelve days (Kirkland-Kyhn, 2017), to less than five days. Methods included use of a Pre-Ostomy Survey, which was distributed and completed by the nursing staff. Pre-survey analysis identified the need for three ostomy educational tools which were developed using a set of evidenced based patient care “milestones” and included: a Colostomy and Ileostomy Nursing Resource Binder, Patient Milestone Checklist, and the R.N. Postoperative Process For Ostomy Patients. The evidenced …

Assessment Of Fall Protocol Use On A Medical-Telemetry Unit, Ashia Mar

Master's Projects and Capstones

Purpose: This quality improvement project serves to implement a fall prevention plan to decrease patient falls on the medical-telemetry unit of a large metropolitan hospital.

Background: Patient falls are a persistent nationwide problem in the acute care setting. Between 700,000 and 1,000,000 falls occur in hospital every year and approximately 30-35% of these falls result in injury and 11,000 falls result in death (Health Research & Educational Trust, 2016). Falls always cause harm to the patient, whether it is emotional or physical; but, falls can also cause harm to the providers, family, and organization. Patient injury, additional hospital expenses, and …

Baseline Prevalence Study Of Hendrich Ii Fall-Risk Assessment Tool At A Local Community Hospital, Emanuelle Vasconcelos Barbosa Borba Pontual

Master's Projects and Capstones

Each year, 700,000 to 1,000,000 people in the United States fall in hospitals; 30%–35% of those sustain injuries, and 20% of falls will cause serious traumatic injuries. Yet, research shows that close to one-third of these falls could be prevented. This paper presents the analyses of two fall-risk tools, Hendrich II fall risk model (HFRM II) and PMAT, in a local community hospital. Extensive review of literature and statistical analysis of 106 patients’ assessments practices were used to determine the current assessment skills for falls and PMAT. The aim was to understand if RNs are using the tools appropriately and …

Surgical Site Infection Reduction Through Nasal Decolonization Prior To Surgery, Melissa S. Schmidt

Master's Projects and Capstones

Surgical site infections (SSIs) are the most common and expensive healthcare-acquired infection. The objective of this nurse-driven process improvement project was to implement a cost-effective and practical decolonization protocol to improve outcomes for high-risk veteran populations undergoing surgery at a large veteran’s hospital in the Pacific Northwest. Prior to the implementation, a decolonization protocol was used for cardiac and orthopedic preoperative patients. The process involved screening for methicillin-resistant Staphylococcus aureus (MRSA) colonization via nasal swab preoperatively and treating positive patients with mupirocin ointment to nares BID and chlorhexidine showers for five days prior to surgery. Adherence to the protocol was …

Clostridium Difficile: An Investigation On A Medical Surgical Unit, Neftali Cabezudo

Master's Projects and Capstones

The objectives for this CNL Internship Project were to: (1) identify the strongest contributors to the rising trend of Clostridium difficile cases on this medical-surgical unit, (2) review all Clostridium difficile cases for correlational factors that are of significant relevance, (3) examine current unit practices and adherence to established policies, and (4) provide recommendations for enhancing existing prevention strategies. The population examined included male adults between 56-83 years old being treated for other medical conditions. The methods used to address this clinical issue included a joint venture between nursing and housekeeping staff to ensure proper terminal cleaning and a renewed …

Fall Prevention Protocol In Acute Care Setting, Allie Di Angelo

Master's Projects and Capstones

Purpose:

Purpose: The purpose of this quality improvement project is to implement a falls intervention to improve falls on the Medical Telemetry unit in the large metropolitan hospital.

Background: Between 700,000 and 1,000,000 falls occur in hospitals every year. Furthermore, approximately 30-35% of these falls result in injury and 11,000 falls result in death (Health Research & Educational Trust, 2016). Falls harm patients, families, and providers. They are also a high cost, as many insurance companies will not reimburse care when a patient falls. As a hospital organization it is important to ensure funds are going to the appropriate places. …

Assessment Of Falls On A Medical-Telemetry Unit, Sahar Taravati

Master's Projects and Capstones

Purpose: The purpose of this quality improvement project is to implement a falls intervention to improve falls on the Medical-Telemetry unit.

Background: Between 700,000 and 1,000,000 falls occur in hospitals every year. Furthermore, approximately 30-35% of these falls result in injury and 11,000 falls result in death (Health Research & Educational Trust, 2016). Falls harm patients, families, and providers. They are also a high cost, as many insurance companies will not reimburse care when a fall occurs. As a hospital organization, it is important to ensure funds are going to the appropriate places. Currently the metropolitan hospital had …