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Nurses’ Knowledge Of Cognitive Behavioral Therapy As A Treatment For Schizophrenia, Iwalola Stella Omojola

Walden Dissertations and Doctoral Studies

Existing evidence indicates that medications alone are not able to fully manage the psychotic symptoms associated with schizophrenia. Inadequately treated schizophrenia not only affects a patient's physical and mental health but also can lead to the onset of more complex issues such as substance and alcohol abuse disorders, homelessness, family conflicts, and violent behavior. Cognitive behavioral therapy (CBT) can assist in bridging the gaps associated with the use of medications in the treatment of schizophrenia. The purpose of this project was to increase the knowledge of nurses working at a private healthcare facility regarding the effective utilization of CBT as …

Weight Management Clinical Practice Guidelines For The Obese, Pre-Diabetic, And Diabetic Population, Dawn Williams

Walden Dissertations and Doctoral Studies

AbstractDiabetes is among chronic or lifestyle-related illnesses posing health care challenges at epidemic proportions, pressuring health care systems infrastructure for positive outcome-driven practices and sustainable costs, as continued research suggests that obese people are up to 80 times more likely to develop type 2 diabetes. In June 2021, a weight-loss and wellness center serving this high-risk population established recommended guidelines for Hemoglobin A1C (HbA1C) screening and education. During the initial 3 months of implementation, data findings captured 37% in a total of 220 with elevated HbA1C levels. The gap in practice is that the Wellness Center did not have a …

Staff Education For Identifying, Assessing And Managing Pain In Patients With Dementia, Nadia S. Handspike

Walden Dissertations and Doctoral Studies

Pain is a common symptom in healthcare settings, especially among patients with Alzheimer's Disease (AD). AD patients have cognitive and communication impairment making it difficult or impossible for them to communicate their pain to their caregivers or healthcare practitioners. The purpose of this project was to implement a staff education program for healthcare professionals on evidence-based practices for assessing, recognizing, and managing pain in patients with AD. The practice-focused question explored if a staff education program on identification, assessment, and management of pain in patients with AD improves the staff's knowledge, skills, and attitude towards timely and effective pain assessment …

The Difference In Compliance When Visual Education Is Present, Jamie Lenee Joseph

Walden Dissertations and Doctoral Studies

Lack of patient compliance is a dangerous, widespread problem, often linked to a patient’s misunderstanding of their diagnosis or treatment plan. This project’s practice questions pertained to exploring the impact of a staff education update on visual presentation and patient evaluation with patients taking factor Xa inhibitors in oral anticoagulants and how the staff education increased patient compliance while taking these medications. A combination of the ADDIE model and Kirkpatrick model were used in the planning, development, and evaluation of this project. A pre and post evaluation survey was used to determine the efficacy of the changes made within the …

Nurse Manager’S Leadership And Communication Skills And A Registered Nurse’S Organizational Citizenship Behavior, Satisfaction, And Intent To Leave, Emmitte J. Hall

Walden Dissertations and Doctoral Studies

The Veteran’s Health Administration (VHA) is the largest employer of registered nurses in the United States. The American Association of Colleges of Nursing predicts there will be a nursing shortage through the year 2030 and replacing and training each nurse is expensive and negatively impacts patient care. A review of the literature showed organizations with high levels of organizational citizenship behavior (OCB) had high levels of job satisfaction, which reduces turnover, but there was no research on the existence and impact of OCB in a federal health care facility, specifically the VHA. The purpose of this quantitative, correlational research was …

Changing The Ways Bedside Nursing Staff Think About ‘All Things Urinary Catheters, Angela Foard

Doctor of Nursing Practice Projects

The purpose of this project was to bring attention to the importance of the bedside nursing staff’s "back to the basics" approach to nurse-led interventions to help reduce the number of increasing hospital-acquired infections (HAI), specifically catheter-associated urinary tract infections (CAUTI). The motivation to address this problem was due to the bedside nursing staff under-utilizing best practice interventions to prevent insertions and re-insertions of urinary catheters. A high number of urinary catheter insertions and re-insertions increases the risk of a CAUTI. Evidence-based interventions should be reinforced and utilized by bedside nursing staff to prevent insertions and re-insertions. Evidence-based nurse-led practices …

The Impact Of Mindful Breathing On Stress Of Employees Working From Home, Lindsey Goldberg

Doctor of Nursing Practice Projects

This DNP project was designed to decrease stress among employees working from home (WFH) by educating them on mindful breathing practices. Through the implementation of a mindful breathing activity, the intended project outcome was to improve stress levels of employees working from their homes. Mindful breathing is an evidence-based strategy that has demonstrated decreased stress levels. Mindful breathing was implemented among two companies employing an estimate of 170 WFH employees to improve health and well-being with potential long-term positive impact on sustainability of organizations in the post-COVID, work from home environment. The participants were invited to perform 8-minutes of daily …

Implementation Of An Amiodarone Infusion Nurse Practice Guideline To Reduce The Incidence Of Phlebitis: A Quality Improvement Project, Kristen N. Cottrill

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Patients have an increased risk of developing phlebitis when amiodarone is delivered through a peripheral intravenous catheter. In a 32-bed cardiac surgery step-down unit, patients experienced phlebitis at a rate of 28.57% despite following manufacturer recommendations. Individual interventions targeted at amiodarone-related phlebitis have presented mixed results, however, when an amiodarone infusion practice guideline was established, the rate and severity of phlebitis consistently decreased across studies. Purpose: This project aimed to implement an evidence-based amiodarone infusion guideline to reduce phlebitis development or severity in cardiac-surgery step-down patients without a central venous catheter who received a peripheral intravenous infusion of amiodarone. …

Implementation Of An Agitation Scale In Three Emergency Departments In An Urban Area Of Northern California, Adam Pelzl

Doctor of Nursing Practice (DNP) Projects

Background. Behavioral health patients in the emergency department are customarily treated without an objective assessment of agitation at presentation and throughout their hospital stay.

Local Problem. Behavioral health patients presenting with agitation in three emergency departments in Northern California are customarily treated with activation of a Code Grey emergency alert, use of physical restraints, or emergent sedation medication administration to manage the situation, prevent escalation, and protect the staff.

Context. Agitation in patients that is not recognized can lead to emergent sedation medication administration, physical restraints placed, and Code Greys activated to support the clinical staff.

Interventions. An evidenced-based agitation …

Nurse Practitioner-Led Care Pods: A Team Communication Enhancement Model, Miranda Saint-Louis, Miranda Saint Louis

Doctor of Nursing Practice (DNP) Projects

Background: Communication has become a key performance measure in the shift to value-based healthcare. Given the impact of communication failures on patient harm, length of stay, and dissatisfaction with care, new models of care with better communication through structured teamwork and interdisciplinary collaboration are needed.

Problem: In a 16-bed geriatric medical/surgical unit of a New York City multispecialty community hospital, the workflow structure unintentionally created inconsistent handoff communication, gaps in continuity of care, missed care events, and inattention to the patient’s priorities in the care plan. A gap analysis identified communication deficiencies that impacted team effectiveness and patient care …

Inpatient Observation Safety Assistant Practices, Jennifer Knight

Doctor of Nursing Practice Projects

Abstract

Introduction. Sitter usage is a patient safety practice used across healthcare organizations and the world. Sitters go by many other names, such as patient safety assistants, patient care assistants, care partners, and observation partners. There is literature that supports different variations of practices in healthcare facilities. A scoping review of the literature revealed multiple initiatives to reduce sitter cost and observation through nurse empowerment.

Purpose of Root Cause Analysis. The purpose of this root cause analysis is to determine why personnel inconsistently use the sitter policy. The appraised data will be used to improve the sitter process at this …

Improving Access To Reproductive Life Planning Following Implementation Of One Key Question® In Practice, Ashley Wittler

Doctor of Nursing Practice Projects

Abstract

Inadequate reproductive life planning (RLP) education is a widespread problem for women in the United States. This deficit leaves women without necessary guidance regarding contraceptive choices and maximizing pre-conception health. Use of RLP is endorsed by the American College of Obstetricians & Gynecologists (ACOG) and the Center for Disease Control (CDC). Lack of use of an RLP tool in a large, multi-site obstetrical and gynecological practice located in the Metro East is an issue that greatly impacts the patient population. The goal was to initiate the use of an evidence-based RLP tool, known as One Key Question®. The use …

The Resilience Vaccine, Sara Horton-Deutch T. Duffy

Master's Projects and Capstones

Healthcare workers have been working in unprecedented circumstances since the declaration of the COVID-19 pandemic. Caregivers have been taxed with burnout. A large healthcare organization’s 26-bed, medical-surgical, telemetry, COVID-19 overflow unit was significantly impacted. Many healthcare organizations have adopted advocacy for attaining joy in work as an extra dimension of the Institute for Health Improvement’s Triple Aim. Adding this fourth aim supports averting caregiver burnout (CBO) while promoting joy in work.

This quality improvement project examined nurse leaders’ interventions that address CBO, promote healthy work environments, and promote joy in work. From June through August 2021, an 8-week resilience program …

Ventilator-Associated Pneumonia Bundle Care, Jeemole Kattezham Binnichan

MSN Capstone Projects

Ventilator-associated pneumonia (VAP) is one of the most significant nosocomial infections in intensive care units (ICU) worldwide. Patients who have this infection due to lengthy hospital stays face excessive hospital expenditures and are forced to spend more time away from their families than is necessary. VAP is a prominent cause of morbidity and mortality in ICUs, prompting plenty of studies. The most crucial target is its prevention. Understanding how to reduce VAP would help patients live longer, have a better quality of life, and reduce hospital liability. Ventilator-associated pneumonia bundle (VAPB) has been shown in numerous studies to be an …

Implementing A Shared Governance Program, Mayra Elizondo

MSN Capstone Projects

Aim: To see the relationship between nursing satisfaction and patient safety outcomes through the implementation of a shared governance program.

Background: The adoption of shared governance in hospitals across the country would enable more nurses to have more resources, more autonomy in their practice, and thus higher satisfaction in their work environments which would improve patient outcomes.

Implications for future research, clinical practice and policy development: The following paper summarizes that shared governance programs increase the amount of satisfied nurses and improve patient outcomes. Further research is needed to develop effective guides for implementation of shared governance in healthcare facilities …

Bridging Mental Healthcare, Kristin L. White

MSN Capstone Projects

Nurses have an important role in the care given to mental health patients presenting to the emergency department (ED). Without expectations or encouragement toward growth or continued education, the quality of care and the therapeutic ability for care are crippled, as evidenced by nurses' knowledge/competency deficits and negative attitudes. Through ongoing/continued education, the cultivation of a therapeutic culture toward patients that present to the ED for mental health complaints could result. Additionally, these improvements in care, in turn, could promote not only the closure of gaps that exist for quality mental healthcare but may also lead to an increase in …

Impact Of Nurse Residencies On A Graduate Nurse’S First Year, Melinda R. Fox

MSN Capstone Projects

The purpose of this presentation is to highlight the importance of the graduate nurses first year in their clinical role and highlight the positive impact of nurse residency programs. The target audience for this presentation includes, but is not limited to, the University of Texas at Tyler students and professors enrolled in NURS 5382: Capstone. The observers of this presentation will be able to describe the rationale behind the importance of Nurse Residency Programs, discuss the current literature recommendations, and understand the overview of the change process proposed.

Reducing Surgical Site Infections Through Combination Skin Preparation: A Benchmark Study, Jennifer Schacherer

MSN Capstone Projects

Reducing surgical site infections allows for a tremendous reduction in healthcare costs, reduces length of hospital stay, decreases hospital readmissions, and promotes patient safety. The Centers for Disease Control and Prevention estimates that surgical site infections have a 3% mortality rate and 75% of all surgical site infection-related deaths are directly attributable to the surgical site infection (Centers for Disease Control and Prevention [CDC], 2020). With millions of surgeries being performed every year, the reduction of surgical site infections enhances patient safety and ensures the protection of the public. Currently, no standard protocol exists for skin preparation beyond the parameters …

Quality Improvement Project: Communication Guidance During And Following Maternal Hemorrhage, Kathleen Giramur

Doctor of Nursing Practice

Background. Maternal hemorrhage is a significant cause of worsening maternal morbidity and mortality in the United States. If timely, effective, and compassionate communication is not provided during and following traumatic birth events, negative mental health problems may result that affect maternal well-being, bonding with the baby, and family relationships. A gap analysis carried out at the clinical site showed that a written, evidence-based guidance on communication with patients and families during and after a maternal hemorrhage event was needed. Compliance through documentation is required by the Joint Commission. Trauma-Informed Care is an evidence-based communication approach that incorporates principles of safety, …

Strategies To Prevent Hospital Acquired Pressure Injuries In The Intensive Care Unit, Theresa Ann Pomerleau

Doctor of Nursing Practice

Background. Despite prevention strategies, hospital acquired pressure injuries continue to occur, especially in intensive care units. This led to an impetus for nurses to have a robust knowledge of pressure injuries to promulgate prevention strategies in their practice. Significance of the Problem. The hospital acquired pressure injury rate in the medical surgical intensive care unit for the year 2019 at Hospital X was greater than the national benchmark. Purpose. The global aim statement was to improve the quality of patient care by developing an evidence based educational suite in collaboration with interdisciplinary team members for prevention of hospital acquired pressure …

Development And Implementation Of An Evidence-Based Guideline For Spinal Cord Injury/Disorder Patients Requiring Colonoscopy, Tanya D. Young

Student Scholarly Projects

Practice Problem: Colorectal cancer is one of the leading causes of preventable cancer death in the United States. Spinal cord injury/disorder (SCI/D) patients present with unique challenges for maximizing bowel prep and successful attainment of screening and therapeutic colonoscopy procedures. Current practice for bowel prep regimens does not take into consideration the specific needs of the SCI/D population resulting in significant patient dissatisfaction.

PICOT: The PICOT question that guided this project was in adult patients with spinal cord injuries/disorders requiring colonoscopy (P), how does the development and implementation of evidence-based guidelines for the care of the spinal cord injury/disorder patient …

Evidence-Based Follow-Up Care For The Cardiac Patient: A Benchmark Project, Natalie E. Kelley

MSN Capstone Projects

Since the implementation of the Affordable Care Act (ACA) in 2012 and the Hospital Readmission Reduction Program (HRRP), hospitals and organizations have been encouraged to improve care coordination to reduce the number of avoidable readmissions (CMS, 2020). Three of the six publicly reported condition or procedure-specific 30-day risk-standardized unplanned readmission measures in the HRRP are cardiac-related: heart failure, acute myocardial infarction, and coronary artery bypass grafting (CMS, 2020). Although guidelines call for structured follow-up in patients with cardiac diagnoses after a hospital admission, just over half of admitted patients are being scheduled for follow-up (Goyal et al., 2016; Heidenreich et …

Development And Implementation Of An Opioid Risk-Reduction Strategy, Heather Darmetko

Student Scholarly Projects

Practice Problem: Accidental overdose is a continued concern for those who are prescribed opioids, and it is essential that healthcare members intensify prevention and response measures in order to prevent death or misuse from this medication.

PICOT: The PICOT question that guided this project was: “In adult patients at an outpatient chronic pain management clinic (P), how does development and implementation of a safe opioid risk-reduction office policy (I), compared to usual practice (C), improve patient rates of naloxone availability and health literacy (O) over eight weeks (T)?”

Evidence: The CDC’s Guideline for Prescribing Opioids for Chronic Pain, the …

Organizational Learning During Covid-19: A Qualitative Study Of Nurses' Experiences, Bret Lyman, Morgan K. Horton, Alyssa Oman

Faculty Publications

Aim: The aim of this study is to test the validity of the Organizational Learning in Hospitals model in the context of the COVID-19 pandemic.

Background: Organizational learning is especially crucial in circumstances of intense, complex, enduring change, as with the COVID-19 pandemic. Nurse managers need additional guidance for fostering organizational learning under such circumstances. The Organizational Learning in Hospitals model may be a helpful resource but requires additional validation.

Methods: Semi-structured interviews were conducted to gather 19 nurses' first-hand experiences of organizational learning during the COVID-19 pandemic. Data were analysed using deductive thematic analysis.

Results: Nurses' experiences of organizational …

Maximizing Mobility In The Icu, Stephen Kupiec

Master's Projects and Capstones

Problem: In a large tertiary medical center in Northern California, the patients in the 20-bed ICU achieved averaged maximum mobility (AMM) scores well below the regional target. These patients had longer lengths of stay in the ICU and spent more days on ventilators, as compared to patients in other ICUs in the region. Barriers to mobilization included patient diagnosis, sedation practices, staff burnout, insufficient staffing, a knowledge deficit around the safety and benefits of mobility, lack of standard workflows, and lack of interdisciplinary collaboration.

Context: A microsystem assessment focused on metrics-that-matter to determine the focus of this quality improvement project. …

Mindfulness-Based Intervention And Relapse Rates In Adults With A History Of Substance Use Disorder, Tamieko Ross-Anyaso

Student Scholarly Projects

Practice Problem: Substance abuse disorder (SUD) has become an increasingly prevalent community health problem worldwide, affecting individuals in all geographical regions regardless of age, race, sex, and socioeconomic status, despite decades of efforts to find a solution (Bowen et al., 2014). A lack of treatment engagement and substance‐misuse crisis calls attention to the effectiveness of relapse‐sensitive care and treatments.

PICOT: The question addressed in this evidence-based project was “ In adults over 18 years of age with substance use disorder (P), how does the effect of mindfulness-based treatment (I), compared with no mindfulness-based treatment (C), reduce the risk of relapse …

Implementation Of The National Early Warning Score Tool In The Acute Care Setting, Amanda Reyes

Student Scholarly Projects

Practice Problem: The organization arbitrarily called a rapid response or code blue call based on abnormal vital signs or intuition and needed a new process to identify early recognition of patient deterioration.

PICOT: For adult inpatients in an acute care setting in a large healthcare system (P), will implementation of the National Early Warning Score (NEWS) across the organization (I) compared to data from the last fiscal year where NEWS was not used (C) decrease code blue calls (O) within 8-weeks (T)?

Evidence: Eleven high quality studies met the inclusion criteria and found that the NEWS is a validated …

Evaluating Quality Of Life And Participant Satisfaction In A Cancer Support Community Yoga Program., Lauren Topp

Doctor of Nursing Practice Papers

Purpose: The purpose of this EBP project was to evaluate program processes and outcomes of an established cancer support community yoga program for persons impacted by cancer and explore the impact of the program on quality of life (QoL) in persons with cancer.

Design: This project was a quality improvement project with a pre-test/post-test design. QoL was explored through the EROTC QLQ C30 questionnaire. Descriptive and explorative methods were conducted through a survey of participants’ satisfaction with the yoga program. Feedback for future improvements around QoL services were provided.

Methods: Members of Gilda’s Club (440 persons) received an …

Reduction Of Inpatient Fall Rate In An Adult Acute Care Setting, Manjusha Maprel

Student Scholarly Projects

Practice Problem: Falls are among the most reported hospital-acquired conditions and can lead to severe injuries, increased length of hospital stays, pain, distress, and emotional trauma in the elderly. The Centers for Medicare and Medicaid Services (CMS) identifies falls as preventable and no longer authorizes reimbursement to healthcare systems for treating inpatient fall-related injuries.

PICOT: The PICOT question that guided this project was: In adult, acute care patients admitted to the telemetry unit (P), how does implementing evidence-based multimodal fall prevention strategies (I) compared to routine fall prevention strategies (C) affect inpatient fall rate (O) over a period of 6-8 …

Introduction Of A Nursing Evidenced-Based Practice Model To Improve Heart Failure At A Rural Community Hospital, Brandi Fields

Graduate Theses, Dissertations, and Capstones

Abstract

BACKGROUND: This project took place at a community-based rural hospital in eastern Kentucky. During completion of a needs assessment, adoption of an evidence-based nursing practice model and improvement of clinical outcomes of the community’s heart failure patient population were revealed as opportunities.

PURPOSE: The purpose of this project was to introduce the organization’s key stakeholders to the Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP), encourage implementation of an evidence-based practice (EBP) committee, and to use heart failure as an exemplar to facilitate discussions and stakeholder education.

METHODS: The goal of this project was to develop a supportive EBP culture …