Digital Commons Network^™

Assessing The Cost-Benefit Of Hiring A Deu-Prepared Rn Graduate: Does It Help Reduce Organizational Costs?, Tonya D. Bryant

UNLV Theses, Dissertations, Professional Papers, and Capstones

Costs associated with training new nurses from the time of hire to the time of independent practice can cost organizations nearly $100,000 per nurse (Acuna, Yoder, Madrigal-Gonzalez & Yoder-Wise, 2017; Silvestre, Ulrich, Johnson, Spector, & Blegan, 2017; Trepanier, Early, Ulrich & Cherry, 2012). New-hire costs for a dedicated education unit (DEU)-prepared newly qualified newly hired nurse (NQNHN) may be prohibitive for some hospitals when considering the cumulative amount of time and costs dedicated to training these specially prepared nurses who have previous clinical and organizational experience from their time as nursing students within the organization over the duration of their …

Acuity-Based Staffing: Improving Patient Outcomes And Staff Satisfaction, Natalie Long

MSN Capstone Projects

Traditionally, nurse staffing practices have been based on a nurse-patient ratio model and have not incorporated patient acuity. More recent literature has shown that acuity-based staffing can improve patient outcomes and staff satisfaction. The Emergency Department (ED) is an area that has fluctuating patient acuity and volume. To incorporate acuity in to staffing in the ED, the acuity mix over the past year can be used to calculate required nursing hours, therefore providing the number of required nurses for that facility. The calculated number of staff can then be distributed over a 24 hour period. By incorporating acuity in to …

Home Telemonitoring In Heart Failure, William Huff

MSN Capstone Projects

Heart failure (HF) exacerbation is a major source of hospitalization, mortality, and healthcare cost to home health agencies. Unmonitored accumulative fluid retention between skilled nurse visits, base knowledge deficits in HF pathophysiology and dietary restrictions, and lack of basic monitoring equipment such weighing scales are primary contributors to HF related hospitalizations in the home health setting. It has been discovered that early recognition of decompensating HF can reduce or eliminate HF related hospitalization, mortality, and healthcare costs associated with the management of exacerbation. When a patient is sent to the emergency room (ER) for fluid overload secondary to HF, massive …

Effect Of Lifestyle Modifications On Blood Pressure And Bmi In Overweight Or Obese Adults With Primary Hypertension, Mariska Vandenbergh

Evidence-Based Practice Project Reports

Hypertension (HTN) and obesity contribute to poor cardiovascular outcomes which can be managed with diet and exercise lifestyle changes. In addition, self-awareness (SA) of eating patterns can be a useful tool to promote adherence to lifestyle changes. The purpose of this project was to determine the effect of lifestyle education, the DASH diet, and tools to increase SA for adult clinic patients who were overweight with hypertension. The REAP and PIH tools were utilized to increase patients’ SA of their diagnosis and current dietary habits. A literature search over five databases was conducted and analyzed thoroughly. National guidelines strongly recommend …

The Influence Of End Of Life Education On Stress, Anxiety, And Attitude Of The Healthcare Profession Student, Chiquesha Davis

DNP Final Reports

Providing comfort and support to the dying patient is a significant part of the dying process. When soothing a patient, who is dying, the goal is to prevent or relieve suffering as much as possible. Respecting the patient's health and quality of life goals and decisions is essential. Healthcare profession students can experience multiple levels of anxiety, stress, and a negative attitude while taking care of the dying patient. The implementation of a successful intervention is at the cornerstone of helping reduce stress, anxiety, and attitude change in healthcare profession students. The application can also have a positive impact on …

Implementing Protocols In The Emergency Department To Improve Care For Sexual Assault Patient, Kelly Ciccone

Student Scholarly Projects

This quality improvement project answered the following question: Does implementation of sexual assault forensic examination protocols with educational training increase the number of staff who are knowledgeable and available to complete sexual assault forensic examinations and reduce wait times for individuals who present to the emergency department and have indicated that they were sexually assaulted, over no use of protocols, within a 15-week time frame? Evidence-based state protocols for performing sexual assault forensic examinations were implemented through educational training that incorporated national training criteria and hands on simulation skills practice. Evaluation of outcome measures confirmed an increase to over 80% …

Increasing Adult Influenza Vaccination Rates In The Primary Care Setting, Leah Prescott Msn, Fnp-Bc

Doctor of Nursing Practice Projects

Background: Provision of vaccinations is one of the most basic interventions aimed at health promotion and disease prevention in the primary care setting. Despite increased public awareness and improved access to vaccinations through minute-clinic settings, health fairs, and employer-offered vaccination clinics, adults in the United States continue to fall short of national goals. Literature demonstrates vaccination rates among adults vary widely and may be affected by a multitude of factors, however vaccination rates may be greatly improved with increased provider engagement.

Objectives: The purpose of this project was to develop, implement, and evaluate a program to improve immunization rates in …

Time For Quiet Reducing Nighttime Interruptions In The Icu (Turn In-Icu): Evaluation And Implementation Of A Nonpharmacological Sleep Bundle To Improve Sleep Quality, Delirium, And Nighttime Sedation Requirements, Christina Junker, Msn, Rn, Ccrn

Doctor of Nursing Practice Projects

Background: Undisturbed, restful sleep is essential for physiological as well as psychological well-being. For critically ill patients, sleep deprivation caused by frequent nighttime interruptions is associated with poor sleep quality and negative patient outcomes.

Objectives: The purpose of this Quality Improvement (QI) project was to promote uninterrupted sleep between the hours of 10 PM and 5 AM. Outcomes for evaluation consisted of the following three components: (1) sleep quality, (2) incidence of delirium, and (3) nighttime sedation requirements. Except for sleep quality, these variables were compared before and after the intervention.

Methods: A descriptive, before and after design for data …

Nurse’S Perception Of Safety Culture And Patient Safety Following Implementation Of A Handoff Communication Process Between Pre-Operative And Operating Room Nurses, Tracy Willett, Msn, Mba, Rn, Nea-Bc, Cnor

Doctor of Nursing Practice Projects

Background: In a hospital environment the care of the patient is transferred multiple times during his or her stay. Current needs assessment indicates that nurses’ perception of safety culture with handoff communication and patient safety is an area of focus for the practice site.

Objectives: This study aimed to improve the Pre-operative and Operating Room nurses’ perception of safety culture measured with four valid and reliable survey questions. The second study’s aim was to improve patient safety with the handoff process, measured by the number of adverse events reported by the practice site.

Methods: Pre-implementation data was collected. Nurses worked …

Utilizing A Mentorship Approach To Address The Underrepresentation Of Ethnic Minorities In Senior Nursing Leadership, Kimberly Jean-Louis, Msn, Mpa, Rn, Nea-Bc

Doctor of Nursing Practice Projects

Many healthcare institutions have acknowledged the benefits of and the need for a workforce that reflects the diverse patient populations they serve. However, few healthcare organizations have made progress in increasing the diversity of their leadership teams. The American Hospital Association’s Institute for Diversity in Healthcare Management (2016) found that while minorities represent 32% of hospital patient populations across the nation, they only account for 11% of executive leadership. The objective of this DNP project was to implement a 4-month mentorship program that empowered minority nurse leaders who desire career advancement to executive leadership roles and provide them with realistic …

Effect Of Provider Education On Urinary Incontinence Knowledge And Assessment, Kendra L. Roloff

Nursing Capstones

Nearly 50% of women in the United States will experience urinary incontinence at some point during their lives. Urinary incontinence impacts multiple aspects of a woman’s life, yet remains underdiagnosed by primary care providers. The purpose of this project is to implement education and reminders for primary care providers, in order to improve urinary incontinence knowledge and assessment of women 18 years of age or older. The project was carried out in a primary care clinic with primary care providers serving as the participants.

A quasi-experimental one-group pretest-posttest design was utilized. Data from a five question pre- and posttest were …

Meeting The Educational Needs Of The Busy Bedside Nurse: Curbside Education An Innovative Program, Ashley O'Connell, Kayla Waldoch, Amy Junes

Nursing Posters

• Seek out educational needs of staff based on current changes, trends and new hires
• Provide on the spot reinforcement of skills, policies, education and policy changes for all staff
• Implement skill stations, including "off shifts", to increase staff cohesiveness and preparedness in emergent and nonemergent scenarios

Implementation Of An Anxiety Screening And Treatment Protocol In Primary Care, Danielle E. Garcia

Student Theses, Dissertations and Capstones

Background: Anxiety is a prevalent problem frequently presenting in the primary care setting in the United States. The lack of routine anxiety screening and evidence-based treatment protocols in the adult primary care setting causes physical, social, and economic consequences.

Purpose: The purpose of this Doctor of Nursing Practice (DNP) evidence-based practice (EBP) quality improvement project was to implement an EBP anxiety screening and treatment protocol for adults in a primary care clinic to increase early identification and improve management of generalized anxiety disorder (GAD).

Theoretical Framework: W. Edwards Deming’s Plan-Do-Study-Act (PDSA) cycle framework was utilized for this project. The PDSA …

The Lived Experience Of Novice Senior Nurse Leaders During Organizational Role Transitions, Sharon Kauffman

Student Theses, Dissertations and Capstones

The qualitative interpretive phenomenological study investigates the lived experiences of novice senior nurse leaders, who have transitioned to new organizational roles within a single healthcare organization in the Southeast United States. Senior nurse leaders have complex responsibilities but may not have training adequate to lead masterfully at new organizational levels. This phenomenon is poorly understood. Senior nurse leaders who do not develop the appropriate interpersonal skills and systems thinking may experience a sense of role insufficiency. Yet, strong leadership among senior nurses is vital to the successful performance of healthcare organizations, given the current landscape of change and the rapidity …

An Organizational Readiness Assessment And Patient Survey For Adoption Of An Opioid De-Escalation Protocol In Curative Oncology Patients, Adria Myers

Doctor of Nursing Practice Projects

Since 2012, statistics illustrate an explosion in the number of Americans admittedly misusing prescription opioids which increase the risk of long-term adverse effects. By 2016, individuals admitting to taking opioids for non medical reasons exceeded eleven million and 1.9 million of these individuals met the mental health guidelines for opioid abuse. Oncology patients represent a target population with an unmet met need for opioid reduction. Goals for de-escalation or tapering opioids for non-cancer pain have gained increasing attention across healthcare. Evidence-based opioid de-escalation guidelines specific for curative oncology patients are lacking in the literature. The aim of this DNP project …

Barriers To Reporting Workplace Violence In Emergency Departments: A Systematic Review, Kari Gaston

Walden Dissertations and Doctoral Studies

Underreporting of workplace violence by emergency department (ED) nurses is a global practice concern. When workplace violence is not reported, the breadth of the issue is not reflected in the data, which is necessary to support legislative action, regulatory requirements, and organizational changes to prevent violence. The purpose of this systematic review of literature was to appraise and synthesize evidence regarding ED nurses’ barriers to reporting workplace violence. The practice-focused question addressed the barriers to reporting workplace violence according to emergency nurses. The theory of planned behavior was the theoretical framework for this project. Melnyk and Fineout-Overholt’s critical appraisal of …

Preparing Clinical Faculty To Teach And Reinforce Hourly Rounding, Lisa Bailey

Walden Dissertations and Doctoral Studies

A gap exists in the knowledge of clinical faculty teaching prelicensure students about hourly rounding. The purpose of this project was to develop an educational program to prepare clinical faculty teaching student nurses to conduct hourly rounding. Hourly rounding trained faculty ensure safe practice by students and adherence to hospital policies. Hourly rounding includes the 4 Ps, which entails the assessment of “potty”, pain, position, and possession/periphery. Models and theories used to inform the project included the American Academy of Pediatrics’ 10-step process for developing training courses, Knowles’ theory of adult learning, Kirkpatrick's evaluation model, and the Accreditation Commission for …

Integrating Technology In Improving Communication To Reduce Discharge Cycle Time, Julieta Fajardo

Walden Dissertations and Doctoral Studies

One of the most important milestones during a patient’s transition to care is discharge from hospital. Consequently, delays in the discharge process can lead to patient dissatisfaction and affect outcomes in intensive care and emergency rooms. The purpose of the project was to evaluate the tools built into the electronic system to improve communication and reduce the discharge cycle time. The focus of the project is to enter the expected date of discharge (EDD) and identify discharge barriers within 24-48 hours of admission to reduce this time. Evidence was from the project site’s discharge initiative dashboard. Analysis of the problem …

A Systematic Review Of The Literature On Bedside Shift Reports, Dana Wickersheim

Walden Dissertations and Doctoral Studies

AbstractIn 2017, The Joint Commission issued a sentinel event alert regarding inadequate nurse hand-off communication. Inadequate hand-off communication can lead to medication errors, delay in treatment, falls, and wrong-site surgery. To help ensure safe handoff of care between nurses by involving the patient and family, bedside shift report was created. Bedside shift report was developed to help improve patient safety and quality, patient experience of care, nursing staff satisfaction and time management, and accountability between nurses. Despite the implementation of bedside shift report in nursing practice, it continues to be inconsistently applied, which poses risks to patients and can lead …

Nurse Leaders’ Perspectives On Animal-Assisted Interventions, Samantha Vita Abate

Walden Dissertations and Doctoral Studies

Knowledge deficits and unfavorable attitudes are commonly cited barriers that prevent adoption of animal-assisted interventions (AAIs). Nurse leaders’ (NLs’) knowledge of and attitudes toward AAIs have not been well documented in the literature. The purpose of this study was to identify NLs’ perspective on AAI, including their usage, knowledge, and attitudes. This information may be helpful in overcoming common barriers to AAI usage. The theory of transformational leadership guided this 3-manuscript dissertation study, which included 3 studies on NLs’ use of AAIs, the relationship between NLs’ knowledge of AAIs and NLs attitudes toward AAIs, and the potential impact of AAI …

Nurses’ Aesthetic Responses And Emotional Judgements To Senior Leaders’ Symbolism, Lucinda A. Easler

Walden Dissertations and Doctoral Studies

Stress can be heightened during a merger; understanding how acute care nurses who work in a hospital undergoing a merger, experience senior leaders’ use of symbolism may help to promote hospital and leader sustainability. Executive symbolism unfolds into aesthetic experience, normally considered a response to art, with few studies of its existence and benefit to organizational life. The purpose of this phenomenological-hermeneutic study guided by Parker’s aesthetic theory was to examine acute care nurses’ emotional responses and experiences with senior leaders’ use of executive symbolism in the midst of the organizational change. Interviews with 11 acute care registered nurses were …

Evaluation Of A Concussion Management And Discharge Education Training Module For Emergency Department Nurses, Carmen Frede

DNP Projects

Purpose: The purpose of this project was to improve the Emergency Department (ED) nurses’ knowledge on identifying patients at risk for concussions and delivering effective concussion discharge education using an educational training intervention.

Methods: This project used a descriptive, non-randomized pre-post survey design. Participation involved three stages: a pre-education survey to assess baseline concussion education knowledge, an educational intervention consisting of a narrated PowerPoint presentation, and a post-education survey to evaluate knowledge on concussion discharge education. The intervention was delivered online via the UK Canvas educational platform.

Results: The majority of nursing staff participants were female (97%) and had a …

Nutritional Strategies For Nurses In A Fast Paced Occupation, Zachary Christman

Department of Agronomy and Horticulture: Dissertations, Theses, and Student Research

The foundation of the medical system are the nurses and certified medical assistants. Their personal health condition affects how well diseases and other medical conditions are handled. This article will begin with an overview of the eating behavior of nurses. Three different interventions which have been shown effective in a fast paced workplace are presented in order to improve the health of nurses and certified medical assistants. The first intervention is organizational changes that would increase the amount of time nursing staff have to eat. The second is the use of a messenger bag delivery system to provide needed food, …

Nutritional Assessment Of Patients In The Intensive Care Unit, Jennifer Maureen Brown

Walden Dissertations and Doctoral Studies

Impaired nutrition is associated with prolonged hospitalization, poor patient outcomes, high mortality, and increased health costs. Nutritional assessment in intensive care unit (ICU) patients is important in recognition of changes in the patient’s nutritional status from admission to discharge and may promote early nutritional interventions by the health providers to prevent complications of poor nutrition. The purpose of this staff education doctoral project was to assess ICU nurses’ knowledge of nutritional assessment for critically-ill patients and to provide education on an assessment tool for patient nutritional assessment- the malnutrition universal screening tool (MUST). The guidelines from the American Society for …

A Staff Educational Model For Prevention Of Type 2 Diabetes In The Primary Care Setting, Mieshia Staples Clark

Walden Dissertations and Doctoral Studies

Type 2 diabetes is a chronic, debilitating disease affecting millions of Americans. Though preventable, it is the most common form of diabetes in the United States, costing the U.S. health care system billions of dollars annually. Lifestyle modifications taught, encouraged, and supported in established, evidence-based diabetes prevention programs (DPP) are proven to be more effective than medications alone in preventing Type 2 diabetes. While DPPs are cost-effective and can reduce or delay the incidence of Type 2 diabetes, they are greatly underutilized due to primary care providers’lack of knowledge about the benefits and availability of these programs and also due …

Increasing Compliance Of Chlorhexidine Wipes To Prevent Hospital-Acquired Infections, Kelly Jean Dunn

Walden Dissertations and Doctoral Studies

AbstractHealthcare-acquired infections (HAIs) are complications of healthcare linked to increased mortality, morbidity, and length of stay. Assiduous surveillance and constant reeducation can decrease HAI incidence and reduce the healthcare burden caused by these events. Evidence has demonstrated that using 2% chlorhexidine wipes instead of bathing with soap and water greatly reduces the bacteria on the skin and prevents infections such as catheter-associated urinary tract infections and central line-associated bloodstream infections. The practice-focused question for this quality assurance doctoral project was to evaluate if an educational intervention improved compliance of chlorhexidine wipe use among ICU nurses with the hope of improving …

Improving Rabies Aftercare By Educating Emergency Department Providers Of Care, Gloria Denise Evans

Walden Dissertations and Doctoral Studies

According to an evaluation completed by the local health department in the state where the project was conducted, patients were not returning to the emergency department (ED) for post-exposure prophylaxis (PEP) rabies vaccine as recommended. Educating the ED providers on care, who are usually the first point of contact after an animal bite with possible rabies virus transmission, is critical to improving patients' outcomes secondary to rabies postexposure. The focused for this project is educating ED personnel about rabies PEP administration after rabies virus exposure which will their increase knowledge regarding rabies follow-up care. Lewin's change theory provided the theoretical …

Civility Promotion: How It Affects Workplace Incivility, Shawanda Lang

Doctor of Nursing Practice Projects

Incivility is also known as uncivil behavior, horizontal violence, or bullying. These terms are often used to describe the conduct an individual may display toward another that are deemed undesirable in healthcare organizations. Uncivil behavior has been an increasing topic in healthcare and has consequently gained the attention of organizations such as the American Nurses Association and regulatory agencies such as The Joint Commission. Incivility has the opportunity to affect teamwork, individual well-being, and patient safety. The aim of this project was to promote civility by bringing knowledge and awareness of the participants through an educational series. Although the pre …

The Effect Of Dyad Rounding On Collaboration And Patient Experience, Amy Christensen, Korby Miller, Jason Neff, Rusty A. Moore, Sharee Hirschi, Katreena Collette Merrill

Faculty Publications

Communication among the healthcare team is essential to providing high-quality patient care. In the hospital, nurses care for multiple patients during their shift. Physicians or advanced practice clinicians (APCs) visit hospitalized patients daily to update orders, complete assessments, and contribute to care plans. One method to ensure that healthcare providers communicate effectively is interdisciplinary, or dyad, rounding in the hospital. This consists of purposeful rounding on each patient by the nurse and the physician or APC together to review the patient's status and update the care plan. When healthcare providers and nurses round together, it improves communication, patients are more …

Evaluation Of The Impact Of An Educational Intervention Aimed At Improving Tuberculosis Infection Control Knowledge Among Health Care Workers In A Military Treatment Facility: A Quality Improvement Project, Allen C. Potter

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Florida (FL) is one of the top five states in the nation for Tuberculosis (TB) infections. A majority of new infections can be found in the minority populations which represents 78% of all TB infections in the state. A combination of TB rates in FL, Orlando located 60 miles away and a transient population who frequently deploys worldwide to austere locations may result in an increased risk of acquiring TB. Literature suggests Health Care Providers (HCPs) obtain training regarding TB Infection Control (TB-IC). The Patrick AFB Military Treatment Facility (MTF) lacked a TB Infection Control (TB-IC) plan. Objective: The …