Digital Commons Network^™

Implications For Delayed Versus Immediate Umbilical Cord Clamping, Laura Ann Shaver

All Electronic Theses and Dissertations

Purpose: The purpose of the critical review of literature was to identify and analyze benefits of delayed umbilical cord clamping in full term and preterm infants with a focus on iron stores, hemoglobin, hematocrit, and hyperbilirubinemia. Methods: Twenty-two articles were included in the critical literature review with the purpose of determining whether delayed umbilical cord clamping caused increases in iron stores, hemoglobin and hematocrit, or had no clinical significant increases in hyperbilirubinemia causing neonatal jaundice and the need for phototherapy treatment. Results/Conclusion: Delayed umbilical cord clamping is a low risk, cost effective intervention that is safe and has many benefits …

Development Of A Leadership Program For Hospital Employees:, Diana Marie Beckman

Doctor of Nursing Practice Projects

Healthcare leader’s ability to respond to the dynamic environment of healthcare is essential for positive health care outcomes. Leaders set the strategic direction for healthcare organizations, and this requires that leaders assess themselves and their employees to develop effective education programs needed to meet any knowledge gaps limiting the workforce ready to respond to the new demands. The purpose of this project is to implement and assess a revised curriculum of a leadership development program by measuring gained self-identified development of leadership practices.

The Effect Of Patient Activation On Transition Clinic Adherence, Megan Sue Mcgraw

Nursing Theses and Capstone Projects

Heart failure (HF) affects more than 5 million Americans and is one of the most commonly occurring reasons for admission to the hospital among adults aged 65 and over. Evidence is growing that the higher amount of patient engagement or activation, the better the health and cost outcomes. The purpose of this study was to determine if there was a relationship between a higher patient activation score, as determined by the PAM-10, and completion in the heart failure transition clinic. The design for this study was a quantitative descriptive study. The patients were given the questionnaire prior to discharge from …

Evaluating Adn Faculty Job Satisfaction, Karen M. Thies

Doctor of Nursing Practice Projects

Background

The U.S. is facing a critical shortage of nurses as the aging baby boomer generation is requiring more nursing care. Contributing to the nursing shortage is the inability to educate larger numbers of nurses, attributable to a lack of nursing faculty. Insufficient numbers of nursing faculty results in qualified applicants being turned away from nursing programs.

Project Design

This project evaluated faculty job satisfaction in 703 accredited Associate Degree Nursing (ADN) programs in the U.S. The Index of Work Satisfaction (IWS) (Stamps, 1997), was designed to measure specific factors of nurses' job satisfaction and was emailed to all full …

Seven Foundational Principles Of Population Health Policy, Dhrubajyoti Bhattacharya, Jay Bhatt

Nursing and Health Professions Faculty Research and Publications

In 2016, Keyes and Galea issued 9 foundational principles of population health science and invited further deliberations by specialists to advance the field. This article presents 7 foundational principles of population health policy whose intersection with health care, public health, preventive medicine, and now population health, presents unique challenges. These principles are in response to a number of overarching questions that have arisen in over a decade of the authors' collective practice in the public and private sectors, and having taught policy within programs of medicine, law, nursing, and public health at the graduate and executive levels. The principles address …

Advanced Triage Protocols In The Emergency Department, Lijuan Zhao

Walden Dissertations and Doctoral Studies

Overcrowded emergency departments (EDs) are a major problem in the United States resulting in inefficiency in operation and performance. A Southern California hospital ED was the site for this project because it had operated over its maximum capacity during the last decade. Advanced triage protocols integrating standard order sets were implemented to improve quality of care; however, no evaluation of the protocols had been done. The purpose of this project was to evaluate the effect of the advanced triage protocols. Two project questions determined whether advanced triage protocols reduced ED length of stay (LOS), number of patients who left without …

Increasing Primary Care Hepatitis C Screening In The 1945-1965 Birth Cohort, Maria M. Shimizu

Doctor of Nursing Practice Projects

Background: Over 3.2 million American citizens have been infected with the Hepatitis C virus (HCV). It is estimated three fourths of this population are from the birth cohort born between 1945 and 1965, otherwise known as Baby Boomers. Despite the Centers for Disease Control and Prevention (CDC; 2014) recommendations to screen this population at least one-time regardless of risk factors, screening practices in the primary care setting have been suboptimal (American Association for the Study of Liver Diseases [AASLD], 2015).

Aim: The aim of this project was to identify barriers to HCV screening of the Baby Boomer population in the …

Nursing Leadership Influence On Evidence-Based Practice Culture And Integration, Natalie Kay Lenhart

Walden Dissertations and Doctoral Studies

Translating research to practice takes 10-20 years or more and evidence-based practice (EBP) integration remains at 10%-20%, despite recommendations requiring EBP-guided decisions. EBP integration has been associated with up to 30% decreases in healthcare system spending, improved quality outcomes, and increased staff satisfaction. Nurse leaders are accountable for EBP enculturation, yet rate quality and safety as the highest priority and EBP as the lowest. This knowledge gap perpetuates low EBP integration rates and hinders EBP enculturation. Asking whether EBP facilitative interventions for nurse leaders increase scores on organizational culture and readiness, beliefs, and EBP use scales addressed the knowledge gap …

Improving The Quality Of Nursing Documentation In Home Health Care Setting, Chidiadi Obioma

Walden Dissertations and Doctoral Studies

Poor nursing documentation of patient care was identified in daily nurse visit notes in a health care setting. This problem affects effective communication of patient status with other clinicians, thereby jeopardizing clinical decision-making. The purpose of this evidence-based project was to determine the impact of a retraining program on the quality of documentation of patient care in nurses' notes in a home health agency in central Texas. A retrospective audit of quality of nursing documentation using the Nurse and Midwifery Content Audit Tool (NMCAT) was done. A pre- and posttest design was used. A convenience sample of de-identified nurses' notes …

A Quality Improvement Project To Reduce The Incidence Of Clostridium Difficile Infection Through Implementation Of Evidence-Based Terminal Clean Procedures, Tamara Cook

Theses and Dissertations

Hospital-acquired infections (HAIs) are a huge economic burden and threat to patient health and outcomes. Clostridium difficile is the most common HAI. Effective hand hygiene and proper environmental cleaning procedures are significant to preventing the spread of C. difficile infections. The research question used to guide this project is: Does the use of a monitoring system for post C. difficile isolation terminal clean procedure reduce the rate of hospital-acquired C. difficile in the acute care population? A thorough organizational assessment was performed and directed this project to identify causes that may contribute to the recurrences of C. difficile infections. The …

The Use Of Seclusion And Restraints In The Inpatient Psychiatric Hospital Setting: A Systematic Review Of The Literature, Angela M. Kaucic

Williams Honors College, Honors Research Projects

The use of seclusion and restraint (S/R) is a practice that has been shown to be potentially harmful to patients on a physical and emotional level. This review examines 20 research publications in order to address the attitudes of staff and service users regarding use of this intervention, as well as to explore how use of alternative behavioral and environmental modification interventions compares to standard nursing care in terms of S/R prevalence. The review found that there are many viable interventions alternative to S/R that are more palatable to patients and nurses. Variability of interventions addressed in the included studies …

Organizational Learning In A Cardiac Intensive Care Unit: A Learning History, Bret Lyman, Kalene M. Ethington, Carly King, Jonathan D. Jacobs, Hayley Lundeen

Faculty Publications

Introduction: Providing high-quality care to every patient is challenging, particularly in critical care units (CCUs). However, this standard can be achieved through organizational learning. Unfortunately, the process of organizational learning in CCUs is not well understood.

Objective: The objective of this study is to describe the developmental progression of a cardiac intensive care unit (CICU) to reach its current state of reliably excellent clinical performance.

Methods: The method selected for this study was a learning history. A total of 43 individuals with experience working on the CICU participated in small group interviews. Participants included nurses, surgeons, unit clerks, administrators, nursing …

Decreasing Primary-Care-Related Emergency Department Visits In The Hispanic Population Using Patient Navigators, Arthur Dominguez Jr.

Walden Dissertations and Doctoral Studies

Primary-care-related emergency department (PCR-ED) visits by Hispanic patients enrolled in a not-for-profit Medi-Cal and Medicare health plan resulted in longer wait times in the emergency department (ED) at a regional medical center in Southern California. This congestion decreased access for those with true emergencies, created capacity issues, increased ED length of stay, and resulted in potential safety risks. This project focused on decreasing PCR-ED visits in the Hispanic population using patient navigators in Southern California. Applying the health belief model and Lippitt's theory of change, this doctoral project involved the creation and implementation of a culturally appropriate, population-specific patient navigator …

Hospital Administrators' Strategies For Reducing Delayed Hospital Discharges And Improving Profitability, Sheree Boyd

Walden Dissertations and Doctoral Studies

Inefficiencies in leadership and limited leadership strategies in hospitals contribute to delayed hospital discharges and an increased financial burden on a hospital. Three administrators from 2 hospitals who are part of a hospital conglomerate in Chicago, Illinois were selected for interview in this qualitative multiple case study to explore how hospital discharge strategies reduce delayed hospital discharges and improve profitability. Contingency was the primary theoretical theory for this study. The purposive sampling consisted of the selections of individual who were knowledgeable and had experience to organize, manage, and implement processes in an organization. Data collection occurred using face-to-face semistructured interviews, …

Evidence-Based Practice Project Proposal: Reducing Chfrr Through The Get Well Networks Chf Prevention Education Materials, Susan Kay Richmond

Walden Dissertations and Doctoral Studies

In the United States, congestive heart failure (CHF) impacts 6.5 million adults and costs about $39 billion year with a projected incidence increasing by 25% by 2030. CHF can be addressed by advancing patient self-care knowledge through interactive patient education. For this project, the Health Beliefs Model guided a strategy to stimulate behavior modification based on perceived benefits of self-care. The purpose of this quality improvement project was to implement an interactive patient education video system, called the Get Well Network, to encourage patient self-care to reduce CHF readmission rates at a veteran's administration hospital. Four evidence-based CHF video order …

Translating Evidence Of Skin-To-Skin And Rooming-In To Practice, Francisca Njoku

Walden Dissertations and Doctoral Studies

The old practice of separating the mother-baby-dyad was without measurable benefits to mothers or their infants. Evidence has shown that skin-to-skin care (SSC) prevents hypothermia and hypoglycemia, decreases crying during painful procedures in newborns, and reduces maternal anxiety, stress, and postpartum depression. Rooming-in care (RIC) has been linked to an increase in the rate of breastfeeding and mother-infant interaction, as well as a decrease in the infant morbidity rate. This project assessed the effect of an educational intervention to increase rates of SSC and RIC in an obstetric unit, in addition to measuring nurses' attitudes and barriers in relation to …

Program Evaluation Of Patient Safety And Risk Mitigation Educational Interventions For Medical Errors In Primary Care Settings By Patricia Rose Gould, Patricia Rose Gould

Walden Dissertations and Doctoral Studies

The Institute of Medicine reported in 2016 that medical errors are the 3rd leading cause of death in the United States. In the primary care setting, frequency and severity are unknown. Medical error research is limited related to evaluation of interventions conducted by medical professional liability (MPL) companies of risk mitigation strategies. The purpose of this program evaluation was to determine the impact of multifaceted patient safety and risk mitigation educational interventions conducted in primary care settings on patient safety, reporting, and liability. The program evaluation employed a retrospective secondary analysis of actuarial data from a MPL carrier's educational interventions …

Alleviating Discharge Confusion For Older Patients Using The Teach-Back Method, Tracey Marie Haire

Walden Dissertations and Doctoral Studies

Discharge instructions and medication directions can be overwhelming for older adults, which can lead to potential medication errors, noncompliance, readmissions, and patient safety concerns. At a specialty lung clinic, the goal is to improve patient safety and to decrease the chance of errors by standardizing the discharge process via a Teach-Back education policy and protocol. Without consistency, there is a potential for mistakes and misunderstandings. The Agency for Healthcare Research and Quality (AHRQ) and the Institute for Healthcare Improvement (IHI) considers the Teach-Back discharge method as best practice and should be considered universal practice among health care workers. Using the …

Strategies Clinic Managers Use To Reduce Missed Medical Appointments, Sophea Ey Skym

Walden Dissertations and Doctoral Studies

Patients who miss their medical appointments increase health care costs for themselves and for clinics. The purpose of this qualitative, single exploratory case study was to explore strategies health care clinic managers use to reduce medical no-shows for patient-scheduled appointments. Change management theory guided the scope and analysis. The data collection included a single clinical operations manager who have strategies to mitigate no-shows for patient-scheduled appointments participated in a semistructured interview in southeastern Virginia, the direct observation of 2 office workers in their natural setting of scheduling appointments, and for methodological triangulation, a review of organizational archival documents about missed …

Violence Against Nurses, Terri Lynne Declerck

Walden Dissertations and Doctoral Studies

Workplace violence against nurses causes stress, job dissatisfaction, injury, and financial burden. The purpose of this project was to examine training for nurses on violence, risk factors and on reporting workplace violence. The practice-focused question was designed to examine the effectiveness of educating nurses regarding violent patients and how to report episodes of violence. Benner's novice to expert theory guided the skill acquisition training of a convenience sample of 25 Midwestern medical nurses. The nurses participated by completing a survey prior to and following a violence simulation. A qualitative design was used with the 25 nurse participants who completed the …

How Does Organizational Culture Impact Rn Engagement, Veronica Anntionette Ruffin-Ellis

Walden Dissertations and Doctoral Studies

Lack of RN engagement in the acute care setting can result in poor staffing, nursing shortages, increased stress levels for nurses and decreased morale. When nurses are not engaged in their work setting, quality of care suffers. A wide range of literature focuses on the importance of RN engagement; however, few health care organizations have taken the initiative to implement programs that foster RN engagement, demonstrating a gap in practice. This study examined the relationship between the levels of RN engagement and their perceptions of their organizational culture. Kolcaba's humanistic approach to meeting the needs of RN staff was used …

Implementation Of A Standardized Multifactorial Fall Prevention Program In A Rehabilitation Facility, Shanetta Monique Ancrum-Lee

Walden Dissertations and Doctoral Studies

One and a half million people are currently living in residential care facilities; as the baby boomer generation ages, this number will increase to 3 million. Approximately 3 out of 4 residents of these facilities fall each year, and 10% to 20% of those falls result in serious injuries such as fractures, disability, and a decreased quality of living. The BOUNCE Back fall initiative is a multifactorial program that uses a systematic approach starting on admission and to re-evaluate a resident following a fall. Nursing and therapy uses the Morse Fall Scale and the Elderly Mobility Scale to assess and …

Introduction Of Evidence-Based Practice To Acute Stroke Center Nursing In Jakarta, Indonesia, Tonya Sue Stagner

Walden Dissertations and Doctoral Studies

Evidence-based practice (EBP) is a relatively new concept for nurses in Indonesia; it has not

been integrated into nursing care. This project sought to introduce EBP to nurses at an acute stroke center (ASC). The knowledge transfer team approach guided the project. The goal was to identify and analyze current data and to develop an EBP guideline for clinical nursing practice in the ASC. Sources of evidence that was used to address the practice-focused question included project team members, organizational documents, and a database search to identify EBP guidelines for the nursing care of acute stroke patients. A database search …

Introduction Of A Comprehensive Modified Early Warning Scoring System In A Large Rural Hospital, Beth A. Meade

DNP Projects

PURPOSE: To develop and test a comprehensive modified early warning scoring (MEWS) system for use on two medical-surgical-telemetry units in a large rural hospital in northeastern Kentucky; to educate and train nursing staff in utilization of a new MEWS system and early identification and management of clinical deterioration; and to determine nursing satisfaction regarding education, training, and use of a new MEWS system.

BACKGROUND: Adult medical-surgical patients are at risk for clinical deterioration. Rapid response systems and MEWS systems are strategies that have been employed to assist nursing staff in early identification and management of clinical deterioration. Testing of a …

Examining Nurse Satisfaction With A Bedside Handover Report Process, Imelda C. Principe

Walden Dissertations and Doctoral Studies

Nurses' job satisfaction affects work performance at the point of care in hospitals. The incoming nurses who are able to receive a comprehensive patient report at shift change are more prepared in comparison to incoming nurses who are not able to receive a comprehensive patient report to provide care that is safe. The purpose of this project, guided by the theory of organization change, was to explore whether the use of a bedside handover process impacts nurses' satisfaction in an adult postoperative orthopedic and spine unit. A post-implementation survey of the bedside handover process was conducted after one month and …

Barriers To Transition Of Care For Heart Failure Patients, Catherine Mary Murray

Walden Dissertations and Doctoral Studies

Heart failure (HF) is an escalating chronic disorder that impacts patients, families, and society. HF necessitates efficient transition of care and complex self-care knowledge in a population often burdened with low health literacy and high readmission rates. The purpose of this project was to improve transition of discharged HF patients from a Level 1 trauma system in a mostly rural area of South Carolina to its affiliated nurse-led HF clinic. The no-show rate for initial visits to the health care system's outpatient HF clinic by postdischarge patients was 59%. Using Henderson's need theory and Stevens's knowledge transformation model for theoretical …

A Systems Approach To Moral Distress In Long Term Care, Margaret Lemley

Electronic Theses and Dissertations

Abstract: The question that this dissertation seeks to answer is whether or not a Systems Approach to Moral Distress can serve to positively address issues of moral distress within the Long-Term Care setting. Because moral distress has largely been understood as a phenomenon of the individual, efforts to address and reduce incidents of moral distress have focused almost entirely on the individual and his or her reaction to specific triggers. Building upon the existing literature this dissertation argues that previous efforts to understand moral distress within the healthcare setting have been limiting in two very important aspects. The first …

Developing Psychiatric Nursing Competencies On An In-Patient Hospital-Based Psychiatric Unit, Beverly J. Sedlacek

Doctor of Nursing Practice Projects

Problem Statement

Offering staff development training for psychiatric nurses has not kept pace with the advances in psychiatric knowledge and skills in nursing. Purpose: The purpose of this quality improvement doctor of nursing (DNP) project was to implement a competency-based staff development program on a community hospital-based inpatient psychiatric unit to determine if the psychiatric/mental health nursing knowledge, nurse patient relational skills, and attitudes of the nurses would improve or change.

Methods

A mixed method of quasi-experimental, non-randomized pre-test/post-test and semi-structured interview design was used, which utilized a convenience sampling approach. Data were collected in two phases. Three domains of …

Concept Of Self: Approach To Behaviors In Mental Health, The Tapout Program, Tina Goodrow

Walden Dissertations and Doctoral Studies

Violence in mental health care continues to be a problem. The incidence of violent episodes in healthcare settings with aggressive behavior of patients aimed at staff members or other patients is almost four times greater in healthcare than in other industries. Reducing violent episodes enhances the quality of care and improves safety for staff members and for patients. The project focused on development of a staff education program exploring the practice-focused question: Will this program effectively guide staff member approaches to mental health patients with challenging behaviors? The purpose of this project was to address the identified gap in practice …

Relationships Between Interprofessional Teamwork And Clinical Management Of, Jacqueline G. Stephens

Walden Dissertations and Doctoral Studies

Diabetes mellitus (DM) is a highly prevalent chronic disease that affects 29 million people in the United States including over 2 million veterans who receive care through the Veterans Administration. Patient-aligned care teams (PACTs) are an interprofessional teamwork system designed to improve outcomes of chronic illness, but empirical explorations of the efficacy of the PACTs have been insufficient. Utilizing the chronic care model, the purpose of this retrospective study was to determine if PACTs have been efficient in the diabetic management of veterans receiving care through a Southeastern VA. Medical records for 114 veterans with type 2 DM were randomly …