Digital Commons Network^™

Developing An Evidence-Based Supportive Services Program For Cancer Survivors In A Private Oncology Practice, Joseph Ellul

Doctoral Projects

Improvements in cancer treatment have led to a rapidly increasing survivor population. In response, multiple side effects of cancer and cancer treatment as well as the various wellness needs of survivors have been recognized. Survivorship programs have been developed to care for survivors with residual effects of cancer and the side effects of treatment; however, additional support is needed. The purpose of the project was to highlight the need for a comprehensive supportive services program for the cancer survivor population and describe the steps that were required to successfully develop the program. The clinical question addressed by the project was: …

Development Of A Depression Screening Protocol For At Risk Patients Based On The Adverse Childhood Experience Questionnaire, Brittany J. Taylor

Doctoral Projects

Background: Adverse childhood experiences (ACEs) are associated with increased risk for adult depression. Utilization of the Patient Health Questionnaire Nine (PHQ-9), in combination with Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSMV) criteria, aids in the diagnosis of comorbid depression and assessment of severity.

Objectives: To standardize the process of screening new adult patients at a specialty care clinic for ACEs. Then, implement a depression screening protocol based on ACE criteria to identify adult patients with comorbid depression.

Methods: Demographic, ACE score, PHQ-9 score, and protocol implementation data collected and analyzed by the Doctor of Nursing Practice (DNP) …

In Situ Pediatric Mock Codes: The First Five Minutes, Josephine N. Ruiz

Doctoral Projects

The purpose of this quality improvement project was to use in situ simulation-based mock codes to evaluate the effectiveness of participants’ actions and perceived confidence, and to potentially reinforce and improve knowledge retention, skill acquisition, and confidence levels of nursing staff with regards to pediatric emergencies. Simulated drills were evaluated with a tool focused on high-performance teams and team dynamics as outlined by American Heart Association Pediatric Advanced Life Support 2016. Twenty-four simulated drills were conducted from January to February 2019. Each hour-long session was composed of pre-briefing, simulated drill or scenario, and debriefing and took place in empty patient …

Examining Caregiver Vigilance For Child Sexual Abuse, Kate K. Chappell

Theses and Dissertations

Child sexual abuse (CSA) affects approximately one in four US children through adolescence. As an adverse childhood experience (ACE) implicated in long-term health and wellbeing, CSA is a pervasive safety concern. The influence of caregivers and healthcare providers is under-realized in CSA prevention. Examining the thinking processes preceding CSA vigilance response has been limited in research. Understanding the complexities in healthcare related to addressing CSA will facilitate caregiver-focused intervention in primary care. Guided by social ecology and protection motivation theories (PMT), the goals of this two-phase study were to explore caregiver cognitive processes towards vigilance for CSA and the challenges …

Toward Quality Preceptorship: A Dyad Sudy, Laurie Ann Kunkel-Jordan

Dissertations (1934 -)

Problem: Approximately 70% of newly graduated nurses work in hospital settings, but their turnover rates are high, costly to employers, and due, in part, to lack of satisfaction with job orientation processes. Effective preceptorship is widely regarded as pivotal to newly graduated nurses’ successful transition to the professional nurse role; yet, the critical elements of preceptorship have not been empirically determined. Numerous researchers proffer the preceptor - newly graduated nurse interpersonal relationship as key, but preceptorship research has not been focused on this dyadic interaction. Consequently, its true impact remains unknown. Accordingly, this study addressed the following research question, “Are …

Identifying Gaps In Care In The Geriatric Trauma Patient With Rib Fractures, Kathy A. Crystal

Doctoral Projects

Introduction: Rib fractures in the geriatric patient can be life altering. Across the country trauma centers are caring for an increased volume of geriatric patients aged 65 years and older (Ali-Osman et al., 2018). The geriatric patient with thoracic injury has the second highest mortality rate among the trauma population in the United States (Mentzer et al., 2017). The assessment of the patient is key to identify critical changes due to high risk of adverse events from rib fractures. Despite efforts to standardize the assessment and care provided to the patient with rib fractures, a lot of variation occurs. Research …

An Education Implementation Project In An Emergency Department To Increase Awareness And Referral For Trafficked Person Encounters, Stacey Lynn Alderman

Doctoral Dissertations and Projects

Human trafficking impacts sufferers on a global scale with serious and lifelong health issues associated with the illegal practice. Interventions for these victims’ extensive health issues must ignite healthcare staff education and expert clinical interventions. Due to these health problems, healthcare staff function on the front lines to identify and help trafficked persons. This study focused on the scope of trafficking and health staff awareness, identification strategies to help recognize trafficked persons, techniques for interviewing, best practice strategies for intervention and referral, and new coding guidelines. During the intervention, health staff received a human trafficking pre-education questionnaire, a research supported …

Practice With Purpose & Passion, Mary Kay Bader

Books, Presentations, Posters, Etc.

Objectives:

• Integrate the components of clinical practice in an ICU environment including elements of team membership/performance, teamwork, shared decision making, communication and collaboration
• Demonstrate passion in delivering care in the ICU environment by reflecting on the meaning of nursing care and generating fuel to inspire the clinical team in the work environment

Population Based Patient Navigation : 24-Hour Personalized Cancer Care For The Entire Cancer Continuum, Jenna Cowan, Jennifer Kerkvliet

College of Nursing Faculty Publications

Cancer One word that bears immense significance for so many individuals For some, it is the word that took them by surprise, imposing new routines and adjustments to daily life as quickly and succinctly as it rolls off the tongue For others, the word evokes complex and multifaceted emotions fear, strength, apathy, gratitude, anger, hope, grief, determination the list is endless and ever changing The impact of this diagnosis extends far beyond the patient to their family, their care team, their community and more In 2017 there will be an estimated 1 688 780 new cancer cases diagnosed in the …

Understanding The Autism Spectrum Disorder Population: An Opportunity To Improve Patient Care, Jean A. Timmons

Nursing Theses and Capstone Projects

There is a documented need for caring education regarding patients with autism spectrum disorder (ASD) for nursing students and nursing staff. The autism spectrum population is increasing, one in 59 children in the United States as reported by the CDC’s Autism and Developmental Disabilities Monitoring (ADDM) Network (as cited in Baio et al., 2018). Nurses are expected to provide appropriate care, showing respect and understanding at all times to both the client and family. Through lack of knowledge and misunderstanding the ASD population has not been given this care. Based on Watson’s Theory of Caring, an educational ASD caring program …

Cultivating Confidence: Creating A Flipped Classroom Environment, Hallie H. Barnett

Nursing Theses and Capstone Projects

The purpose of this pilot study was to examine if the application of the flipped classroom teaching method versus traditional lecture in new hire hospital nursing orientation played a role in practicing nurses’ self-confidence to competently practice at the patient’s bedside. By exploring two different teaching methods in orientation, a correlation would be determined to recognize self-confidence levels with the nurse’s ability to use policy, procedure, and equipment when responding to a medical emergency in a new facility. The research study was conducted using a convenience sample at a community hospital during nursing orientation which occurred consistently twice per month. …

A Systematic Review Of The Relationships Among Psychosocial Factors And Coping In Adults With Type 2 Diabetes Mellitus, Melissa A. Mccoy, Laurie A. Theeke

Faculty & Staff Scholarship

Type 2 diabetes mellitus contributes to poor health outcomes including mortality, yet there is a gap in the literature when seeking to understand the influence of psychosocial factors on coping in this population. The paper presents a systematic review of quantitative studies that examined relationships among psychosocial determinants and coping in adults with type 2 diabetes. This review is the second layer of knowledge discovery for the concept, “Taking on a life-altering change is a rhythmical journey of experiencing ups and downs on the way to acceptance.” The life-altering change was determined to be a diagnosis of type 2 diabetes, …

Developing And Implementing Trauma Informed Care Principles: A Pilot Project, Lisa Blair Bell

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

Background: Exposure to childhood trauma have lifelong consequences effecting the health and well-being of the individuals who experienced or witnessed the trauma. As healthcare providers, we must recognize patients who have been exposed to trauma and ensure that it is responded to appropriately. This approach is known as trauma informed care.

Objective: The purpose of this quality improvement project was to increase knowledge, opinion, and self-rated competence related to trauma informed care through the use of an educational intervention. Application of trauma informed care into daily practice was monitored through semi-structured interviews with project participants.

Methods: Registered nurses from the …

An Evaluation Of A Pilot Inpatient Hospice Unit And The Impact It Has On End-Of-Life Care At An Academic Medical Center, Cynthia Minetree

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

Background: Research shows that acute care hospitals with inpatient hospice units have an increase in hospice resource utilization and provide end-of-life care that is more aligned with patients’ end-of-life goals compared to hospitals that do not have inpatient hospice units.

Methods: A pilot six-bed General Inpatient (GIP) hospice unit was implemented at an acute care hospital, located in Washington, D.C., to provide hospice care for patients that were not able to transfer to another inpatient setting for hospice care. A six-month evaluation of the pilot GIP hospice unit was done to evaluate the feasibility of the unit and the impact …

Improving Hepatitis C Screenings In The 1945 To 1965 Birth Cohort In Outpatient Primary Care, Betina Muse Nakoda

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

Background: Hepatitis C virus (HCV) is a silent epidemic affecting a vulnerable patient population in our society. Among those considered high risk for having HCV are those individuals born between 1945 and 1965, termed the baby boomer population. Baby boomers are five times more likely to have and suffer mortality from HCV than any other patient population (CDC, 2018). HCV may not present with signs or symptoms until 20 to 30 years post contraction of the virus (CDC, 2018). In 2012, the Centers for Disease Control and Prevention (CDC) updated its recommendations for Hepatitis C screenings to include the baby …

Measuring Levels Of Preparation For Decision-Making And Patient Satisfaction In A Breast Cancer Support Group, Catherine Hagan Aylor

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

The Carilion Clinic Breast Diagnostic Center diagnoses approximately 250 women with breast cancer annually, all of whom are invited to attend the Carilion Clinic Breast Cancer Support Group (CCBCSG). The primary aim of this project was to evaluate if participants with more frequent attendance of CCBCSG had increased levels of preparation for decision-making (PDM) and higher satisfaction with breast cancer treatment decisions. A REDCap survey was emailed to 137 patients who participated in at least one CCBCSG within the past five years, with a 39.4% response rate. The survey assessed levels of patient PDM, patient satisfaction about treatment decisions, and …

The Impact Of A Revised Discharge Process From Acute Care To Home Care On Hospital Utilization In Children With Single Ventricle Heart Disease, Brian M. Stahulak

Doctor of Nursing Practice Projects

Problem Description: It is estimated that approximately ~0.5%, or ~400,000, of all U.S. children, are identified as having complex chronic conditions (CCC) and account for as much as one-third, or ~$100 billion, of health care spending for all children. The goal of this quality improvement (QI) project was to identify the impact of a revised discharge process for children with Single Ventricle Heart Disease (SVHD) on hospital utilization rates and the parent’s perception of discharge readiness during the interstage period. The QI project was conducted in a 44-bed cardiac care unit within a 336-bed freestanding pediatric, academic medical center in …

Ethical Patient Care Overview For Doctoral Nursing Students, Courtney Reinisch

School of Nursing Faculty Scholarship and Creative Works

Clinical care is guided by knowledge, competency, and the maintenance of ethical standards. Maintenance of ethical standards is necessary by all care providers across disciplines. Attention should be paid to the following ethical tenets: autonomy, beneficence, non-malfeasance, justice, veracity, and confidentiality. Avoiding paternalism is a goal for providers to optimize outcomes for individuals and families. Providers who demonstrate a thorough understanding of ethical principles best serve individuals, communities, and populations by strengthening trust with adherence to ethical standards.

A Qualitative Evaluation Of A Young Parents Program (Ypp) - Parent And Facilitator Perspectives, Cecily Strange, Elaine Bennett, Maggie Tait, Yvonne Hauck

Nursing Papers and Journal Articles

Issue addressed: Young parents (<25 years) have lower engagement with health and community services and are more likely to experience negative outcomes in the perinatal period compared to older parents. The aim of this study was to evaluate the short to medium‐term outcomes of the Young Parents Program (YPP), specifically designed to engage and support young parents, using responsive and codesign strategies in a community setting.

Methods: A qualitative case study used data from interviews with participating parents (n = 20) and a focus group with YPP facilitators (n = 5).

Results: The findings report on the following short to medium‐term YPP outcomes for parents and children. Young parents: are engaged in early parenting services that are welcoming, non-judgemental and holistic; build parenting skills, knowledge, confidence and are tuned into their infants’ needs; are empowered to codesign program activities to meet their parenting and non-parenting needs; have developed friendships and a social support network in their local community; and, are linked …

The Nursing History Of Ngala Since 1890: An Early Parenting Organisation In Western Australia, Elaine Bennett, Selma Alliex, Caroline Bulsara

Nursing Papers and Journal Articles

Background: This study was the first phase of a larger study which explored the past, present and future of nursing in early parenting services in Australia.

Aim: The aim of this paper is to describe the history of nursing within an early parenting service in Western Australia (WA).

Methods: Triangulation of multiple data sources was used to summarise the nursing role over 120 years. The history was discovered through a document analysis of archives, including oral histories, organisational documents, focus groups, nurses’ diaries and interviews with nurses.

Findings: The nursing role and context is described over three time periods: 1890–1960; …

General Practice Physicians' And Nurses' Self- Reported Multidisciplinary End-Of-Life Care: A Systematic Review, Hugh Senior, Matthew Grant, Joel J. Rhee, Michèle Aubin, Peta Mcvey, Claire Johnson, Leanne Monterosso, Harriet Nwachukwu, Julia Fallon-Ferguson, Patsy Yates, Briony Williams, Geoffrey Mitchell

Nursing Papers and Journal Articles

Background: General practitioners (GPs) and general practice nurses (GPNs) face increasing demands to provide end-of-life care (EoLC) as the population ages. To enhance primary palliative care (PC), the care they provide needs to be understood to inform best practice models of care.

Objective: To provide a comprehensive description of the self-reported role and performance of GPs and GPNs in (1) specific medical/nursing roles, (2) communication, (3) care co-ordination, (4) access and out-of-hours care, and (5) multidisciplinary care.

Method: Systematic literature review. Data included papers (2000 to 2017) sought from Medline, Psychinfo, Embase, Joanna Briggs Institute and Cochrane databases. …

Effect Of Multiple Entry Levels Into Nursing Practice And Professionalism, Ogechi Abalihi

Walden Dissertations and Doctoral Studies

Entry into professional nursing practice in the United States occurs at varied education levels including a diploma, an associate degree, and a baccalaureate degree. These multiple entry levels into practice create a situation where academic preparedness for nursing practice varies, which may influence the professional behavior of nurses and, consequently, patient care and outcomes. The purpose of this quantitative comparative study, guided by Miller's wheel of professionalism in nursing, was to determine if there is a difference in the professional behaviors of associate degree prepared registered nurses (RNs) compared to the professional behaviors of baccalaureate degree prepared RNs. The Behavior …

Exploring Education Needs For Heart Failure Patients' Transition Of Care To Home, Michelle D. Williams

Walden Dissertations and Doctoral Studies

Transitions of care is a model designed to ensure that patients have resources needed to assist them to care for themselves at home after hospital discharge, which helps to decrease preventable adverse events. For people with heart failure (HF) to transition home from the hospital successfully, specific education is needed that is individualized to the disease process, but most patients' educational needs after discharge are unmet. The purpose of this qualitative study, guided by the Meleis middle range theory of transition, was to explore the perspectives of people with HF about their educational needs in order to gather data that …

Sunshine In Our Soul, Susan Halchishak Allen

Lake Union Herald

No abstract provided.

Improving Care For Transgender Veterans Through Staff Education, Stephanie C. Henrickson

Walden Dissertations and Doctoral Studies

The VHA Directive 1341 (2018a): Providing Health Care for Transgender and Intersex Veterans, outlines care for transgender patients. Staff members at the project site lacked knowledge of the directive and available resources, making their care of transgender veterans inefficient. The purpose of the project was to implement staff education about the directive and resources to increase transgender patient visits and access to care. The practice-€focused question asked whether the development and implementation of staff education about the national directive and transgender services would affect the number of transgender patient visits in a 2-€month period. The Iowa and Community Readiness Models …

The Effect Of A Behavioral Health Specialist Program On Providers’ Perceptions Of Mental Illness, Self-Efficacy And Satisfaction In The Inpatient Medical Unit., Trinity D. Thomas

DNP Projects

PURPOSE: The purpose of this DNP project was to assess the effect of a Behavioral Health Specialist (BHS) program on providers’ perceptions of mental illness, self-efficacy and satisfaction in the inpatient medical unit.

METHODS: This DNP project used a mixed-methods approach to obtain data, which included a pretest-posttest design, and key informant interviews. The survey data was obtained from provider responses to an email that was forwarded from managers of four targeted medical-surgical floors. A cover letter was included in the email which further provided information about key informant interviews and the contact information for the principle investigator to arrange …

A Pilot Of Emergency Department-Initiated Buprenorphine For Opioid Withdrawal And Opioid Use Disorder: A Quality Improvement Project, Jason Lucey

DNP Scholarly Projects

Background: Emergency department (ED) visits for opioid related visits have increased dramatically during the opioid epidemic. Buprenorphine is an evidence-based therapy for treating opioid use disorder (OUD) and withdrawal. Unfortunately, lack of access to pharmacotherapy for OUD, including buprenorphine, remains a challenge. Research supports ED-initiated buprenorphine as a practical, cost-effective strategy which engages patients in treatment better than non-pharmacologic alternatives.

Purpose: The aims of this improvement project were to 1) develop a pilot process in an ED for providing buprenorphine to patients in opioid withdrawal or for OUD; 2) recruit and train a cohort of ED staff on the process; …

Improving Compassion Fatigue And Vicarious Trauma Knowledge For Psychiatric Nurses, Natalie P. Rebelo

Walden Dissertations and Doctoral Studies

Nurses are exposed to traumatic patients and high stress regularly; this repeated exposure can increase rates of compassion fatigue and vicarious trauma. When nurses are not properly educated about compassion fatigue and vicarious trauma, it can impact their ability to provide effective patient care and result in harmful effects including insecurity, altered cognitive functioning, loss of empathy and diminished self-esteem. This project focused on educating psychiatric nurses regarding compassion fatigue and vicarious trauma. The theory guiding the project was the Neuman's system model. Fifty-six psychiatric nurses were administered a pretest consisting of 10 multiple choice test questions. They were educated …

Quality Improvement Initiative To Improve Patient Attendance In Diabetes Self-Management Education Classes, Charon Denise Randel

Walden Dissertations and Doctoral Studies

Diabetes self-management education (DSME) is a key resource in the battle against diabetes and its secondary effects. This quality improvement project was conducted to address the decreased attendance rates of DSME classes in a community health center in the southern United States. The practice question for this project explored process-related strategies to increase patient attendance in DSME classes. Based on review of patient reports of reasons for nonattendance and an evaluation of peer reviewed literature on improving attendance in DSME, the following strategies were implemented: (a) alternative solutions such as providing patients with the dates for a year of initial …

Nurses' Lived Experiences Of Comfort Care Among Residents At The End Of Life, Ezekiel Olufemi Osundina

Walden Dissertations and Doctoral Studies

Nurses provide comfort care for individuals who are at the end of life and reside in the long-€term care environment. However, how nurses provide comfort care to those who are dying and nurses' perceptions about providing comfort care are not known. The purpose of this phenomenological study, guided by Kolcaba's theory of comfort, was to examine nurses' lived experiences of comfort care among residents at the end of life in long-term care facilities. The research questions were designed to elicit rich data about the lived experiences of nurses in providing comfort care to dying residents to find out factors that …