Digital Commons Network^™

Evidence-Based Practice Sustainability And Nursing Professional Governance, Melora D. Ferren

Dissertations

Patient care that is not based on evidence-based practice (EBP) could be considered malpractice, and it threatens patient safety, quality, and fiscal performance. EBP implementation is complex, and sustainment of these practices is such a persistent challenge that up to 70% of organizational change fails to be sustained. Sustainment of EBP decreases healthcare costs and improves patient outcomes. Professional attributes that influence sustainability are not well understood. Nursing professional governance (PG) is a framework of professional attributes that includes accountability, professional obligation, collateral relationships, and decision-making. This framework includes attributes that are necessary for professionals to effectively govern their profession …

Nurse Educators' Consensus Opinion On Using An Academic Electronic Health Record: A Delphi Study, Darlene S. Hanson

Dissertations

The purpose of this study was to determine the opinions of nurse educators in the state of North Dakota (ND) who were using the academic Electronic Health Record (EHR) known as SimChart. In this dissertation research study, factors that either hindered or facilitated the introduction of SimChart in nursing programs in ND were examined. Additionally, opinions were sought from nurse educators regarding whether or not SimChart contributed to student learning.

Clinical Reasoning In Experienced Nurses, Barbara Simmons

Dissertations

This qualitative descriptive study was designed to explore the cognitive strategies used by experienced nurses as they think about assessment findings on their assigned patients. As an essential component of nursing practice, clinical reasoning is used to assimilate information, analyze data, and make decisions regarding patient care. Changes in health care settings and patient acuity challenge nurses to make complex decisions under conditions of uncertainty and risk. With fewer expert nurses available to act as mentors, experienced nurses who are not yet experts must utilize varied reasoning strategies to care for acutely ill patients. Few studies of nurses' clinical reasoning …

Level 2 And Level 3 Patients In A 5-Level Triage System: Factors Related To Acuity Assignment And Trajectory Of The Emergency Department Experience, Roxanne O. Garbez

Dissertations

Clinical decision making in the emergency department (ED) can have a significant impact on patient safety and health care outcomes. One type of clinical decision making is the process of emergency department triage. Within the context of the 5-level Emergency Severity Index triage system, it is not known what factors influence patient assignment by the triage nurse to ESI acuity levels 2 and 3. To increase the validity of patient assignment to levels 2 and 3, more explicit criteria are needed.

Purposes: (1) Describe factors that influence triage nurse assignment of patients to level 2 and level 3; (2) Examine …

A Study Of Nurses' Experiences With Behaviors That Compromise A Healthy Work Environment In The Hospital Setting, Connie K. Schultz

Dissertations

The existence of disruptive behaviors in the hospital setting has been shown to affect the communication and collaboration between healthcare professionals. This study explored nurses' experiences with behaviors that compromise a healthy work environment. The data collection was accomplished through semi-structured interviews and review of organizational documents. The results of the analysis concluded that there existed a low incidence of disruptive behaviors in the selected organization. Themes were determined that reflected inconsistencies in the nurses' practice environment that contributed to the presence of disruptive behaviors. Inconsistency in communication and collaboration, in holding colleagues accountable, and the lack of visibility of …

The Experience Of The Expectant Mother Following A Diagnosis Of A Fetal Anomaly, Janet A. Tucker

Dissertations

The experience of pregnancy complicated by a fetal anomaly diagnosis is comprised of many concepts: uncertainty, information needs, stress and anxiety, waiting, decision-making dilemmas, isolation, fragmented health care, multiple losses and grief, foreknowledge, acceptance and adaptation. There is great variance in what is understood about each concept. The purpose of this study was to explore uncertainty and waiting among expectant mothers from the time period of a prenatal diagnosis of a fetal anomaly through the post-partum period.

The Neuroendovascular Procedures In The Cath Lab: An Educational Intervention, Jolly M. Kuruvilla

Dissertations

Stroke is the fifth leading cause of death and a major cause of disability. Catheter-based therapies for acute ischemic and hemorrhagic stroke have emerged as the latest model of care for patients experiencing stroke. Catheterization laboratories are now performing neuroendovascular procedures such as thrombectomy and embolization for stroke; it is critical that nurses assist with cardiac catheterization be proficient in neuroendovascular procedures. The project began with a clinical question: Among nurses practicing in a cath lab, will there be a difference in knowledge level and clinical competencies in preparing and monitoring patients for thrombectomy and embolization (neuroendovascular procedures) before and …

Perceptions Of Undergraduate Nursing Students On Racism And Racial Disparities In Maternal Health, Monika Costa

Dissertations

The United States has persistent racial inequities in maternal health, with African American women experiencing the highest maternal mortality and morbidity (Centers for Disease Control and Prevention, 2020). Structural inequities, racism, implicit and explicit biases, and discrimination contribute to disparities in maternal health outcomes in the United States (Alshusen et al., 2016; Davis, 2019; Institute of Medicine, 2003, Liese et al., 2019, National Academies of Sciences, Engineering, and Medicine, 2020). In recent years, racial discrimination and bias have been important topics of discussion. However, very little research has been done about nursing curricular preparedness to address implicit bias and racism …

The Use Of Neuraxial Dexmedetomidine In The Caesarean Patient, Garrett Franklin

Group: Samford University Moffett & Sanders School of Nursing

In obstetric patients undergoing a cesarean section, does a spinal block combining dexmedetomidine and local anesthetic compared with just local anesthetic result in a change in the incidence of side effects, density, onset, or duration of the block during the first 120 minutes from insertion of the medication?

The use of dexmedetomidine in spinal anesthesia has been well researched. Dexmedetomidine in the increments of 3,5, and 10 mcg has been shown to consistently reduce the onset time of the sensory and motor block of spinal anesthesia while also prolonging the duration of the sensory block significantly. Evidence shows that adding …

The Effects Of Simulation On Nursing Student Knowledge, Attitudes, And Clinical Preparedness In The Care Of Transgender Clients, Julie Cartney

Dissertations

Nationally, nursing education provides extremely limited coverage of LGBTQIA+ topics and as a result, nursing students lack clinical confidence and knowledge to assess and intervene effectively in this marginalized population. Despite national health goals and organizational calls for health equity, transgender persons continue to experience significant healthcare disparities and barriers in accessing quality health care.

The purpose of this project was to determine if the incorporation of a simulation scenario that features the care of transgender patient would have a positive effect on the knowledge, attitudes, and clinical preparedness of practical nursing students.

Predicting Heart Failure Readmission Using Home Health Clinical Indices, Jamie Murphy

Dissertations

Heart failure is the most rapidly growing cardiovascular disease in the U. S. (Boxer et al., 2010) and is the most common cause for hospital readmission (Fang et al., 2008; Heidenreich et al., 2013; Jencks et al., 2009) with a 30-day readmission rate of 24.8% (Centers for Medicare and Medicaid, 2012). Currently, many heart failure patients are discharged quickly from the hospital without adequate skills and knowledge to perform self-care tasks. Moreover, home health nurses provide the same care for all heart failure patients and have limited knowledge on what clinical health indicators might affect readmission. As a result, home …

Student Nurses' Perception Of Preceptors' Authentic Leadership Effect On Self-Efficacy, Venise D. Bryan

Dissertations

The study examined the relationship between final year nursing students' perceptions of preceptor authentic leadership and self-efficacy. Nursing students are required to engage in a preceptorship experience at the end of their nursing education for socialisation into the profession and learning consolidation to facilitate optimum transition from student to nurse. Unfortunately, preceptorship has been identified as the most stressful experience that nursing students engage in and poor relations with clinical staff and low competence beliefs to nurse have led to attrition after graduation. To date, a limited number of studies have examined preceptors' leadership style, particularly authentic leadership and student …

Simulation Usage As A Partial Replacement Of Traditional Clinical: A Study Of Administrator And Faculty Perceptions In Practical Nursing Programs In Pennsylvania, Cynthia A. Cornelius

Dissertations

There has been a significant amount of research regarding simulation use in nursing education; however, there is limited research available regarding the replacement of traditional clinical with simulated clinical. This research included a mixed-method design formulated to determine Pennsylvania Practical Nursing Programs' current simulation usage and Pennsylvania Practical Nursing Directors', Assistant Administrators', and Faculty Members' perceptions regarding replacing a portion of traditional clinical with simulated clinical. An 18-item electronic questionnaire was delivered to 309 potential respondents via the Qualtrics electronic survey distribution system, with 191 responding.

The Influence Of Knowledge And Value On Nursing Students' Quality Of Supportive Feedback To Peers, Joni L. Tornwall

Dissertations

Peer review in nursing is an expectation of every registered nurse in the workplace, and it is essential to accountability and self-regulation of practice in the nursing discipline. However, the literature reveals that professional nurses and nursing students feel peer review is not their responsibility. Research has shown that they state they do not have time to do it, and they feel unprepared for and anxious about the process of providing good feedback to peers. Academic nursing programs should be teaching future nurses to participate in peer review and recognize its value to professional nursing practice. Training in peer review …

Women's Lives After An Induced Abortion: A Phenomenological Study Of The Long-Term Post Abortion Experience, Rosanna Formanek Hess

Dissertations

Most previous research investigations on the post abortion experience studied women up to two years post abortion. The findings of many of these short-term studies indicate that 5-20% of women have severe psychiatric distress two years after the abortion. Little is known about the long-term effects of an abortion in women who experienced the event.

The purpose of this study was to explore the abortion experience in women who had a legal, elective, first trimester, induced abortion > 5 years before the interview. The main objective of the study was to learn how each woman was affected by the abortion and …

Influence Of Leadership Styles On Expatriate Nurses' Professional Integration In The Uae, Emmah Ncube

Dissertations

Transnational nurse migration has evoked a growing interest in the phenomenon of professional integration of expatriate nurses into their host societies. Despite research connecting employee and organizational outcomes such as job satisfaction and organizational citizenship behavior to the quality of leadership styles, there remains a lack of research linking professional integration of expatriate nurses to nurse leadership styles in the UAE. The purpose of this grounded theory study was to develop a theory that would explain how nurse leadership styles and behaviors impacted the professional integration of expatriate nurses into the multicultural work environment of the UAE. The research questions …

Faculty Caring Behaviors: A Quantitative Examination From The Ethnically Diverse Student's Perspective, Donna M. Hedges

Dissertations

The increase in patient ethnic diversity in the health care environment has not been mirrored by an increase in ethnic diversity within the nursing profession. There is a need for increased focus on the retention of ethnically diverse nursing students in order to meet the needs of an ethnically diverse patient population. The quality of caring demonstrated by faculty in the faculty - student relationship can have significant influence on the student's successful completion of the nursing program. Faculty understanding of how ethnically diverse students perceive caring faculty behaviors may assist faculty to mitigate attrition of these students. The purpose …

Impact Of Telecommuter Status, Manager Leadership Style, Structural Empowerment And Job Satisfaction On Managed Care Nurses' Level Of Engagement, Jessica Varghese

Dissertations

The work environment impacts nurses' level of work engagement. Nurses are working outside of traditional hospital settings and moving into industries such as the managed care arena. This impacts the way work is experienced as many practices such as telecommuting are more prevalent in the managed care setting. The purpose of this study is to understand the effects of telecommuter status, manager leadership style, structural empowerment, and job satisfaction, on nurses' level of engagement in the managed care workplace setting..

Ramifications And Prevention Of Preoperative Anxiety, Abigail Brady

Group: Samford University Moffett & Sanders School of Nursing

Anxiety is an unpleasant sense associated with fear, unease and nervousness. Researchers report a significant correlation between a patient's level of preoperative anxiety, anesthetic consumption and postoperative pain. Pain in the postoperative period leads to increased narcotic consumption and its subsequent side effects. Other postoperative consequences of preoperative anxiety include nausea, vomiting, cardiovascular disturbances such as tachycardia and hypertension, and increased the risk of infection. It is also reported that the recovery period and length of hospital stay are extended in patients with increased levels of preoperative anxiety.

Practitioners engage in pharmacological and non-pharmacological measures for the treatment of preoperative …

Preoperative Tranexamic Acid Use Inâ Secondary Postpartum Hemorrhage, Katie Waid, Mary Beth Greenway

Group: Samford University Moffett & Sanders School of Nursing

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide and is defined as blood loss greater than 1,000 mL, or blood loss with symptoms of hypovolemia. Primary PPH arises within 24 hours of delivery, while secondary PPH occurs within 12 weeks of delivery. Tranexamic acid (TXA) is an antifibrinolytic that inhibits plasminogen and fibrin binding, thus preventing fibrinolysis and promoting hemostasis. Although uterotonic agents remain the pillar for prevention and treatment of PPH, recent evidence indicates that TXA given prophylactically or as treatment can reduce postpartum blood loss.

Helping Family Caregivers Of Older Community-Based Family Members Who Are Providing End-Of-Life Care, Donna M. Wilson, Gail Low

Creating Healthy Work Environments (CHWE)

Families normally plan and provide most of the end-of-life care that is needed by dying family members. Our four-part research study sought to gain insight from family caregivers as to what help they needed over the end-of-life trajectory of their community-based older loved one, and what is high-quality support.

See attached Full Abstract for further details.

Influence Of Learning Style And Learning Flexibility On Clinical Judgment Of Prelicensure Nursing Students Within A Human Patient Computer Simulation Environment, Elizabeth Sharon Robison

Dissertations

Nursing education is experiencing a transition in how students are exposed to clinical situations. Technology, specifically human patient computer simulation, is replacing human exposure in clinical education (Nehring, 2010b). Kaakinen and Arwood (2009) discuss the need to apply learning theories to instructional designs involving simulation for successful learner-centered outcomes. Developing effective teaching strategies using technology to support enhancing student performance outcomes requires a paradigm shift from traditional, clinical-based models.

The purpose of this study was to begin to close research gaps and support development of evidence-based practice in implementing simulation by examining prelicensure nursing students' learning styles and flexibilities relative …

Preoperative Opioid Education, Hunter Tinnell

Group: Samford University Moffett & Sanders School of Nursing

Opioids are powerful analgesics, typically reserved for severe pain, such as intraoperative and postoperative pain. They are a valuable asset in pain control but have significant risk for addiction and abuse. Most patients are not educated on the risks, benefits, and alternatives to opioids and the majority of patients report never having a discussion regarding opioids with any healthcare provider prior to surgery. Often, patients are initially introduced to opioids for surgical and postoperative pain control. Unfortunately, this can lead to opioid abuse and addiction.

A 55-year-old female with right hip pain presented for a total hip arthroplasty. Risks and …

Transition Experiences Of Novice Mid-Level Academic Nurse Leaders From Educators To Administrators, Joana Velasquez

Dissertations

The shortage of academic nurse leaders (ANLs) is imminent and creates a crisis for the nursing profession. Nurse educators commonly assume leadership roles with minimal preparation and training. However, few research studies have explored the transition of nursing faculty to ANLs. Consequently, several aspects of transitioning from educator to administrator have remained unknown. The purpose of this generic qualitative research was to explore the experiences of novice mid-level ANLs who transitioned from educators to academic administrators, identify the facilitators and barriers to the transition process, and describe the indicators of a successful role transition. The primary research question that guided …

South Asian Low Sodium Study (Salt): A Multi-Method Approach, Salima Hemani

Dissertations

Hypertension (HTN) is prevalent in South Asian Canadians (SAC), and dietary sodium is the primary contributing factor. The overall goal of the South Asian Low-sodium sTudy (SALT) is to describe contextual factors and determine the feasibility of implementing a six-week low sodium community-based dietary intervention to improve outcomes in SAC with stage one HTN.

SALT is a multi-method study consisting of a pilot randomized controlled trial (RCT) and a cross-sectional survey. Following ethics approval, participants with stage one HTN were randomized to a usual care group or an intervention group. Participants in the usual care group received the HTN Canada …

The Relationship Between Staff Nurses' Perceptions Of Nurse Manager Caring Behaviors And Their Perception Of Exposure To Workplace Bullying Within Multiple Healthcare Settings, Lynda D. Olender

Dissertations

This study examined the relationship between staff nurses' perception of nurse manager caring behaviors and their perceived exposure to workplace bullying within multiple healthcare settings. It was based on the theoretical position that caring promotes reciprocal caring and healing for each other and for the larger universe as informed by Watson's theory of human caring (1979, 2006, 2008). Results indicated a statistically significant, negative, linear relationship between the CFS-CM and the NAQ-R (r = -.534, p < .001), meaning that as staff nurses' perceptions of their nurse manager caring increased, their perception of exposure to negative acts (meeting the definition of workplace bullying) significantly decreased. The sample consisted of primarily older, more experienced, staff nurses who worked 10 years or longer within their work environment. Data analysis also revealed that staff nurses who were females and those who worked in Medical/Surgical settings were significantly more likely to perceive their managers as caring (p < .05 respectively) and that a high workload significantly influenced the staff nurses perception of exposure to workplace bullying (p < .05). In view of the predicted nursing shortages as baby-boomer nurses retire at the same time the demand for health care is rising (AACN, 2009), these findings highlight the importance of caring leadership for the health and availability of nurses at the bedside, and may lead to shifting work priorities for nurse managers. Study findings may also foster the design and implementation of a caring curriculum and caring competencies applicable for the nurse managers' role either within nursing academic or clinical settings.

Lived Experiences And Insight On Development Of Emotional Intelligence In Professional Nursing Practice, Jennifer L. Jessen

Dissertations

The purpose of this qualitative, experiential narrative study was to examine how emotional intelligence is applied in clinical nursing practice and how a nurse develops those skills in professional practice using a qualitative, experiential narrative design. The selected research participant was asked to verify her emotional quotient (EQ) score with the MSCEIT emotional intelligence test and participate in repeated interviews detailing the major events, patients, coworkers, mentors, and support systems in her life from her first experiences in healthcare to the present. Evidence of emotional intelligence (EI) was identified in her stories and applied to the Salovey and Mayer model …

Monitored Anesthesia Care For Transcatheter Aortic Valve Replacements, Marlee Murphree, David Sanford

Group: Samford University Moffett & Sanders School of Nursing

Aortic valve stenosis (AVS) is prevalent in 2-4% of the population greater than age 75. Historically, the definitive treatment for patients diagnosed with AVS involved a high-risk open-heart surgery for replacement of the aortic valve. Transcatheter aortic valve replacement (TAVR), a minimally invasive approach, is now the treatment of choice for high-risk patients with AVS. Variation in anesthetic modalities exist for management of TAVR in the operating room (OR). General anesthesia (GA) has been routinely utilized as the anesthetic technique for patients undergoing TAVR, however the hemodynamic and pulmonary risks that induction of GA presents for patients with AVS should …

Perioperative Management Of Patients On Buprenorphine-Naloxone, Surafel Kirubel, David Fort

Group: Samford University Moffett & Sanders School of Nursing

To combat opioid use disorder (OUD), more than 2.2 million patients are reported to be using buprenorphine-naloxone for opioid maintenance therapy. Buprenorphine-naloxone is a semi-synthetic mu receptor agonist-antagonist with potent kappa/delta receptor antagonist effects. Due to buprenorphine's receptor pharmacology, there is a lack of unified guidelines for managing perioperative pain for surgical patients using buprenorphine-naloxone.

2022 Pathway Nurse Of The Year Award™ Winners, Maggie Mccright

Group: American Nurses Credentialing Center (ANCC)

When meaningful recognition occurs in organizations, nurses are acknowledged and appreciated for their contributions. It sends a powerful message that they're valued, which is a key component of a healthy and productive work environment, according to Kaufman and colleagues. Moreover, evidence has shown that recognition is the most significant driver of employee engagement. In addition, Lefton states that meaningful recognition involves "acknowledging one's behaviors and the impact these actions had on others, ensuring the feedback is relevant to the recognized situation, and is equal to the person's contribution." Meaningful recognition is highly personal, acknowledging how specific behaviors impact the practice …