Medicine and Health Sciences Commons^™

Development And Testing Of An Instrument To Measure Informatics Knowledge, Skills, And Attitudes Among Entry-Level Nursing Students, Diane K. Whitehead, Lynne E. Bryant, Jo Ann Kleier

Walden Faculty and Staff Publications

Informatics competencies in nursing education have long been and continue to be a concern. This article reports on the development and psychometric testing of the Knowledge, Skills, and Attitudes towards Nursing Informatics (KSANI) Scale to measure these constructs among entry-level nursing students. A measurement instrument was developed based on the Quality and Safety Education for Nurses (QSEN) Institute informatics competencies for pre-licensure students (Cronenwett et al., 2007). Survey data were collected from a convenience sample of 300 undergraduate nursing students attending the 2014 Florida Student Nurses Association’s annual convention. The data were subjected to Cronbach’s test to estimate the level …

Physical Activity Improves Depressive Symptoms In Older Adults, Karen Lee Fahey

Walden Dissertations and Doctoral Studies

Engaging in physical activity can help older adults to take part in community activities, maintain relationships, and initiate new friendships, thus preventing loneliness and depression. The purpose of this quality improvement (QI) project was to evaluate whether participation in physical activity improved depressive symptoms in 15 older adults at a local senior center. Pender’s health promotion model was used to determine nursing and behavioral science views on components that affect health behavior. The Exercise Benefit/Barrier Scale (EBBS) survey was evaluated before implementation of the walking program to measure the benefits of and barriers to exercise. The EBBS results showed that …

Health Care Clinicians' Compliance With Conducting Spiritual Assessments And Providing Spiritual Care To Infertile Women, Lesa Miller

Walden Dissertations and Doctoral Studies

Infertility is a disease that can cause psychological impairments in women, and the inability to achieve motherhood brings about cultural and social stigma. Spirituality is a protective element that may provide consolation to women experiencing infertility, yet the literature has shown that few clinicians conduct spirituality assessments or provide spiritual care to patients. The objectives of this scholarly project were to conduct an assessment to determine the needs of health care clinicians in regard to spirituality and spiritual patient care and to develop an educational module based on identified knowledge deficits. Guided by the knowledge-to-action cycle, a needs assessment was …

Implementation Of A Nurse Practitioner Residency Program In Critical Access Hospitals, Anna Ngwisah Bolima

Walden Dissertations and Doctoral Studies

Access to health care in rural communities is challenged by workforce shortages. Nurse practitioners (NPs) have been filling the gap created by physician migration into specialty areas. Flex hospital legislation allows critical access hospitals (CAHs) to staff the emergency department with NPs without on-site physicians. NP education often lacks emergency and trauma curriculum, resulting in gaps in practice expectations and significant role transition stress and turnover. The purpose of this project was to construct from the scholarly literature a transition-to-practice residency program to support NP's in providing emergency department care in the CAH. The limbo to legitimacy theory guided the …

Improving Colorectal Cancer Screening In Primary Care, Jenerie Reniedo Navarrete-Pak

Walden Dissertations and Doctoral Studies

Despite indications that colorectal cancer (CRC) screening strategies can decrease mortality and morbidity, screening rates among veterans remains to be low. In the Veterans Affairs (VA), the performance measure for CRC screening is lower than the national standard. This quality improvement (QI) project evaluated the effect of a team-based approach, effective electronic information structures, and the provision of education to nurses and patients in increasing CRC screening rate in primary care from 77% to 85%. CRC screening data were retrospectively collected prior to the start of the project and then compared to screening data 3 months after project implementation. The …

Development Of A Patient And Family Educational Document Following Cancer Treatment, Debbie Slipkovich

Walden Dissertations and Doctoral Studies

New pharmacological interventions for oncology patients have resulted in longer lifespans after treatment completion and a large population of cancer survivors in communities. When patients complete treatment regimens for cancer, they leave the oncology practice with minimal knowledge of community resources that may assist them during this time of transition. These patients may not interact with care providers again until they return for a surveillance appointment in the future. Guided by Bandura's social cognitive theory, this project's aim was to develop a community-specific brochure that described the variety of services available to oncology patients and their families. The practice-focused question …

Improving Pain Management For Hospitalized Patients, Ronda Sweet

Walden Dissertations and Doctoral Studies

Uncontrolled pain has proven effects on both physiological and psychological responses of hospitalized patients. These incapacitating sequelae most often negatively impact patient outcomes resulting in unnecessary suffering and prolong hospitalizations. First line nurses often have preconceived notions about a patient's pain without developing an individualized patient context that considers appropriate pain management knowledge translated from best practice standards. Guided by Bandura's social learning theory and Lippitt's change theory, the purpose of this quality improvement project was to determine if use of the Curriculum Outline on Pain for Nursing from the International Association for the Study of Pain (IASP) improved nursing …

Nurses' Occupational Trauma Exposure, Resilience, And Coping Education, Sherry Lynn Jones

Walden Dissertations and Doctoral Studies

Nursing education courses and professional development (PD) do not include coping and resilience training for registered nurses (RNs) who work in emergency departments (EDs). Exposure to traumatic events, death, and dying may lead to health issues, substance abuse, stress symptoms, nursing staff turnover, and compassion fatigue among ED RNs. Without training, the pattern of adverse outcomes may continue. The purpose of this study was to explore ED RNs' experiences with occupational traumatic stress (OTS), and their recommendations for change to nursing PD programs, using a qualitative bounded intrinsic case study. The conceptual framework for this study included social learning and …

Development Of Evidence-Based Scenario With High Fidelity Simulation To Improve Nursing Care Of Chest Pain Patients, Ma Zolaica Paragas

Walden Dissertations and Doctoral Studies

Cardiovascular disease remains the leading cause of mortality in the United States, and a primary educational objective is to develop professional competency among nurses to ensure the provision of safe and effective care to the cardiac patient. Benner's theory of novice-to-expert led to the development of an evidence-based scenario for the care of the patient with chest pain using risk-free high-fidelity simulation environments that focused on assessment, history taking, and communication, while evaluating improvements in the competency of nurses providing care to chest pain patients. Thirty-six nurses volunteered in the study. Feedback from nurse educators, which led to modifications to …

Chronic Disease Self-Management Program, Raquel Marie Biati

Walden Dissertations and Doctoral Studies

The World Health Organization noted that 2 global health problems have reached epidemic proportions: obesity and type 2 diabetes. These conditions affect nearly 170 million people worldwide. The clinical practice problem addressed by this project was the prevalence of adults ages 50 and older in an ambulatory care setting who suffer from obesity and diabetes and may benefit from a tailored weight management and nutrition education intervention. The purpose of this project was to design a program that would decrease body mass index and hemoglobin A1c in older patients through adaption of the Chronic Disease Self-Management Program. The evidence supporting …

Perinatal Drug Abuse Intervention: Policy Development For Drug Screening, Joeanna Lee Larson

Walden Dissertations and Doctoral Studies

Perinatal drug abuse is becoming a profound issue facing the health and wellbeing of neonates. The community serviced by the project site, which lies within the boundaries of an Indian Reservation, suffers from perinatal drug abuse at a higher rate than state and federal averages. The purpose of this project was to provide the project site with a policy to consistently screen for perinatal drug abuse. Lave's theory of situational learning and the Sanford Way model for quality improvement framed this project. To guide policy development, data were compiled through a systematic review of current literature, national and state guidelines, …

Developmental Evaluation Of A Centralized Denials Management Program, Lisa Schiener

Walden Dissertations and Doctoral Studies

Health care reimbursement is changing, and hospitals are finding it difficult to receive payment due to insurers' denial of services already rendered to patients. A denial can be considered an underpayment by the insurer to the hospital. Using a Six Sigma approach, a large hospital system in the southeast United States found that individual hospitals were not focused strictly on denials, but other tasks as well. Hospital administrators conducted a literature review and found that centralizing denials management team has improved reimbursement outcomes elsewhere. Therefore, the hospital system implemented a centralized denials unit to focus on overturning insurer denials while …

Improving Bedside Swallow Screening In Acute Stroke Patients: An Evaluation Plan, Juliette Segree

Walden Dissertations and Doctoral Studies

A stroke is a life-changing event for a patient and his or her family. The acute stroke patient is at risk for developing aspiration pneumonia, whether silent or overt. Prevention of pneumonia in this population requires timely completion and documentation of the bedside swallow screen to identify those patients at risk for aspiration pneumonia; however, anecdotal data from the emergency department at the site of this project suggested that completion and documentation of the screening were inconsistent. Guided by the quality caring model adopted by the project site as well as the logic model, the aim of this project was …

Development Of Assessment And Screening Tool To Assist With Prevention And Identification Of Charcot Foot In Type 2 Diabetics, Louise S. Wade

Walden Dissertations and Doctoral Studies

Abstract

Development of Assessment and Screening Tool

to Assist with Prevention and Identification of Charcot Foot in Type 2 Diabetics

by

Louise Wade MSN, RN

MS, West Texas A&M University, 2010

BS, West Texas A&M University, 2010

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

August 2016

Abstract

According to the World Health Organization, up to 50% of type 2 diabetic patients

develop neuropathy, which may cause major infections, amputation, and Charcot foot due

to impaired sensation. Early recognition and care is essential for treatment of Charcot

foot and prevention …

Healthy Work Environment: Essentials For Outcome Improvement, Lisa Cuff

Walden Dissertations and Doctoral Studies

The purpose of this project was to identify the standards for the American Association of Critical Care Nurses (AACN). The employees of a 39-bed medical surgical unit within a 697-bed metropolitan medical center were selected through collaboration with the practicum site. Out of 68 allocated positions for this unit, only permanent employees were selected to participate. An employee presented the purpose of the project, the survey process, and inferred consent represented by online login to complete the survey. Following the online assessment, the employee explained the AACN healthy work environment standards in a subsequent presentation. The online healthy work environment …

An Exploration Of Bullied Nurses, Witnesses, And A Hospital's Bottom Lline, Brenda Kay Williams

Walden Dissertations and Doctoral Studies

Nurses experiencing bullying or witnessing other nurses bullied may choose to vacate their hospital positions. Nurse attrition negatively impacts a hospital's bottom line, which can lead to insolvency and a lack of access to healthcare by patients. The purpose of this phenomenological study was to understand the choices nurses made regarding their careers after experiencing or witnessing bullying and to calculate a hospital's cost of loss. Freire's oppressed group theory provided the conceptual framework for the study. The basis of the research questions was to understand how the nurse felt when bullied or observing a coworker bullied, the actions taken, …

Improving The Completion Rate Of Advance Directives In Home Health Agencies, Ndidiamaka Ezinne Mbakpuo

Walden Dissertations and Doctoral Studies

The number of individuals aged more than 65 years in the United States and their life expectancy has been increasing in the past decades. In spite of the presence of federal and accreditation policies recommending completion of advance directive documents by patients admitted to health care settings, advance directive completion rates are low in most health care organizations. The purpose of this study was to determine the level of advance directive completion among home health patients. The health belief model provided the theoretical framework that guided this study. A retrospective chart review was carried out in a home health agency …

Evaluating The Role Of Nurses In Educating Women During The Preconception Period, Oluwatoyin Ottun

Walden Dissertations and Doctoral Studies

Nurses play a crucial role in promoting educational programs aimed at informing women about their reproductive health. However, the role of nurses in providing the health related information is not well defined. Guided by the continuum model, this project evaluated nurses' perceived role in promoting the reproductive health of women during the preconception period. Twenty nurses from 2 outpatient offices wrote responses to an open-ended questionnaire. A summary of the responses indicated that 70% of the participants refer women to community-based programs to enhance awareness for preconception care. Twenty percent of the nurses indicated that they have an educational program …

Developing Policies And Guidelines To Prevent Medication Errors And Ades In Nursing Homes, Marion Johnson

Walden Dissertations and Doctoral Studies

According to the National Patient Safety Foundation, more than 1.5 million Americans are affected by medication errors because of varied factors including miscommunication, bad handwriting, name confusion, poor packaging, and metric or other dosing unit errors. This project addressed medication errors and adverse drug events by developing policy and practice guidelines to support and aid the utilization of health information technology (HIT) systems in addressing medication errors and adverse drug events at a local nursing home in Cincinnati, Ohio. The National Quality Strategy Framework was used by a team of interdisciplinary stakeholders as a guide for the development of policies …

Reducing Length Of Hospital Stay For Intellectually Disabled Psychiatric Patients With Chronic Medical Problems, Joseph Wigwe

Walden Dissertations and Doctoral Studies

Length of hospital stay (LOS) is a major indicator for measuring efficient care. Intellectually disabled psychiatric patients (IDPP) with chronic medical problems have longer LOS due to challenges faced by providers in jointly managing both psychiatric and medical problems. The purposes of this study were to understand the significance of LOS for IDPP, create an intervention toolkit to reduce LOS, establish the content validity of the toolkit, and recommend its implementation. The items of the toolkit are pharmacology, somatic, rehabilitation, psychosocial, and monitoring patients' psychiatric and medical symptoms across care domains. The toolkit was created from the constructs of the …

Case Study Of Stakeholders' Views On Retention And Self-Efficacy In Texas Nursing Programs, Durcilla Kay Williams

Walden Dissertations and Doctoral Studies

Retention of students through the completion of the nursing degree is a problem that exists at local Texas nursing programs, adding to the nursing shortage at local Texas hospitals. The purpose of this qualitative research study was to identify the best practices used by a local Texas college with graduation rates above the benchmark of 85% set by the Texas Higher Education Coordinating Board. The study framework was based on Bandura's theory of self-efficacy and Tinto's theory of student retention. The research questions for the study focused on reasons the college maintained a high retention rate, best practices currently used, …

Examining Nurse Practitioners' Perceptions And Beliefs Regarding Hospice Referrals For African Americans, Karen Jackson Mcclary

Walden Dissertations and Doctoral Studies

Terminally ill patients often have difficult choices at the end-of-life, and electing to receive hospice services is one of them. Hospice has been linked to improved quality of life and death and is accessible to terminally ill patients. Despite the accessibility, African American patients often make the decision to forgo hospice services. The purpose of this descriptive study was to explore perceptions and beliefs of nurse practitioners (NPs) regarding the lack of utilization of hospice for African American patients and the feasibility of NPs for initial referral for terminally ill African American patients. The research questions addressed whether an NP's …

Bone Health Education For Osteoporosis Risk Reduction In Premenopausal Women: A Quality Improvement Project, Gloria Nichols Nichols

Walden Dissertations and Doctoral Studies

In the United States, about 8.5 million women live with osteoporosis. Osteoporosis is a debilitating systemic skeletal disorder characterized by low bone mass and reduced bone mineral density that occurs with the loss of estrogen. The mortality rate for this group is about 3 to 4 times higher than other women and as many as 1 in 3 experience a fracture. Guided by the Health Belief Model, this project evaluated how a bone health fact sheet impacts knowledge about osteoporosis and self-efficacy for preventative behavioral change in premenopausal women (age 40-58 years). The project also evaluated if an electronic medical …

Electronic Learning Management System Integration Impact On Tertiary Care Hospital Learners' Educational Performance, Ahmad Tassi

Walden Dissertations and Doctoral Studies

Technological innovations have been shown to improve the quality of health information and improve safety in health care systems. The purpose of this project was to offer hospital nurses a more flexible and practical alternative to education and training than the traditional face-to-face method, supporting nurse educators in overcoming many of the obstacles in responding to nurses' needs in the clinical areas. This project used a randomized, 2-group posttest-only experimental design to measure the effect of treatment at a targeted hospital. The experimental group received a new instructional approach using an Electronic Learning Management System (ELMS) and the control group …

Development Of A Program Proposal For A Nitrous Oxide Program In Pediatrics, Sarah Oleson

Walden Dissertations and Doctoral Studies

When pediatric patients are admitted to the inpatient or outpatient hospital setting they potentially have to endure procedures that cause pain, fear, and anxiety which can have a lifelong impact on the child's response to future healthcare needs. The purpose of this project was to create a comprehensive program proposal for a nitrous oxide sedation program to minimize those perceptions towards medical procedures. The project utilized a systematic review of literature and secondary data to address the most important indicators for developing a comprehensive program proposal to present to the pediatric leadership team. Multiple studies have shown nitrous oxide having …

Transforming Care Of The Behavioral Health Patient In An Emergency Department Setting, Theresa J. Kubiel

Walden Dissertations and Doctoral Studies

Behavioral and mental health issues contribute to the needs of many patients presenting to emergency departments, and yet these needs often go unrecognized. Patient processing procedures in emergency departments may not include mechanisms to consistently identify and triage patients whose care is complicated by behavioral illness. The purpose of this project was to plan a program to improve early identification and management of behavioral health patients presenting to the emergency department. The objective of this project was to develop a rapid mental health screening tool and policies guiding use of the tool in the emergency department. A multi-disciplinary team of …

Effect Of Home Telehealth On Vterans With Chronic Heart Failure, Yolanda Major

Walden Dissertations and Doctoral Studies

More than 5 million Americans have heart failure, with approximately 5% of those affected being veterans. As the number of patients with CHF continues to rise, new treatment options are needed to improve the quality of care. Current studies show Telehealth is one treatment option. The purpose of this scholarly project was to determine if veterans diagnosed with CHF were able to maintain optimal weight and blood pressure following participation in Care Coordination Home Telehealth (CCHT) program. The CCHT program provides care to veterans, through the use of monitoring devices placed in their home. Bandura's self-efficacy theory was used as …

Evaluation Of Clinical Reasoning Of Nursing Students In The Clinical Setting, Stefanie Lynn Legrande

Walden Dissertations and Doctoral Studies

The primary focus of nursing education in the 21st century is to graduate students with well-developed critical thinking and clinical reasoning skills. This descriptive case study explored the perceptions of 6 faculty and 6 unit staff nurses concerning the assessment of critical thinking and clinical reasoning skills of nursing students in the clinical setting. Benner's novice to expert theory served as the conceptual framework for the research. The guiding research questions focused on faculty and staff perceptions concerning unit staff nurses' level of preparedness to assess the critical thinking and clinical reasoning ability of nursing students, and explored how faculty …

Impact Of Simulation Training On Novice Nurses, Sheila Marjean Moore

Walden Dissertations and Doctoral Studies

In 1999, the Institute of Medicine released its report on building a safer health system. Since then, safety in patient care has become a paramount interest. Given the growing support for increasing patient safety, simulation training has become a common part of novice nurses' orientation program. This simulation training is designed to mimic situations in the acute care setting where novice nurses can practice in a patient safe environment. In this DNP project, a stroke simulation scenario and supporting patient chart was developed as an addition to a novice nurses' orientation program. The National League for Nursing simulation template was …

Creating And Establishing Content Validity Of A Tool Kit To Educate Mothers Of Premature Babies, Lilian Chinyere Ofoegbu

Walden Dissertations and Doctoral Studies

Abstract

Delivering a preterm baby who is admitted to a neonatal intensive care unit can be an enormous hardship for parents and families, and especially for mothers. The consequences of prematurity alter the parental role, affect their confidence in caring for the baby, and subsequently may impact infant outcomes. Adequately educating mothers of premature babies using an evidence-based practice approach may help them gain the confidence and skills needed to care for their infants. The purpose of this project was to create a tool kit to educate mothers of premature babies about the essential components of caring for their babies, …