Medicine and Health Sciences Commons^™

New Graduate Residency Programs, Shareen Estelle Taylor

Walden Dissertations and Doctoral Studies

Nurses are the largest group of healthcare providers in most acute care hospitals, and the demand for registered nurses is expected to grow by 15% by 2026. The new graduate registered nurse (NGRN) is the supply that will fill the shortage; however, NGRNs are reportedly lacking in the ability to connect the lessons learned in the classroom with real patient care, unprepared for necessary skills, emotionally stressed, and have a high first-year turnover rate. Strategies such as nurse residency programs are needed to support NGRNs as these new nurses’ transition from academics to clinical practice. The purpose of this project, …

Experiences Of Postpartum Women With Nurse-Delivered Education And Postpartum, Krystal Evans

Walden Dissertations and Doctoral Studies

Postpartum depression affects many women globally, yet largely remains underdiagnosed. It is thus important for nurses to have all available tools when delivering education and care to the postpartum patient. Yet, there is a lack of information on the experiences of postpartum women related to postpartum education and postpartum depression. The purposes of this quantitative study, for which Beck's postpartum theory was the framework, were to explore postpartum women's perceptions of education experiences and to determine if a correlation exists between the satisfaction with education and scores on the Edinburgh Postnatal Depression Scale. Sixty study participants who were 6-8 weeks …

Evidence-Based Colorectal Cancer Screening Staff Education, Chantal Navalah

Walden Dissertations and Doctoral Studies

Colorectal Cancer (CRC) is the leading cause of cancer-related death, although it is considered preventable with adequate routine screening. Despite the decline in prevalence and mortality of CRC in the United States, the African American population persist in having the highest rates of death and shortest survival for CRC. This doctoral project focused on the gastrointestinal (G.I.) staff knowledge gap about the importance of CRC screening to achieve better patient outcomes. The purpose of this project was to address the knowledge gap among the G.I staff as it relates to CRC screening. The health belief model served as a guide …

Program Evaluation Of A Home-Based Primary Care Practice And Patients With Heart Failure, Anne Rose Walsh

Walden Dissertations and Doctoral Studies

Heart failure (HF) affects over 5.5 million adults in the United States with a prevalence of 10%'€“20% in older adults and accounts for 3% of all hospital admissions with a readmission rate as high as 25% within 1 month of discharge. Patients with HF account for approximately 42% of the doctor of nursing practice project site's patient population, and the health system has a 30-day readmission rate of 35% for patients with HF in 2 large hospitals. Thus, the health system loses almost $13 million per year in Medicare penalties. This retrospective quality improvement project reviewed the effectiveness of care …

Assisting Psychiatric Nurses In Managing Work Stress And Decreasing Callouts And Absenteeism, Prisca Njume

Walden Dissertations and Doctoral Studies

Management and reduction of work stress is important in promoting nurses' well'€being. Understanding how to decrease stress levels may allow nurses to provide better care, improve patient outcomes, and experience increased job satisfaction. The focus of this project was to empower psychiatric nurses to manage work-related stress and decrease callouts and absenteeism. Person-environment fit theory, job demand-control (support) theory, the job demands-resources model, and the effort-reward imbalance model were used to inform the project. Pretest and posttest data were collected from 61 nurses using the Perceived Stress Scale. Deidentified retrospective and prospective data of the number of callouts were also …

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

Walden Dissertations and Doctoral Studies

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

Barcode Medication Administration In The Emergency Department To Mitigate Medication Errors, Holly Gauthier-Wetzel

Walden Dissertations and Doctoral Studies

Electronic health record systems (EHRs) have been adopted in healthcare facilities to unify the workflow process of healthcare professionals. Studies have demonstrated the addition of barcode medication administration (BCMA) software technology within the EHR has decreased medication errors within hospitals and long-term care facilities. However, limited research has been conducted to establish whether using BCMA in outpatient areas has had an influence on medication error rates. Literature reveals that many facilities have not adopted BCMA in outpatient areas. The purpose of this study was to investigate whether medication errors were mitigated after BCMA was implemented in the emergency department (ED). …

Evidence-Based Strategies For Improving Medication Adherence Among Psychiatric Patients: A Systematic Review, Omah S. Tsikada

Walden Dissertations and Doctoral Studies

Nonadherence to psychotropic medications among patients with serious and persistent psychiatric disorders, including bipolar disorder and schizophrenia, is approximately 70%. Nonadherence is a common barrier to the treatment of individuals with mental health disorders. However, there is limited awareness of evidence-based interventions and strategies to address this problem. Therefore, the question for this project asks whether a systematic review can identify strategies to improve adherence of psychotropic medications among individuals with serious and persistent mental illness. The purpose of this systematic review was to explore the evidence-based strategies that can aid in increasing medication adherence in patients with mental health …

Staff Education On Fall Reduction Strategies For Residents Of A Long-Term Care Facility, Olivia C. Anaele-Nwogu

Walden Dissertations and Doctoral Studies

Fall-reduction programs are frequently ineffective in reducing falls among geriatric patients in long-term care (LTC) facilities. Multicomponent strategies have proved to be effective in reducing these falls. However, these strategies require staff education to ensure their success. The purpose of this project was to support the integration of multicomponent fall prevention strategies into practice by providing staff education focusing on the appropriateness use of hourly rounding and the 4Ps (pain, position, prompted voiding and placement) in addition to bed alarms to prevent falls among geriatric patients in the local LTC facility. The Johns Hopkins Nursing Evidence-based model was the conceptual …

Alternative Therapy For Veterans Diagnosed With Post-Traumatic Stress Disorder, Shannon Rae Hill

Walden Dissertations and Doctoral Studies

An increasing number of veterans diagnosed with post-traumatic stress disorder (PTSD) has led to an increased demand for treatment within the Veteran Affairs health care system. Presently, veterans diagnosed with PTSD receive psychotropic medications and intermittent therapy sessions. Nurses are challenged to educate veterans about other health care issues based on verbalized side effects from prescribed PTSD medications limiting veterans’ ability to focus. Identifying alternative treatment options may improve treatment choices, reduce side effects, and promote positive outcomes for veterans with PTSD. This systematic review provided evidence-based practice information by addressing whether alternative therapy such as biofeedback would improve the …

Lived Experiences Of African American Nursing Students In An Associate Degree Nursing Program, Monique Renee Merritt

Walden Dissertations and Doctoral Studies

Despite recognition of the barriers that African American nursing students encounter while pursuing nursing education, leaders of U.S. nursing programs continue to struggle to retain these students and promote their degree completion. Poor retention and lack of completion contributes to the unequal representation of African American nurses in the U.S. healthcare workforce compared to the overall population. The purpose of this qualitative study was to examine the experiences that helped to promote African American nursing students’ success or served as barriers to successful completion of an Associate Degree Nursing program. Tinto’s integration model was used as the theoretical framework. Semistructured …

Nurse Practitioner-Led Education Program For Heart Failure Patients, Shay Felecia Clarke

Walden Dissertations and Doctoral Studies

Heart failure (HF) affects 5.7 million Americans and continues to be a leading cause of hospitalizations and deaths in the United States, posing an enormous burden on patients, families, and the health care system. Readmission rates for HF within 30 days post hospital discharge at small rural acute care facility in the southeast are consistently higher than the national average. The gap in nursing practice was the lack of up to date patient education postdischarge guidelines on HF for the socioeconomically disadvantaged, culturally diverse patient population located in this small rural town. The purpose of this project was to use …

Decreasing Thirty-Day Readmissions For Heart Failure Patients, Willybroad Che

Walden Dissertations and Doctoral Studies

Heart failure (HF) patients have a 20-25% hospital readmission rate within the first month of discharge. Patients experiencing HF often have a decline in health resulting in frequent hospitalizations and encumbering symptoms including dyspnea, fluid retention, and orthopnea. HF is a common condition in nursing homes and accounts for a significant proportion of resident transfers to emergency departments. HF is considered one of the costliest diagnoses in the United States, estimated to cost the healthcare system billions of dollars annually. The purpose of this systematic review was to provide a synthesis of evidence-based literature on the current recommendations and strategies …

Decreasing Hiv Stigmatization For Care Of Young Men Of Color Who Have Sex With Men, Alethea Arnett Miller

Walden Dissertations and Doctoral Studies

HIV-related stigma from healthcare provider attitudes, beliefs, perceptions, or misconceptions has been a barrier to healthcare delivery. This project was conducted to examine whether an HIV-related stigma education provided to healthcare clinic staff with a focus on advance practice registered nurses can improve knowledge and empathy toward young men of color who have sex with men (MSM), which can lead to improved overall quality of healthcare through increased health behaviors and retention in care. An educational intervention was conducted utilizing a blended-learning environment focused on social cognitive theory to influence social behavior change among healthcare professionals, increasing their exposure, knowledge, …

The Effects Of A Clinical Coaching Education On Clinical Faculty’S Coaching Behaviors, Kara L. Kaldawi

Walden Dissertations and Doctoral Studies

New graduates’ readiness to provide safe nursing care is a goal of nursing programs and employers. However, new graduate nurses do not always have the skills to make decisions in the clinical setting during a patient situation, which can result in poor patient outcomes. But clinical coaching is a faculty teaching framework that promotes the development of clinical reasoning through the deliberate practice of questioning and feedback after a patient situation. Thus, the purpose of this study was to determine whether participation in a clinical coaching education program improved the coaching behaviors of clinical nurse educators. Knowles’ theory of adult …

Reduce Postpartum Complications By Improving Postpartum Care Appointment Attendance, Shayla Tennille Buckler

Walden Dissertations and Doctoral Studies

This evidence-based project (EBP) was developed to increase postpartum appointment attendance to improve maternal outcomes for postpartum women. The practice problem was that the postpartum women who received prenatal care failed to return for postpartum care at a community clinic in north east Texas. The practice-focused question explored whether an educational intervention with the nursing staff would increase postpartum appointment attendance. The framework used was Pender’s Health Promotion Model. The preintervention data were retrieved from an electronic medical record (EMR) generated report that provided the number of postpartum appointments attended 30 days before the intervention. The nursing staff received a …

Parents’ Perceptions Of Healthcare Influences On Their Decisions To Vaccinate Their Children, Patricia Frances Badiola Harris

Walden Dissertations and Doctoral Studies

Declining immunization rates are associated with higher incidents of vaccine-preventable diseases. The purpose of this qualitative phenomenological inquiry was to explore the perceptions of vaccine-hesitant parents regarding their healthcare experiences. Ajzen and Fishbein‘s theory of reasoned actions and its key concepts (the intention to perform behaviors, attitudes, subjective norms, and external variables) was used as a framework to understand influences on parents' decisions to vaccinate their children. The research questions for the study examined the healthcare experiences of vaccine-hesitant parents, how these experiences influenced their decisions to vaccinate their children, and how this group perceived the current strategies promoting vaccinations …

Educating Staff On The Benefits Of Vitamin D Therapy For Multiple Sclerosis, Cheniece Harris

Walden Dissertations and Doctoral Studies

Clinical competency is an important factor when delivering care to those with chronic conditions such as multiple sclerosis. Vitamin D therapy through diet, supplements, and sunlight may decrease physical complications. The gap in practice this doctoral project addressed is the lack of education provided to healthcare professionals to promote the benefits of vitamin D. The project examined whether registered nurses who are provided education on the benefits of vitamin D therapy can apply the knowledge into the plan of care for patients with MS within 6 months versus those provided no education. Paradigms and models that were used include the …

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

Walden Dissertations and Doctoral Studies

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

Revisions Of A Clinical Practice Guideline For Diabetes Management Protocol, Daniel O. Huston

Walden Dissertations and Doctoral Studies

Management of type 2 diabetes mellitus (T2DM) is essential from cost and treatment perspectives. In 2017, costs associated with diabetes management in the United States amounted to approximately $327 billion. The treatment of T2DM has been in a dynamic state for the past several years with the arrival of new classes of medications and new data supporting the use of diabetes medications to reduce risks from cardiovascular disease and slow the decline of renal function. This project explored the current evidence on treatment of T2DM to support changing either the flow of the current protocol algorithm or the medications identified …

Evidence-Based End-Of-Life Care Education For Intensive Care Nurses, Kimberly Ann Hare

Walden Dissertations and Doctoral Studies

Most nurses have limited education on end-of-life care (EoLC), which can affect their ability to provide care to meet the needs of the dying patient. Nurses in a critical care unit in a hospital in the Southeastern United States lacked education on EoLC for their patients. The purpose of this study was to develop a project guided by Kolcaba’s theory on caring. The staff education project addressed the attitudes and knowledge of 36 nurses before and after an educational presentation on EoLC. Data were analyzed descriptively. Results indicated that 56% of the staff nurses had never received prior education on …

Moderate-Intensity Risk Reduction Counseling And Acquisition Of Sexually Transmitted Infection, Cindy M. Farina

Walden Dissertations and Doctoral Studies

Sexually transmitted infections (STIs) are a public health problem in the United States, with adolescents and young adults to age 25 bearing a disproportionate burden of infection. Risk reduction counseling (RRC) as a strategy to decrease STI incidence has been a focus of scholars. Research examining RRC efficacy has suggested that RRC is effective for 6 to 12 months after treatment. However, study samples have varied by age, ethnicity, race, gender, and geographic location. Whether RRC is effective for more than 1 year is unknown. The purpose of this post hoc chi-square study was to examine the efficacy of moderate-intensity …

Relationship Between Skepticism And Nursing Experiences When Treating Chronic Noncancer Pain Patients, Emily Jabour

Walden Dissertations and Doctoral Studies

Chronic pain is common, costly, challenging to manage, and affects patients’ quality of life. High confidence is placed in the nurses caring these patients. Nurses displaying skepticism or doubt about patients’ motives for seeking pain treatment contribute to the challenges of effective pain management. The purpose of this quantitative study was to determine if there was a relationship among the nurses’ professional skepticism, level of compassion, and years of experience during the treatment of chronic noncancer pain patients in the acute care setting. The communications model of pain guided the understanding of factors influencing nursing treatment of this patient population. …

Staff Education On Depression Screening In An Outpatient Psychiatric Setting, Naiga Dohnji

Walden Dissertations and Doctoral Studies

Depression is among the common mental illnesses in the United States affecting 1 in 10 Americans. The U.S. Preventive Services Task Force recommended screening for depression irrespective of the risk factors. Yet, providers struggle to implement depression screening. Inadequate use of Patient Health Questionnaire-9 (PHQ-9) screening tool to identify and manage depression can lead to poor patient outcomes. PHQ-9 is valid and reliable tool used to diagnose depression and monitor treatment response. The purpose of this project was to develop, deliver, and evaluate an educational program for providers on the use of the PHQ-9 screening tool for the identification of …

Understanding Male Perpetrated Intimate Partner Violence And Women’S Demands For Condom Use, Linda Musu Edwards

Walden Dissertations and Doctoral Studies

Sub-Saharan Africa is host to more than 70% (25.5 million) of people with HIV/AIDS. More than half of the reported cases of people living with HIV/AIDS are women who are twice as likely to contract HIV than males in sub-Saharan Africa. The purpose of this study guided by the Theory of Planned Behavior was to determine if a relationship between female demands for male partner condom use and male perpetrated intimate partner violence (MPIPV) in opposite sex cohabitating or married couples, as well as examine the relationship between the risk factors of age, education level, socioeconomic status, history of MPIPV, …

Impact Of Nursing Education On Dysphagia Screening Knowledge, Jeanette Doreen Brumm

Walden Dissertations and Doctoral Studies

Dysphagia is a common, life-threatening complication potentially experienced by patients with acute stroke. Complications related to dysphagia can lead to aspiration pneumonia, morbidity, and mortality. Thus, early identification of dysphagia is necessary for improving patient outcomes and avoiding adverse health consequences. Nurses have the unique opportunity to impact patient care by increasing knowledge of evidenced-based treatment of dysphagia in acute ischemic stroke patients. Therefore, the project question asked whether Registered Nurse (RN) dysphagia education could improve nursing knowledge of dysphagia screening. The purpose of this project was to increase RN knowledge regarding dysphagia screening using the Yale Swallow Protocol (YSP). …

Cannabis As A Safer Alternative To Opioid Management Of Chronic Pain, Loren Nedelman

Walden Dissertations and Doctoral Studies

Chronic pain affects approximately 100 million American adults and costs the United States upwards of $635 billion each year in medical treatments and lost productivity. Opioid prescription for pain has increased exponentially over the past several years, with the CDC estimating 20% of prescriptions lasting longer than 3 months for patients with noncancerous pain. Opioid addiction has become a national public health crisis with mortality surpassing 100,000 deaths annually due to overdose. As States have begun to deregulate the use of cannabis and cannabis derivatives for medical purposes; oversight and regulation by the federal government on its use as a …

Evidence-Based Pediatric Diabetic Ketoacidosis Education, Sonya Sandhu

Walden Dissertations and Doctoral Studies

Pediatric patients with diabetic ketoacidosis (DKA) are a unique subset of patients who arrive to the emergency department (ED) for care, and differ from adults regarding symptomology, treatment, and adverse effects. Nurses who will encounter this patient population must have adequate knowledge and confidence to care for them, yet research continues to show a gap in practice. The purpose of this doctoral project was to determine if a staff education project would increase ED nurse knowledge and confidence in caring for pediatric emergency patients with DKA. Utilizing Kirkpatrick’s evaluation model, an evidence-based staff education program was formulated, reviewed by an …

Fall-Related Patient Education: An Essential Feature Of A Fall Prevention Program, Immaculata Okonkwo

Walden Dissertations and Doctoral Studies

This project documented the evaluation of a voluntary patient falls prevention education

program (VPFPEP) of a rehabilitative facility in a Mid-Atlantic US state and ascertained

its sustainability. The project was designed using the customized Moore et al. evaluation

model and Lippitt’s planned theory of change to encourage patient engagement in

physical activity (PA) through fall prevention education to allay patients’ fear of falling.

The sample included patients who opted into the facility’s VPFPEP. Evaluation was

performed using run charts to visually and quantitatively monitor trends and patterns of

fall incidents over time. Run charts also facilitated comparison of injuries sustained …

Prevention Of Care Of Catheter-Associated Infections In Long Term Care, Maureen Edozie

Walden Dissertations and Doctoral Studies

The incidence of catheter-associated urinary tract infections (CAUTI) in long-term care settings ranges from 1.5 to 3.3 per 1,000 catheter days for adult. Over 380,000 nursing home residents are hospitalized due to infections each year. Staff education using Agency for Healthcare Research and Quality (AHRQ) practice guidelines showed knowledge gained. The use of an evidence-based practice guideline developed AHRQ has been shown to significantly reduce the rate of CAUTI in the long-term care residents. The clinical practice problem was a CAUTI rate higher than the national average in the long-term care facility of interest due, in part to inconsistent nursing …