Medicine and Health Sciences Commons^™

The Impact Of Implementing Bedside Report To Transition Patients Across Units, Tonya Johnson

Walden Dissertations and Doctoral Studies

Evidence supports bedside report as a mechanism to improve communication, patient safety, quality of report, and nurse and patient satisfaction when implemented in a closed unit. The purpose of this project was to examine the impact of implementing a bedside report process to transition patients from the emergency department to a medical-surgical unit. Specifically, the goal was to analyze the impact of a bedside- reporting process on patient progression and on nurse and patient satisfaction. Lewin's change model provided the theoretical framework for this quasi-experimental study. Patient progression data consisted of 706 patient transitions from the emergency department to the …

Centering Pregnancy Implementation And Its Effect On Preterm Birth And Low Birthweight, Carole Ann Moleti

Walden Dissertations and Doctoral Studies

Preterm birth (PTB) and low birthweight (LBW) babies are the source of a large burden of infant, neonatal, and childhood morbidity. The purpose of this project was to expand the use of the CenteringPregnancy^TM Group Prenatal Care Model as an evidence-based intervention for management of both medical and psychosocial risk in low-income, ethnic and racial minorities in New York City. The standardized model developed by Schindler Rising decreases the incidence of preterm birth and low birthweight and increases the rate of breastfeeding. A CenteringPregnancy^TM program implementation plan, customized to meet the needs of a multisite urban hospital system, …

Steps To Reducing Heart Failure Hospital Readmissions Through Improvement In Outpatient Care, Paticia Laubach Dunn

Walden Dissertations and Doctoral Studies

The outpatient care of the heart failure (HF) patient is fragmented due to the lack of evidence-based practice guidelines use. The primary goal of this project was to improve the care of the HF patient in the outpatient arena through use of clinical pathways using the logic model as the project framework. The intervention was carried out over a 4-week period on a convenience, random sample of patients (n = 80) attending a cardiology practice. The patients were recruited from 2 physicians' patient populations and were selected based on an adult diagnosis of HF, reduced ejection fraction of <40% at some point in time, and the New York Heart Association (NYHA) functional class II-V. Comparisons were made in the documentation of care between patients on or off the pathway. The intervention included documentation of patient education, care follow-up, medications, NYHA functional class, and symptom exacerbation, documented in the electronic medical record. The quality of care data were evaluated based on 3 of the Joint Commission core measures for outpatient care of the HF patient. Additional data were collected regarding use of the clinical pathway based on provider and week of implementation. Data were analyzed via a Chi-square test of independence comparing pathway use by provider and use of pathway as study progressed. The comparative results show statistically significant differences in use of the pathway by provider and a statistically significant increase in use during the project . The quality of care results varied in statistical significance. The pathway utilization increased over time and provided a method for standardizing documentation of care for the HF patient in this outpatient clinic, a benefit for HF patients and providers in this cardiology practice and beyond.

Improving The Quality Of Care In An Acute Care Facility Through Reeducating Nurses About Managing Central Lines, Jacqueline Raffaele

Walden Dissertations and Doctoral Studies

Central line-associated bloodstream infections continue to be some of the most deadly hospital-associated infections in the United States. Guided by Lewin's change theory which focuses on prior learning, rejection, and replacement, the purpose of this study was to improve the quality of care patients receive in an acute care facility by reducing life threatening central line infections. The research question examined whether additional education using Venous Access Nurse (VAN) customized newsletters and manager coaching of nurses in an acute care setting would improve the quality of care for patients with central lines. This was a quantitative nonexperimental descriptive retrospective study …

Program For Healthcare Personnel To Improve Anti-Hypertensive Medication Adherence In Black Adults, Verena D. Johnson

Walden Dissertations and Doctoral Studies

Medication nonadherence is a healthcare problem that costs the United States billions of dollars annually. The purpose of this project was to propose an evidence-based program for healthcare personnel to increase the rate of medication adherence in hypertensive Black adults who require daily, oral medication. The transtheoretical model of change was used to explain the process of change and to identify approaches to changing non-adherent behaviors related to medications. Motivational interviewing was used to explain the process that nurse-educators would use to guide patients through the stages of change. In the initial step of this quality improvement program, a convenience …

Employee Wellness Model For Obesity, Barbara Siebold

Walden Dissertations and Doctoral Studies

Obesity, a condition of having a body mass index (BMI) greater than 30, is a universal epidemic with the greatest prevalence in the United States. The greatest concern with this epidemic health problem is that it presents with many comorbidities and is a risk factor for other chronic diseases. Employee wellness programs (EWP) have been in place for years and incorporate programs on weight management, nutritional education, and smoking cessation to reduce risk factors associated with chronic diseases. These programs utilize the concept of empowerment, often guided by Pender's self-management theory, to encourage employees to take onus for their health …

The Effect Of Evaluating A Quality Improvement Initiative On Reducing Hospital Transfers Of Nursing Home Residents, Denise Eileen Jarboe

Walden Dissertations and Doctoral Studies

The Effect of a Quality Improvement Initiative on Reducing Hospital Transfers of Nursing Home Residents

by

Denise Eileen Jarboe

MSN, Walden University, 2010

BS, University of Maryland, 1981

Project Study Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

February 2015

Nursing homes (NH) in the 21st century provide skilled healthcare services for resident populations who are older, frailer, and often suffering from multiple incurable chronic medical conditions. Nurses practicing in this setting must be keen observers and effective communicators with the ability to recognize and report subtle changes in health status …

The Relationship Between Compassion Fatigue And Self-Transcendence Among Inpatient Hospice Nurses, Donna Marie Johnson

Walden Dissertations and Doctoral Studies

Health care complexities have limited the understanding of nursing care and have jeopardized the "soft skills" or foundation of caring as the art of nursing. Hospice nurses provide a deeper, more spiritual and complex type of care for critically ill and end-of-life (EOL) patients, which place them at a high risk for compassion fatigue. Using Reed's middle range theory of self-transcendence, the purpose of this project was to examine the relationship between compassion fatigue and self-transcendence among inpatient hospice nurses. A descriptive, correlational research methodology guided this inquiry surveying a convenience sample of 42 inpatient hospice nurses at 4 hospice …

Interpersonal Safety Of Active Duty Women In The Deployed Environment Of Bagram Afghanistan, Cynthia Tara Ferguson

Walden Dissertations and Doctoral Studies

In the United States Armed Forces, 30% of women in the military suffer physical assault each year; in 2009, there were 22 reported cases of sexual assault in the U.S. Central Command. Aggravated assault, gang violence, sexual assault, homicide, and suicide can damage the morale of military personnel at a deployed site and collectively cost millions of dollars over time. Interpersonal violence in the United States military is destructive to the military system and directly diminishes mission readiness. This study was designed to illuminate the environmental, cultural, and political influences that affect interpersonal safety among military women in the deployed …

Automated Medication Dispensing Cabinet And Medication Errors, Marie Helen Walsh

Walden Dissertations and Doctoral Studies

The number of deaths due to medical errors in hospitals ranges from 44,000 to 98,000 yearly. More than 7,000 of these deaths have taken place due to medication errors. This project evaluated the implementation of an automated medication dispensing cabinet or PYXIS machine in a 25-bed upper Midwestern critical access hospital. Lewin's stage theory of organizational change and Roger's diffusion of innovations theory supported the project. Nursing staff members were asked to complete an anonymous, qualitative survey approximately 1 month after the implementation of the PYXIS and again 1 year later. Questions were focused on the device and its use …

Bedside Nurses' Influence On Patients' Continuum Of Care Through Effective Discharge Teaching, Mary Ann Whicker

Walden Dissertations and Doctoral Studies

The evolution of person-centered healthcare reinforces the need for nursing to provide effective patient education. Literature suggests nurses desire to provide strong discharge education to patients, but are challenged by knowledge gaps and other barriers. This DNP project developed a plan for integrating teach-back on a 30-bed cardiac unit, focusing on heart failure patients. Following a logic model, the process improvement plan to implement teach-back includes education on teach-back, empowerment of unit champions to support the project and evaluation of effectiveness of the education plan and impact on heart failure patients. The sample size of 15 cardiac nurses provides a …