Medicine and Health Sciences Commons^™

Reducing Congestive Heart Failure Hospital Readmissions Through Discharge Planning, Lacy Rebaka Thomas

Walden Dissertations and Doctoral Studies

Every year, thousands of congestive heart failure (CHF) patients are readmitted to the hospital within 30 days of discharge. There is a gap in practice in the care continuum of patients with CHF within the transition from hospital to home. One of the factors known to increase a patient's risk for readmission is the lack of patient engagement and self-efficacy regarding the treatment plan. The purpose of this project was to implement a transition of care practice guideline that consisted of the use of a risk identification tool, a customized care plan for patients at high risk for readmission, and …

Using Diabetes Self-Management Education To Enhance Adolescent Transition, Jessica Adkins

Walden Dissertations and Doctoral Studies

Type 1 diabetes is a long-term diagnosis, the prognosis of which is directly related to the patient's ability to self-manage the disorder. Adolescents are not currently taught how to manage diabetes; instead, parents and educators expect self-management to be more of a learned behavior from their parents. The purpose of this project was to create a quality improvement plan which the regional pediatric diabetes center study site could implement to improve adolescent glycemic control. Orem's self-care theory was used as theoretical framework for the design and evaluation of the project. The practice-focused question for this doctoral project was: Can a …

Transition Of Care Guideline For Reducing Heart Failure Hospital Readmission, Geeti Farrahi

Walden Dissertations and Doctoral Studies

Heart failure (HF) patients are among the populations with the highest rates of hospital readmission within 30 days of discharge. Because of the 2010 Health Care Reform legislation, healthcare organizations are subject to financial penalty when a patient population exhibits excess readmissions. A significant reason for readmission of HF patients is a gap in the transition of care from hospital to home. The purpose of this doctoral project was to develop a practice guideline of best practices for transitioning HF patients from hospital to home. The transitional care model and care transitions intervention provided the theoretical underpinnings for developing this …

Improving Care Transitions In Patients With Heart Failure: An Integrative Literature Review, Heather Mae Mclain

Walden Dissertations and Doctoral Studies

Heart failure (HF) hospital readmission reductions are linked to nursing interventions that include scheduling a hospital follow-up appointment with the patient's health care provider within a week of discharge. Yet, patients often leave the hospital without an appointment scheduled. The focus of this integrative literature review was on analyzing data that associated follow-up within 7 days with reduced 30-day readmissions. A search of articles using CINAHL, MEDLINE, Cochrane Database of Systematic Reviews, and ProQuest databases resulted in 4,813 articles retrieved using the following search terms: heart failure, readmissions, follow-up appointments, and heart failure guidelines. Scholarly articles selected for inclusion were …

Development Of A Clinical Nurse Leadership Orientation Program, Sunita Waddell

Walden Dissertations and Doctoral Studies

Nurses are often promoted or hired into leadership positions without the benefit of a formal orientation to their new leadership positions. The challenge of navigating the various expectations of the role of clinical nurse leader (CNL) such as fiscal ownership, staffing patterns, payroll, and disciplinary action process can be overwhelming. The lack of a formalized orientation process and an identified nurse leader to function as a mentor can contribute to the novice CNL feeling unsupported and overwhelmed. The purpose of this project was to identify, develop, and evaluate a CNL orientation manual, outline, and program for newly appointed CNLs. The …

Type 2 Diabetes Management For Geriatric Veterans, Fachecia L. Fort

Walden Dissertations and Doctoral Studies

Managing diabetes in the geriatric long-term care population can be challenging, yet important because diabetes is a chronic, progressive disease. The purpose of this project was to identify clinical practice guidelines for managing Type 2 diabetes in geriatric veterans and to develop a class to educate providers on diabetes management in the geriatric long-term care population at a community living and rehabilitation center. The practice focused question asked if providing education to providers about the clinical practice guidelines for managing Type 2 diabetes in geriatric long-term care veterans would improve knowledge as measured by a pre- and posttest. The project …

Colorectal Cancer Awareness And Screening Guideline For African American Populations, Keyna Omenukor

Walden Dissertations and Doctoral Studies

Colorectal cancer is the 3rd leading cause of cancer-related deaths. Early screening

provides the best prospects for preventing the morbidity and mortality associated with the

disease. Nurses have the duty to promote health and prevent diseases. However, low rates

of colorectal cancer screening continue to be reported, especially among African

Americans who continue to suffer disproportionately from the disease. There is a need for

a culturally-sensitive clinical practice guideline that nurses can use to educate patients

appropriately on colorectal cancer. The practice focused question for this project was

designed to explore whether a culturally-sensitive clinical practice guideline to increase

colorectal …

Improving Human Papillomavirus Vaccination Rates Through Evidence-Based Interventions, Deidra Thompson

Walden Dissertations and Doctoral Studies

Cervical cancer is the most common human papilloma virus (HPV) -associated cancer and is the second leading cause of death in the world. Vaccination against HPV is essential to reduce the incidence of HPV and subsequent morbidity and mortality. According to the Centers for Disease Control and Prevention (CDC), approximately 79 million Americans are currently infected with HPV. The site for this DNP project was a 163-bed facility with inpatient and outpatient services in the southern United States. The vaccination rate at the site was 48%. The facility lacked educational interventions to prepare and remind providers to offer HPV vaccine. …

Educating Oncology Nurses On The Benefits Of Patient Exercise, Roberta Anderson

Walden Dissertations and Doctoral Studies

Exercise benefits patients with cancer during and after treatments. A formalized educational program is lacking at the project's site for oncology nurses on the benefits of exercise for their patients during and after treatment. The purpose of the project was to address the identified gap in practice at the project's site by providing education to oncology nurses on the benefits of exercise for their patients during and after treatment. The ARCS model of motivational design was used as a theoretical foundation to develop and guide the educational program presented to the oncology nurses. The question addressed in the project was: …

Meeting The Nutritional Needs Of Very Low Income Diabetic Patients, Mary Hossley

Walden Dissertations and Doctoral Studies

Adult Type II diabetes is an increasing public health problem, particularly among very low-income minority populations. The purpose of this study was to create a nutritional guide for a diabetic specific meal plan with an accompanying food pantry nutrition packet for very low-income Type II diabetic patients at a rural Mississippi Free Clinic. The practice-focused question is: Will a nurse-prepared nutritional guide with supplemental food packets improve the glucose control in low income diabetic patients? The gap in practice is that there has been no structured nutrition education guide and no food pantry support plan for Type II adult diabetics. …

A Staff Educational Initiative To Improve The Use Of Childhood Obesity Guideline Recommendations, Kris Kuhlmann Louque

Walden Dissertations and Doctoral Studies

Obesity affects one out every six children in the United States, which places them at risk for other chronic conditions such as cardiovascular disease, diabetes, and continued obesity into adulthood. Considering military children are more likely to enter the Armed Forces than their civilian counterparts, an increase in obesity among military families decreases the number of potential future military recruits who are physically eligible to serve. Despite this growing epidemic, providers report a lack of education and a low self-efficacy in the treatment of this condition. This doctorate of nursing practice study addresses this educational gap by attempting to improve …

Use Of Simulation For Tracheostomy Care, A Low Volume, High Risk Nursing Procedure, Vijaya Ramakrishnan

Walden Dissertations and Doctoral Studies

Often, education regarding low volume and high-risk procedures, like tracheostomy, are ignored. Lack of experience, skills, and human resources can lead to decreases in confidence levels, diminished quality of care, and potentially an adverse event. The purpose of this DNP project was to prepare simulation-based education on the tracheostomy procedure and provide hands-on education to bedside nurses. The project answered the question: To what extent will a simulation-based teaching method adequately prepare staff nurses in a post-acute surgical unit to perform this high risk low volume procedure? The Johns Hopkins evidence-based model method was used to assist in translation of …

Patient Self-Assessment For Older Adult Fall Prevention, Deborah Brennan

Walden Dissertations and Doctoral Studies

Falls and falls with injury are a leading contributor to decreased quality of life for adults aged 65 and older. Complications associated with fall occurrences include death, long term disability, decreased mobility, decreased quality of life, and psychological effects.

The practice focused question addressed in the project asked if the use of a standardized publicly available assessment for falls risk will assist registered nurses in learning more about the patient's fall risk. To address the question, the Stay Independent Check Your Risk for Falling Questionnaire (SICRFQ), obtained from the CDC website, was used as the basis for an education program …

Succession Planning And Development Of Nurse Leaders, Christina Martin

Walden Dissertations and Doctoral Studies

Health care organizations can provide comprehensive, formal learning opportunities to develop nurse leaders for advanced leadership roles. The purpose of this doctoral project was to create an evidence-based nursing leadership academy focused on development of advanced leadership skills and competencies to cultivate frontline and midlevel nurse leaders for executive nursing and health care leadership positions. The practice-focused question addressed how an advanced nursing leadership education program would affect the knowledge level and competencies of nurse leader participants. The American Organization of Nurse Executives' (AONE) 5 nurse executive competency domains served as the framework for this project. Data were collected from …

Increasing Referrals Of Hospitalized Obese Patients, Tammy Elaine Cabrera

Walden Dissertations and Doctoral Studies

The rate of obesity continues to rise in the United States and globally, placing populations at

increased risk of obesity related conditions, such as diabetes, hypertension, heart disease, cancer,

and other disease states. Literature review shows that there have been many different methods

utilized to halt obesity's progression, however rates continue to increase. The United States

Preventative Services Task Force (USPSTF), American Heart Association (AHA), and other

agencies recommend obesity screening and counseling at every patient encounter, but most

hospitals do not have a current obesity policy in place to accomplish this task. The purpose of

this project is to …

Educational Outcomes Of Online Registered Nursing To Bachelor Of Science In Nursing Students, Shuba Samuel

Walden Dissertations and Doctoral Studies

The projected nurse workforce shortage and the need for nurses with bachelor's degree has increased the number of accelerated and online programs in nursing education. The evolving healthcare system demands registered nurses (RNs) to demonstrate critical thinking skills and evidence-based practice in varied healthcare settings. The purpose of this quantitative study was to analyze if academic variables, such as preadmission grade point average (GPA), predicted evidence-based skills and research utilization skills among students enrolled in the online RN to Bachelor of Science in nursing program. The theoretical foundations of this study was comprised of Knowles's adult learning theory, Benner's stages …

Nurse Practitioners' Knowledge, Skills, And Confidence In Providing Tobacco Cessation Education, Indra -. Sinanan

Walden Dissertations and Doctoral Studies

Ceasing tobacco use benefits smokers regardless of age; therefore, it is essential for health care providers to consistently identify smokers and offer evidence-based cessation treatments to those wanting to stop smoking as a proactive approach towards tobacco abstinence. The purpose of this doctoral project, which was underpinned by the knowledge-to-action framework, was to educate nurse practitioners about evidence-based tobacco cessation interventions and assess the impact of the education on their knowledge base, skills, and self-confidence in implementing tobacco-cessation protocols. Participants (n = 14) completed a knowledge-based questionnaire and the Skills and Confidence for Smoking Cessation Tool before and after an …

Education Plan To Empower Wound Care Nurses For Evidence-Based Practice, Patricia Stevenson

Walden Dissertations and Doctoral Studies

Non-healing wounds can claim thousands of lives and costs billions of dollars each year, and nurse-led wound clinics are becoming necessary to fill a gap in care for patients with wounds. Even among certified wound nurses using evidence-based clinical protocols, key considerations of care are being missed. Therefore, this project was focused on developing and validating a new biofilm education module for certified or certification eligible wound care nurses. The aim of the module was to boost clinical assessment knowledge and improve patient outcomes. Benners skill acquisition model informed the development of this project. The design of the project also …

Improving The Care Of Patients With Urinary Catheters Through A Quality Improvement, Ashley Nicole Holmstrom

Walden Dissertations and Doctoral Studies

Catheter-associated urinary tract infections (CAUTI) significantly increases patient morbidity and mortality, length of stay, and organizational cost. In the 2 years prior to project implementation, the incidence of CAUTI increased by 15% in the local acute care, inpatient facility that served as the project site. Nursing leaders at the project site linked the increase in CAUTIs to a nursing knowledge deficit related to CAUTI prevention principles. The clinical question focused on the impact of CAUTI prevention staff training on the incidence of CAUTI, length of stay, and cost to the local acute care organization. After a review and critical appraisal …

Emotional Self-Management Experiences Of Practical Nursing Students, Cindy Ko

Walden Dissertations and Doctoral Studies

In Ontario, Canada, practical nurses (PN) are educated through a 2-year diploma program. A review of PN program curricula in Ontario suggested that emotional intelligence (EI) and the core concept of emotional self-management are not specified in curriculum outcomes or courses. The study explored PN students' lived experiences with emotional self-management in the clinical settings where they are exposed to stress related situations using van Manen's orientation to hermeneutic phenomenology. The original four-branch ability model of EI by Mayer and Salovey was used as the theoretical framework to guide the explorative and interpretative processes of the study. Face-to-face interviews were …

Evidence-Based Pulmonary Rehabilitation Reduces Hospital Readmissions In Adults With Copd, Christiana Otuwa

Walden Dissertations and Doctoral Studies

Many patients are affected by chronic obstructive pulmonary disease (COPD), a progressive lung disease that obstructs air flow, resulting in dyspnea and inability to carry out daily activities. Despite optimal pharmacological management, COPD patients make frequent emergency room visits and are hospitalized due to exacerbations of COPD. Literature has suggested that pulmonary rehabilitation (PR), a nonpharmacological treatment, could help to decrease the symptoms that lead to illness exacerbation, hospital readmissions, and decreased quality of life in patients with COPD. The purpose of the project was to increase the quality of life and reduce admission rates for patients diagnosed with COPD …

Weight Bias In Healthcare: An Investigation Of Impact On Obesity, Jennifer Scheffler, Fnp

Walden Dissertations and Doctoral Studies

More than two-thirds of Americans are obese or overweight. Obesity rates have risen to an epidemic level, contributing to health inequalities and leading to reduced health-related quality of life. When obese and overweight persons face weight bias by health care providers, fragmented care may occur. Ensuring positive relationships with healthcare providers is important in helping those who are obese or overweight. The purpose of this project was to understand the factors that contribute to negative weight bias in the provider-patient relationship and to identify the most effective interventions that would reduce stigmatizing attitudes and support self-awareness, acceptance, and resolution for …

Fall Reduction Among The Geriatric Population In Assisted Living Facilities, Marylyn A. Hagerty

Walden Dissertations and Doctoral Studies

Incidents of falls among the elderly increase with age. About $31 million is spent annually in the United States on medical costs related to fall injuries in the elderly. This project evaluated the outcomes of a fall reduction program implemented in an assisted living facility (ALF). The Stop Elderly Accidents, Death & Injury program developed by the Centers for Disease Control and Prevention was implemented by the ALF for 60 days prior to the outcome evaluation project. The program included a convenience sample of 62 residents and involved medication evaluation, exercises, assistive devices, environmental risk reduction, and evaluation of blood …

Nonpharmacological Behavioral Interventions For Patients With Dementia: An Integrative Literature Review, Michelle Monique Spears

Walden Dissertations and Doctoral Studies

The use of antipsychotic medications in older adults with dementia increases risk of

mortality; therefore, it is critical that nurses use nonpharmacological interventions in dementia care. The nurses' role is integral to implementation of treatment strategies to dementia patients and efforts to improve care in patients with dementia using a nonpharmacological approach are necessary. Therefore, guidelines outlining nonpharmacologic dementia care management will enable nurses to provide a wider spectrum of care to dementia patients. The purpose of this project was to make recommendations for the development and implementation of interdisciplinary practice guidelines to standardize care in the organizational setting. An …

Educational Training Of Staff Nurses For Evidence-Based Practice, Tina June Theriaque

Walden Dissertations and Doctoral Studies

Translating research into practice takes 10 to 20 years or more. Evidence-based practice (EBP) integration remains at 10% to 20%, despite recommendations requiring EBP-guided decisions. Up to 30% decreases in health care system spending, improved quality outcomes, and increased staff satisfaction result from EBP integration. Nurse leaders, who rate quality and safety as the highest priority but EBP as the lowest, are accountable for EBP enculturation; a desire to support bedside registered nurses in EBP exists, yet this EBP use knowledge gap supersedes this goal. The purpose of this project was to provide an EBP education program introducing the use …

A Community Oriented Solution To Access To Care, Margaret Louise Thornell

Walden Dissertations and Doctoral Studies

Access to primary health care services is a significant issue for many communities seeking to improve the health of their populations. This single case study describes the 12-year journey of 2 adjoining rural counties in 2 states towards meeting the primary and specialty care needs of the uninsured and underinsured population. Data were triangulated using historical documents, first-person interviews, and health utilization data. The community leadership moved through various models including a free clinic and a university-sponsored health center before finally establishing a federally qualified health center, which now serves 40,000 citizens in these counties. The site is now hosting …

Perceptions Of An Ebp Module Mobile Application By New Graduate Nurses, Kristin Wilson Carlson

Walden Dissertations and Doctoral Studies

Evidence-based practice (EBP) is a key driver of care and advancements within nursing. It is essential to emphasize EBP early in a nurse's career to promote inquisitive minds and enthusiasm for seeking evidence. The purpose of this project was to implement an EBP mobile app into a nurse residency program (NRP) to improve the process of providing EBP information and resources to new graduate nurses. The intent of the project was to leverage mobile technology to engage new graduate nurses in evidence-based practice. Roger's diffusion of innovation framework guided the project. The target audience for the project was 16 new …

Pilot Texas Red Cross Virtual Disaster Health Services Model-Case Study, Kathryn Elaine Weseman

Walden Dissertations and Doctoral Studies

The Red Cross traditional method of Disaster Health System (DHS) response is ' boots on the ground.' Texas, the 2nd largest state by population and land mass, has only 15 DHS volunteer nurses who were not able to meet the needs of disaster victims in Texas with the traditional response method. The Texas Red Cross DHS volunteer nurses began piloting a virtual DHS model in 2014. The research question was how Texas Red Cross nurses designed, developed, implemented, and evaluated the Texas Red Cross virtual DHS Model. The purpose of this case study was to provide this information in a …

The Use Of Scorecards To Improve Documentation Of Obstetrical Blood Loss, Marilyn Cejka Steinberg

Walden Dissertations and Doctoral Studies

Obstetric hemorrhage is one of the most common causes of maternal morbidity and mortality. The measurement of quantitative blood loss (QBL) at delivery prevents clinicians from failing to recognize hemorrhage in healthy obstetric patients who initially compensate for excessive blood loss. The purpose of this project was to improve the compliance of labor and delivery nurses in a community hospital with consistent QBL measurement. Key theories that formed the basis for the project were Lewin's theory of planned change and homeostasis. The project question addressed was: Is the use of weekly scorecards to provide feedback to nurses with both blinded …

Cesarean Births Rates After Implementation Of Labor Management Guidelines, Margie Allyn Bridges

Walden Dissertations and Doctoral Studies

Cesarean birth rates are associated with increased maternal morbidity. This project evaluated a quality improvement (QI) initiative implemented to reduce cesarean births among Nulliparous Term Singleton Vertex (NTSV) obstetric populations, the largest contributor to cesarean births. Variations in labor management practice contribute to cesarean birth rate; implementation of labor management bundles have been endorsed to influence practice- and system-level changes in the promotion of vaginal births. The problem addressed in this project was an organizational NTSV cesarean section rate of 30%. The purpose of the project was to use secondary data to evaluate a previously implemented labor management bundle at …