Medicine and Health Sciences Commons^™

Using Unfolding Case Studies To Develop Critical Thinking In First-Semester Nursing Students, Carol Cook

Doctor of Nursing Practice Projects

There is a crisis in competency among new nurses in the United States. Prelicensure nursing education prepares them to pass the NCLEX-RN, but it does not provide the necessary foundation for sound clinical decision-making. Mistakes in the clinical setting can lead to failure to rescue, resulting in the third leading cause of death: medical error. A radical change is needed to prepare nurses with the clinical judgment skills necessary for patient care. Educators must be mindful of the academic-practice gap and adopt evidence-based improvements, including active learning with unfolding case studies. This quality improvement project involved a four-part unfolding case …

Improving Handoff Communication In The Emergency Department, Amy Shepherd

Doctor of Nursing Practice Projects

Ineffective handoff communication has been recognized for years as a practice issue and is the most frequently reported cause of sentinel events in U.S. hospitals (Dufault et al., 2010) and responsible, at least in part, for 30% of all malpractice claims (Fucik, 2019). The development of standardized tools has been identified as a key component to improving handover practice. For this project, a standardized SBAR tool was modified for a local emergency department. The intervention was a process change in the emergency department to utilize an SBAR tool during handoff reports. The project was implemented by educating staff on the …

Combating The Sedentary Lifestyle In A Rural North Carolina Community, Kelsey Toliver Watts

Doctor of Nursing Practice Projects

A rural North Carolina community is experiencing an increase in inactivity, obesity, and comorbidities. The project leader collaborated with the local health department and recreation department to implement community walking events. The events aimed to promote physical activity while providing education to the residents as to why physical activity is important. The project leader used optional pre-walking event and post-walking event surveys to assess activity change and increased knowledge. Out of the 90 attendees, 68% completed the pre-event survey and 14% responded to the post-event survey. This created limited data available for follow-up. All participants who completed the follow-up plan …

Advanced Practice Registered Nurses And Healthcare Disparities: Understanding The Impact Of Implicit Bias, Marla Lepley-Starr

Doctor of Nursing Practice Projects

Introduction: Disparities in healthcare have long been a challenge for physicians, advanced practice providers, nurses, and other interdisciplinary team members. More recently, population health-focused efforts have been implemented to manage everincreasing rates of diabetes, hypertension, and obesity, as well as lack of transportation, limited access to care, and poverty (North Carolina Department of Health and Human Services [NCDHHS], 2019). Racism, sexism, ageism, sizeism, etc., are present in the healthcare setting and manifests in implicit bias during care delivery. This can manifest as beliefs, behaviors/practices, and emotions of the provider (Paradies et al., 2014). Research is limited related to the …

Connecting Simulation-Based Learning And Quality Improvement Among Student Nurses To Prevent Catheter-Associated Urinary Tract Infections, Jason Defreitas

Doctor of Nursing Practice Projects

Hospital Acquired Infections (HAIs) are a form of infection a patient acquired during hospitalization. Whether through the application or implementation of medical devices, performing bedside procedures, or non-adherence to following aseptic techniques, healthcare providers are responsible to ensure patients remain safe throughout the course of their inpatient treatment. Over the past 2 years, the Centers for Disease Control and Prevention (CDC), has reported HAIs, specifically catheter-associated urinary tract infections (CAUTI) have increased above pre-pandemic reported cases (CDC, 2021). These types of infections can lead to many factors that affect the patient and their family such as, “increased length of stay …

Using A Nurse Manager Prep Course To Spark Interest In Nurse Manager Succession Plan Participation, Sharon Pettiford

Doctor of Nursing Practice Projects

Hospitals strive to become Magnet-accredited facilities. Having Magnet status indicates an institution has high standards regarding nurse work environments and positive patient outcomes. The American Nurses Credentialing Center (ANCC) created the Magnet program criteria in 1994 (Dierkes et al., 2021). Obtaining Magnet accreditation is a coveted goal for hospitals. The target organization is currently not a Magnet-accredited hospital, nor does it have a nurse manager succession planning program. In preparation to achieve this accreditation, the target organization needed to implement a succession plan for nurse leaders. Institutions with successful succession planning programs pay careful attention when selecting participants for succession …

Enhancing Emotional Intelligence In Prelicensure Nursing Students, Aimee G. Motley

Doctor of Nursing Practice Projects

Nursing programs are intended to prepare nursing students to become competent nurses, that can make decisions to promote positive patient outcomes. However, studies suggest that as students transition into clinical practice, they are still lacking decision-making skills. Emotional Intelligence (EI) has been suggested to improve communication skills, problem-solving, and resilience. The purpose of this project was to enhance the emotional intelligence of Baccalaureate prelicensure nursing students. The PICOT statement was: Can formal EI training combined with interactive EI training, influence EI awareness, knowledge, and skills of baccalaureate nursing students as evidenced by scoring 77% or higher on an EI posttest …

Ultrasound-Guided Peripheral Intravenous Catheter Insertion Training, Carmen Mclamb

Doctor of Nursing Practice Projects

Achieving peripheral venous access in patients is one of the first steps in most treatment protocols. Delays or even failures to obtain peripheral venous access can delay lifesaving treatments, prolong hospital stays, and affect patient outcomes. Peripheral venous access can be difficult due to chronic disease processes, scarring of valves from frequent cannulation, limitation due to dialysis fistulas, or due to acute conditions such as hypovolemia and hypotension. Studies have found the use of ultrasound-guided techniques can achieve peripheral venous access quickly and prevent the need for more aggressive procedures (Skulec et al., 2020). However, there is a gap between …

Improving Intravenous Catheter Insertion Success In Difficult Access Patients, Heidi Berry

Doctor of Nursing Practice Projects

Around one in every nine Emergency Department (ED) patients have Difficult Intravenous Access (DIVA) and 25% of ED patients will require more than one attempt (Fields et al., 2014a). Failed insertion attempts contribute to decreased patient satisfaction, care delays, and financial losses. The freestanding ED affiliated with a multi-state, not-for-profit healthcare system in an urban community had difficulty with first-attempt Peripheral IV (PIV) insertion success in identified patients. The target population was the clinical staff of the freestanding ED which included Registered Nurses and Paramedics. The objective outcome was to enhance personal knowledge of PIV catheter insertion in difficult-access patients …

Increasing Clergy Members Awareness, Sensitivity, And Knowledge (Ask) Of The Lgbtqia+ Community Improves Health Outcomes, Claudette Green

Doctor of Nursing Practice Projects

Introduction: Individuals who identify as belonging to the LGBTQIA+ community in the context of religion and faith often experience spiritual discrimination and are made to feel like an outcast (Cole & Harris, 2017). Often, spiritual leaders lack the training, knowledge, and skills necessary to understand and communicate in a way that offers solace and comfort to their LGBTQIA+ congregants (Yarhouse & Sadusky, 2020). Moreover, the church has been at the forefront of leading the discrimination and condemnation of LGBTQIA+ members. This discrimination has led many to leave the church and become involved in self-harming behavior, ongoing mental health struggles, …

Decreasing Nursing Burnout Post Covid-19 Pandemic Through Complementary Therapies, Linda Martiin

Doctor of Nursing Practice Projects

This quality improvement project aimed to address the problem of nursing burnout post COVID-19 pandemic through complementary therapies. Nursing burnout can be mental, emotional, or physical exhaustion which an excessive amount of prolonged stress can cause. Nursing burnout has affected nursing staff worldwide, directly impacting the care provided to patients and the patient's satisfaction. The Nursing Worklife Model was utilized as the theoretical framework for this project (Appendix A). The literature review exhibits the prevalence of nursing burnout in nursing staff. A quantitative study was utilized for this project. The Oldenburg Burnout Inventory was utilized to establish the participant's level …

Increasing Future Health Care Providers’ Understanding Of The Complexity Of Endometriosis To Facilitate Early Diagnosis, Christina Alexander

Doctor of Nursing Practice Projects

The DNP project was designed to improve future healthcare providers’ knowledge on the complexity of endometriosis by providing students with a lunch and learn session on endometriosis. The intent of the project implementation was to improve students’ knowledge on endometriosis to facilitate early diagnosis for patients. Improving provider knowledge of evidence-based endometriosis guidelines is imperative to achieve early diagnosis. The educational session provided students with information regarding symptoms, impact of delayed diagnosis, discerning differential diagnoses, associating timing of symptoms, and identifying endometriosis lesions. The impact of the project implementation was measured using pre/post-survey data evaluating overall knowledge, symptoms awareness, “best …

Integrating A Community Mental Health Resource Tool In A Rural Emergency Department Setting, Robert Rash

Doctor of Nursing Practice Projects

Providing effective discharge education to patients who are treated in the emergency department setting remains a very important component of a patient’s visit to an emergency department. Literature confirms although there are various governmental regulatory agencies that set forth regulations and guidelines, there remains a need to continually evaluate and critique the discharge education process to best meet the evolving needs of the patients, stakeholders, and community. Universally understood standards include appropriate reading levels and usability of the discharge education being provided. Discharge education can be very simple to complex creating higher demands on nursing staff to ensure they understand …

Increasing Cpr Awareness In School Staff, Savanna Parker

Doctor of Nursing Practice Projects

There are a limited number of staff members in Stokes County Schools that are CPR certified. A CPR workshop was conducted to provide an opportunity to allow more staff members to become certified, to gain knowledge and gain confidence in Cardiopulmonary Resuscitation, and to reduce delays in administering aid. Participants were asked to complete the Perceived Competence Scale (PCS) before and after participation in the CPR Workshop. The PCS is a 4-item questionnaire, based on a 7-point Likert scale. Answer choices range from Not True to Very True. Each question provides a lead-in statement, allowing for the concept being studied …

Self-Advocacy Training To Support Self-Confidence In Transition To Practice, Debora Shingleton Allder

Doctor of Nursing Practice Projects

Background: The crisis in the competency of newly licensed graduate nurses continues to grow despite the efforts of nursing academia. Transition to practice programs has improved new graduate attrition and narrowed the gap of practice readiness, but much of the responsibility to train graduate nurses falls on nurse preceptors. Many of these preceptors have minimal nursing experience and little to no training in fostering clinical judgment. Furthermore, nurse preceptors must balance providing care for their clients while also guiding novice nurses. They often do not have the time to provide the emotional support, real-time reflection, and timely feedback required to …

Sexually Transmitted Disease Awareness Amongst Adolescents 13 To 18 Years Of Age, Ngwanma Nwokoro

Walden Dissertations and Doctoral Studies

Abstract Sexually transmitted infections or diseases (STIs/STDs) acquired through sexual activities lead to compromised sexual health. The adolescent population is at high risk of acquiring STIs/STDs due to their lack of knowledge. The gap in practice was that the nurse practitioners (NPs) were deficient in standard of care; adolescent patients lacked consistent evaluation, education, or documentation of the education in their medical records. The practice-focused question focused on the evaluation of the effectiveness of a quality improvement (QI) initiative that incorporated the use of the American Association for Pediatrics screening and Center for Disease Prevention and Control (CDC) treatment guidelines …

A Staff Education Project On The Administration Of Clinical Practice Guidelines For The Treatment Of Obesity And Overweight Children And Adolescents, Emilia Ochiabuto Okoye

Walden Dissertations and Doctoral Studies

AbstractObesity among children and adolescents has reached epidemic proportions in the United States (U.S). Nurses in pediatric settings have a critical role to play in assessing and managing childhood obesity. The partner site for this project has a childhood obesity rate of 35% compared to the national average of 19%. However, the nursing staff lacked adequate knowledge, competence, and confidence in assessing and managing childhood obesity in line with the recommended guidelines. The problem was addressed by implementing the Clinical Practice Guideline for the Treatment of Obesity and Overweight Children and Adolescents via an education program. The program’s content was …

Cardiomems Staff Education To Improve Use Of Pulmonary Artery Sensor Data In An Emergency Department, Betty Sue Reynolds

Walden Dissertations and Doctoral Studies

Assessing volume status in patients with congestive heart failure (CHF) remains a difficult task. Newer technology, such as CardioMEMS, allows providers to download pulmonary artery pressure measurements from an implanted sensor. In a large rural emergency department (ED), lack of staff education on CardioMEMS made the device useless when a patient presented to the ED. The purpose of this project was to develop a staff education in-service to address the gap in practice. The theory used to guide development of an effective curricular program and instruction method was Knowles’ theory of andragogy. Application of the analysis, design, development, implementation, and …

Nurse Practitioner Education On Caring For Patients Using Medical Marijuana, Zainab Kalokoh Mansaray

Walden Dissertations and Doctoral Studies

AbstractNurse practitioners are crucial components of community health care because they treat and manage individuals who use medical marijuana. Overuse of medical marijuana without proper examination and certification may result in undesirable patient outcomes, such as increased patient dependency and death, which may have a severe impact on society. The medical marijuana primary care clinic for which this Doctor of Nursing Practice project was developed lacked the information required to certify and evaluate qualifying conditions for medicinal marijuana users. The practice-focused questions investigated how nurse practitioners caring for patients using medical marijuana education based on the National Council of State …

Nursing Knowledge And Breastfeeding Education, Mary Aguirre

Walden Dissertations and Doctoral Studies

According to the Centers for Disease Control and Prevention, the Healthy People 2020 breastfeeding goal immediately after birth of 81.9% was surpassed in 2016, with approximately 83.8% of babies breastfed shortly after delivery. However, by seven days post birth, this number decreased to 82.9%, reduced even more for infants who were exclusively breastfed to 64.7%. Local research has shown that breastfeeding decreases at one week after discharge, which may be due, in part, to the lack of nurses' knowledge related to breastfeeding. This lack of knowledge related to breastfeeding by the nurses, in turn, may negatively impact the support staff …

Impact Of Family Health Outcomes And Work Balance On Health Services Organizations’ Workplace Attendance, Marcus Levinsky Wade

Walden Dissertations and Doctoral Studies

Work-life balance (WLB) is employees’ ability to effectively manage between job obligations and everyday life activities involving family, health, and social life. Successful WLB has become increasingly important to healthcare administrators due to staff shortages and essentials of job performance, attendance, and satisfaction. The purpose of this quantitative study was to determine if there was a correlation between WLB, workplace stress, and employee workplace attendance. The two research questions were correlational; the dependent variable was workplace attendance, and the independent variables were workplace stress and WLB. The compensation theory served as the foundation for the study, in which both family …

Implementation Of Night Shift Rounding To Improve Nursing Communication And Reduce Days Of Intubation In The Intensive Care Setting, Lisa Wilkinson

Walden Dissertations and Doctoral Studies

Multidisciplinary rounds are the gathering of various health care providers who have a shared interest in a patient’s well-being to discuss the plan of care and the patient’s progress through their hospital stay. This multidisciplinary group of staff can be the providers, the nurse, charge nurse, social worker, pharmacist, dietician, respiratory, chaplaincy, and occupational and physical therapists. On night shift at the project site, this rounding process did not occur, leaving the staff feeling they were not involved in the plan of care. The purpose of this quality improvement evidenced-based project was to create a process change, introduced to the …

Nurses’ Perception Of Facilitators And Barriers To The Community College Faculty Role, Hallie Roselie Coppi

Walden Dissertations and Doctoral Studies

There is an increased nursing faculty shortage throughout the United States (U.S.) which can have a significant impact on student enrollment in nursing programs. The purpose of this descriptive qualitative study, which was guided by Herzberg’s two-factor theory, was to explore perceptions of nursing faculty about their role in community college associate degree nursing (ADN) programs in the western U.S. Data were collected via in-depth semi-structured interviews with 14 nurse educators to gain insights regarding experiences with role transition, work expectations, and plans in academia. Transcribed interview data were thematically analyzed to reveal seven overarching themes which were motivation, role …

Experiences Of Transgender Adults Living In West Virginia, Kerry M. Drabish

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Transgender adults experience disrespect, rejection, and discrimination. This is further complicated by the incongruence and internal conflict stemming from pressure to conform to a binary system of gender. Studies describing the experiences of transgender adults are limited. Therefore, the concept coexisting between the assigned and identified self was developed to better understand how transgender adults acknowledge turmoil and marginalization in coming to embrace identity.

Purpose: The purpose of this study was twofold: (1) describe the experiences of transgender adults living in WV, and (2) gather empirical evidence about the concept coexisting between the assigned and identified self. The …

Educator Preparedness In The Use Of Simulation In Nursing Education, Marcelene E. Hart

Walden Dissertations and Doctoral Studies

AbstractNurse educators lack preparation when using simulation as a teaching modality in educating nurses and nursing students within their clinical environment. The purpose of this basic qualitative study was to understand nurse educators’ perceptions of the challenges in preparing for simulation-based training experiences for nurses and nursing students. Vygotsky’s constructivist theory was used as the conceptual framework for the study to emphasize students’ innate ability to learn using active and hands-on processes through simulation experiences. Questions were developed to explore the challenges nurse educators encounter when preparing for simulation activities. Survey questionnaire invitations were sent through email to hundreds of …

Evaluating A Virtual Reality Simulation-Based Tool In Undergraduate Nursing Students For Impact On Accuracy, Clinical Judgment, Fear, And Self-Confidence When Donning, Doffing, And Disposing Of Personal Protective Equipment, Stacy Lynn Russell

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: PPE training is essential to prevent transmission of infections or autoinoculation of infections among healthcare providers and patients. Student nurses play a vital role in infection control practices to protect themselves and patients from transmittable infections. The purpose of this study was to evaluate an innovative teaching and learning strategy known as virtual reality simulation in teaching proper PPE use in comparison to more traditional learning.

Research Questions: This study aimed to answer three research questions: (1) What is the acceptability among faculty of using a head mounted VRS to train undergraduate nursing students in the proper …

Descriptions Of Breast Self-Care From Inner-City African American And Hispanic Women Seeking Care In A Comprehensive Breast Care Center, Salamata Yoda

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: A plethora of inquiries has irrefutably revealed a decline in the death rates of breast cancer in some ethnic populations due to timely diagnoses, and enhancement in treatment measures. However, not all women have gained equal access to these innovations in healthcare. Certainly, as a repercussion of the noted disparity, the overall breast cancer prevalence among African American and Hispanic women has steadily escalated. Although no single test can detect all breast cancers early, practicing breast self-care consisting of breast self-awareness (BSA) in combination with other screening methods such as clinical breast exam (CBE), mammogram screening, and a suitable …

Effectiveness Of Speech Intervention Methods In Children With Speech Delays, Andrea Noel, Rachel Windemuth, Brett Porter

Williams Honors College, Honors Research Projects

Speech delays in children is a common issue that can be treated by a wide variety of interventions. Our PICOT question is, in children, ages six months to thirteen years, with speech/language delays, how does the addition of innovative and supplemental interventions, compared with standard interventions alone, effect improvements in the delays. All three group members have known someone who has suffered from a speech delay, and we want to research the best possible methods to overcome that obstacle to answer our questions, we will begin to take on the task of creating and writing a systematic review. This review …

Use Of The Rasch Model For Fit Statistics And Rating Scale Diagnosis For The Student Perception Appraisal- Revised, Robert J. Hawkins, Janice Hawkins, Beth Tremblay, Lynn Wiles, Karen Higgins

Ellmer School of Nursing Faculty Publications

Background and Purpose: Nursing student retention is essential to meet workforce demands. Jeffrey's Nursing Student Retention Student Perception Appraisal-Revised (SPA-R1) has been used extensively to understand factors that impact retention. Psychometric testing of the SPA-R1 contributes to greater confidence in the instrument's reliability and validity.

Methods: Item response theory and specifically, the single parameter polytomous Rasch model was used as a framework for fit statistic testing and rating scale diagnostics of the SPA-R1. This was a secondary analysis of a convenience sample of undergraduate prelicensure nursing students. The setting for the previous study was virtual, and the study period was …

Creating A Primary Care Track In Prelicensure Nursing Education, Janice E. Hawkins, Lynn L. Wiles, Jamela Martin, Beth Tremblay, Karen Higgins, Ingrid Mahoney

Ellmer School of Nursing Faculty Publications

BACKGROUND: RNs practicing in primary care (PC) increase access to health care and contribute to better patient outcomes and cost savings, yet undergraduate nursing education traditionally focuses on disease-oriented care. This article describes a curricular track for infusing PC prelicensure programs.

METHOD: PC content is threaded across four semesters with targeted assignments and clinical experiences. Providing clinical immersion experiences with practicing RNs as preceptors in community and PC settings is a key component of this initiative.

RESULTS: Student feedback has been favorable. Students stated they gained insight to the role of RNs in PC through class assignments and clinical rotations. …