Nursing Commons^™

The Effect Of Providing End Of Life Care On The Mental Health Of Critical Care Nurses, Christy Nelson

Master's Projects

Critical care nurses are providing care to acutely ill patients now more than ever and may experience moral or emotional distress due to providing end of life care to their patients. The purpose of this literature review is to determine the mental health effects of a critical care nurse providing palliative end of life care. A literature search using PubMed and CINHAL was conducted and fourteen published articles between 2012-2023 were included in this review. Several interventions were identified which may be useful in decreasing burnout and moral distress in critical care nurses. Overall, nurses experienced the most negative mental …

Efficacy Of Gabapentin Versus Benzodiazepines In The Management Of Alcohol Withdrawal Syndrome, Douglas R. Fredona

Master's Projects

Alcohol abuse, complicated by a dependency relationship, is the third leading modifiable cause of death in the United States. In patients with chronic alcohol use disorder who experience a sudden cessation or significant decrease in alcohol consumption, half will experience symptoms of alcohol withdrawal syndrome. Benzodiazepines are the typical first line treatment for alcohol withdrawal. However, benzodiazepines carry with them significant risks and side effects. As a result, ongoing research has taken place to find either an alternative treatment or a method of reducing total benzodiazepine dosage during treatment. Gabapentin is a medication that is primarily used for seizure control …

Tiered Centralized Education In The Transition-To-Practice Program To Improve Nurses' Level Of Confidence On Nursing Sensitive Indicators Outcomes, Froiland Agana Ascaño

Doctoral Projects

A tiered Centralized Education in the Transition-to-Practice (TTP) Program is crucial to improving nurses' Level of Confidence on nursing-sensitive quality indicators. The benefits of a structured orientation program taught by trained content experts are evident in the literature. In addition, training transition-to-practice RNs during onboarding with training and assessment sessions throughout the orientation program to increase frequency provides skills acquisition. This study examined the impact of a house-wide education program on the nurses' confidence levels of CLABSI prevention, a measured nursing-sensitive quality indicator. This quasi-experimental quality improvement study measured the confidence and comfort levels of transition-to-practice RNs and identified that …

Impact Of Mindfulness Practice On Compassion Fatigue In Pediatric Cardiovascular Critical Care Nurses: A Quality Improvement Project, Kendy Luu

Doctoral Projects

Background: A considerable proportion of the extant literature on healthcare has documented compassion fatigue (CF) as a major factor that contributes to poor job performance, satisfaction, and negative patient outcomes (Figley, 2002). CF is well known to negatively impact patient care and outcome, relationships, and job satisfaction among pediatric cardiovascular intensive care (CVICU) nurses. Developing interventions to reduce burnout and CF bear the potential to reduce costs and improve quality care; one particularly promising approach in this regard is the practice of mindfulness-based stress reduction (MBSR). Purpose: This quality improvement project aimed to determine the impact of an abbreviated MBSR …

Patient-Centered Emr Communication, Christi Lynn Camarena

Doctoral Projects

The electronic medical record (EMR) has become the standard in health care documentation. The EMR has been shown to improve the availability of medical records, provide tools to facilitate communication, and improve patient safety. Because of the absence of standardized training and EMR research, there is a gap in understanding the relationship between the EMR and the provider-patient relationship. The EMR requires the provider to use purposeful and deliberate patient-centered EMR communications behaviors to facilitate a meaningful, engaging, and educational dialogue with patients. These behaviors have been studied in physician populations and standardized tools have been developed to assist in …

Comparing Two Surgical Outcomes: Minithoracotomy Or Full Sternotomy In Coronary Artery Bypass Grafting Surgery, Shirin Badrkhani

Doctoral Projects

Cardiovascular diseases and heart-related conditions can be life-threatening; however, some cardiovascular conditions can be managed with open heart surgery. Coronary artery bypass grafting (CABG) is the most common type of heart surgery performed on adults. There are two different surgical procedures to correct cardiac defects: mini-thoracotomy and full sternotomy. Mini thoracotomy approach has been shown to reduce complications, such as pneumonia, excessive blood loss, and infection in mitral valve repair surgeries. However, little research has been done to compare these two surgical approaches performed for patients undergoing coronary artery bypass grafting (CABG).

Specifically, there is inadequate data to compare these …

Does Preoperative Ostomy Education Decrease Anxiety In The New Ostomy Patient?, Michelle Suzann Harris

Doctoral Projects

Background: There are approximately 100,000 patients with new ileostomies and colostomies created in the United States each year. These patients have specialized needs that include acceptance of altered body image, psychological stress, learning of difficult tasks, and occasionally an ominous diagnosis leading to the need for surgery. In addition to pre-surgical stoma site marking on the abdomen, ostomy nurses have identified early education to be an important factor in long-term success and management of the patient . Early education and stoma site marking may assist with a better-situated stoma leading to fewer complications related to appliance adherence and leakage. …

Addressing Disparities In Nurses’ Understanding Of Congestive Heart Failure, David Tomas Palecek

Doctoral Projects

Congestive heart failure (CHF) continues to affect millions of people a year and remains one of the leading causes of re-hospitalization in the US. Within the Central San Joaquin Valley (CSJV) the incidence of CHF remains significantly higher than the rest of California. In order to ensure appropriate patient care and outcomes registered nurses (RNs) must have a thorough and full understanding of the disease process and its associated symptomatology. This study aimed to find if the implementation of an interactive multimedia educational program focusing on all aspects of CHF could improve RNs education and understanding of CHF. It is …

Establishing A Hybrid Wound And Ostomy Continuing Education Program, Vivian K. Wong

Faculty Publications

Wound and ostomy nurses receive specialty training and certification to provide care in abdominal stomas, ostomies, wounds, fistulas, and pressure injuries. The eight existing nationwide programs in 2011 were inadequate to meet increasing patient population demands. We developed an innovative nondegree, postbaccalaureate continuing wound and ostomy education program using a hybrid design. The program integrated interactive online classes with intensive onsite classes and skills training. The program has been granted seven-year accreditation; student evaluations have been positive.

A Pediatric Respiratory Care Curriculum For Emergency Department Nurses, Luzmaria Alcala-Van Houten

Doctoral Projects

As pediatric visits to community hospitals increase, the Institute of Medicine (IOM) and the Pediatric Emergency Care Network (PECARN) recommend that staff be provided improved education, protocols, and resources to improve patient outcomes (Emergency Medical Services for Children, n.d.). Acute respiratory disorders are the most commonly seen complaints in children aged 0–24 months, with an average of 2–4 visits a year. The purpose of this Doctor of Nursing Practice (DNP) project is to create a pediatric respiratory care curriculum for emergency department nurses in the Kaiser Permanente Central Valley Area (CVA) and to have it evaluated by a group of …

The Influence A Multiple Teaching Modalities Course On Knowledge And Self-Confidence Of Newly Trained Emergency Nurses, Anna C. Montejano

Doctoral Projects

Many new graduate residency programs exist supporting new registered nurses (RN) transition from theory to practice, but what is not reported in the literature are programs for RNs transitioning in practice to specialty care units, such as the emergency department. Furthermore, literature addressing the use of multiple teaching modalities as a method in course work is limited. A quasi-experimental design study explored the influence a multiple teaching modalities course on the knowledge and self-confidence of newly trained emergency department nurses. Results indicated using multiple teaching modalities provided a benefit to newly trained ED nurses with an increase in knowledge and …

End Of Life Care Practices For Patients Who Die In Intensive Care Units (Icu), Jila Ghabeljoo

Doctoral Projects

Today, one in five hospital deaths happens in the intensive care unit with the expectation of twice as many by 2030. Increasing, mortality has triggered a growing attention to end-of-life (EOL) care in the ICU. However, the lack of coveted EOL and palliative care skills creates a challenge for ICU nurses. The aim of this study was to assess the current practices of EOL care in the ICU. In this quantitative research, a retrospective chart review method was employed to analyze the collected data from a population 60 EOL patients who died in the ICU of a Southern California hospital. …

A Comparison Of Educational Approaches To The End-Of-Life-Nursing Education Consortium (Elnec) Course, Jennifer L. Bodine

Doctoral Projects

Purpose: The purpose of this project was to compare the effectiveness of two different educational approaches to teaching the End of Life Nursing Education Consortium course.

Background: Terminally ill patients frequently visit the emergency department for palliative care. However, various references show that staff does not have the knowledge base necessary to provide quality end-of-life care in the emergency setting.

Method: Participants from the emergency department at a Level I Trauma Center were recruited. A quantitative, cross-sectional pilot study was conducted to investigate whether lecture or lecture with simulation was more effective in increasing the knowledge base of participants regarding …

Teaching And Evaluation Of Suicidal Assessment, Five-Step Evaluation And Triage (Safe-T) In The Emergency Department, Evangeline Rico

Doctoral Projects

Suicide remains to be a global and a national problem, and it continues to be one of the leading causes of death in the United States (U.S.) The Emergency Department (ED), being the gateway to the hospital can provide a great opportunity to assess each patient for suicidal ideation, and evaluate if patients present with risk factors for suicide. The competency of the ED staff plays a critical role in early recognition of patients who are at risk, and in implementing a plan of care for those with positive screens. However, researchers showed that knowledge deficit and lack of education …

Effect Of An Emergency Nurse Heart Failure Educational Intervention, Lori Hudgens

Doctoral Projects

Background: Research indicates many nurses lack the appropriate heart failure (HF) education necessary to assist with readmission reduction efforts. Employer approved nurse HF education has resulted in improved nurse HF knowledge, and, reduced readmissions.

Problem: ED nurses require a competent knowledge of heart failure to effectively educate heart failure patients upon admission to the ED. No research has been conducted with ED nurse specific populations to assess ED nurse knowledge of heart failure, and, to determine if heart failure educational interventions increase ED nurse' HF knowledge.

Aims: To evaluate the effectiveness of an ED nurse b.eart failure educational intervention in …

Nursing Input During Interprofessional Rounds In The Intensive Care Unit, Kathrine A. Winnie

Doctoral Projects

Interprofessional rounding has become a standard in intensive care units. Healthcare organizations such as The Joint Commission (2013) and the Institute of Medicine (2010) promote interprofessional teamwork with the goal of improving patient safety and outcomes. The 2010 IOM report, The Future of Nursing – Leading Change, Advancing Health discusses the need for all nurses to work as part of an interprofessional team to improve healthcare. Interprofessional rounding offers a venue for nurses to demonstrate their role as an equal member of the healthcare team. At the hospital of focus, there has been no previous formal attempt to measure the …

Pediatric Nurse Practitioner Home Visitation Is Associated With A Decrease In Home Care And Healthcare Utilization Errors In High Risk Infants, Rupalee Patel

Doctoral Projects

The Santa Clara Valley Health and Hospital System’s (SCVHHS) Babies Reaching Improved Development and Growth in their Environment (BRIDGE) program was developed in 2011 to optimize high risk infants' care transition from Neonatal Intensive Care Unit (NICU) to home. In addition to hospital discharge teaching and public health nursing efforts, NICU infants need further in home support given their medical vulnerability after discharge. The objectives of the SCVHHS BRIDGE program are to provide caregiver interventions to minimize home care errors after NICU discharge and to optimize health care access and utilization across the transition of care. SCVHHS NICU infants at …

The Pupillometer In Practice: Identifying And Overcoming Barriers, Audrey Lee Paulson

Doctoral Projects

Problem: The pupillometer is an assessment tool that provides an accurate assessment of pupil reactivity. It is appropriate for patients who are neurologically impaired due to injury or illness. This tool, available and in use at a local community hospital, has minimal perceived importance in the Neuroscience Intensive Care Unit (NSICU), due to a disconnect experienced by the staff. The hypothesis was that understanding the pupillometer information was insufficient and that improving the knowledge would increase the perception of usefulness. Method: Conduct a survey to determine the cause of the lack of interest and use of the pupillometer. Once the …

The Effectiveness Of A Standardized Positioning Tools And Bedside Education On The Developmental Positioning Proficiency Of Nicu Nurses, Arlene Spilker

Doctoral Projects

Developmental positioning for preterm infants is an essential skill for neonatal intensive care unit (NICU) nurses. The benefits of developmental positioning are evident in the literature, but less is known about how NICU nurses learn about developmental positioning. This study examined the effect of the Infant Position Assessment Tool (IPAT) and informal education on the developmental positioning skills of NICU nurses. This quasi-experimental study measured IPAT scores before and after an educational intervention, and found a statistically significant increase in the means of the two groups. The use of the IPAT and bedside education is useful for improving the developmental …

Developing A Patient Care Standard For Adolescents Based On A Nursing Needs Assessment, Kathryn Blake

Doctoral Projects

Mental health patients often suffer from chronic medical conditions and psychiatric comorbidities requiring frequent emergency, primary care, and acute care visits (Douzenis et al., 2012). Caring for psychiatric patients in acute care hospitals has become an increasing burden on healthcare systems with processes in place to care for acute and critical care patients. Healthcare leaders, providers, emergency departments, and medical/surgical hospitals are straining to provide care for complex patients with acute medical conditions and complex mental health needs (Reiss-Brennan, Briot, Savitz, Cannon, & Staheli, 2010). Caring for children and adolescents with medical and psychiatric problems creates the need for a …

Implementation Of Interprofessional Education And Physician Order Set Improves Compliance With Early Recognition And Treatment Of Maternal Sepsis, Lori Susan Olvera

Doctoral Projects

Septic shock is rare in pregnancy; however, sepsis remains an important contributor to maternal mortality. The perinatal patient can appear deceptively well before rapidly deteriorating to septic shock. There is a need for protocols regarding early recognition and management of maternal sepsis. The Surviving Sepsis Campaign developed guidelines to provide guidance for the clinician caring for patients with severe sepsis or septic shock. The purpose of this doctoral project was to evaluate compliance with early goal directed therapy before, during, and following the implementation of a standardized physician order set and interprofessional education for nurses and physicians in the perinatal …

Pilot Study: Avoiding Readmissions Of Heart Failure Patients Across Transitions Of Care, Analiza Baldonado

Doctoral Projects

Background: A major problem facing the U.S. healthcare system is avoidable hospital readmissions. Patients with Heart Failure (HF) face variety of barriers to health care and are at higher risk for readmissions. To address this problem, evidence-based interventions focused on safe transition from hospital to home are needed.

Methods: A quality improvement pilot project was implemented to evaluate the feasibility of evidence based interventions in preventing avoidable readmissions. The project setting was in a 900 bed health care system. The descriptive statistical methods were means and frequencies. The Transition Coordinator (TC) enrolled a convenience sample of 30 participants. The evidence …

Assessing Culture Competence Among Nurses In An Acute Care Setting, Maleka Virani

Master's Projects

The aim of the study was to assess cultural competence among nurses in an acute care setting. A 25-item questionnaire developed by Campinha-Bacote (2003) titled Inventory to Assess Cultural Competence Among Health Care Providers (IAPCC-R) along with a demographic survey were utilized to assess cultural competence among 100 nurses in an acute care hospital. The results of the study indicated that 70% of nurses (n=63) were culturally aware and 30% (n=27) were culturally competent. There was no statistical significance between the level of cultural competence and years of experience, educational degree or self rating of 'being culturally competent'. The findings …

The Cost Of Negative Perceptions Of The Work Environment Among Intermediate Intensive Care Unit Nurses, Joselyn Peralta

Master's Projects

This descriptive study assessed the perceptions of the work environment and the retention plans among registered nurses (RNs) who worked in the Intermediate Intensive Care Unit at a tertiary university hospital. Results from the Moos Work Environment Scale found that nurses perceived high levels of work pressure and low levels of clarity, coworker cohesion, and supervisor support. Results indicated that the intent to leave the unit was dependent on the nurses having other options in nursing, desiring further education, an undesirable scheduling process and unsafe patient care. The direct and indirect costs to hospitals could be offset by developing strategies …

Does Culture Influence The Needs Of Critical Care Families?, Naomi Alston

Master's Projects

Purpose: This study explores ICU patient's family member needs, particularly Vietnamese and Latino families. Design: Convenience sampling at 24 bed ICU in acute care community hospital serving ethnically diverse population. Methods: Non-experimental survey with pretest-posttest design using Demographic sheet, Critical Family Needs Inventory (CCFNI), and Needs Met Inventory (NMI). Information pamphlets were distributed. Data analysis was by ethnic groups using measures of central tendency and descriptive statistics. Findings: CCFNI results indicate family members of all ethnicities experience the same priority of needs; support and information are top two needs. English, Spanish and Vietnamese pamphlets met information needs of the majority …

Nurses' Perception Of Family Presence During Resuscitation, Josephine Njoku

Master's Projects

Background Family witnessed resuscitation (FWR) is the concept of allowing family members at bedside during cardiopulmonary resuscitation. Studies have shown that the lack of standard policies by hospitals regarding FWR forces nurses to make different decisions regarding family presence at bedside during resuscitation. The framework for this study is Sandman's teleological model. Objectives To examine nurses' perceptions of having family members present during adult cardiac resuscitation. Methods A descriptive study of 57 registered nurses (n = 57) from northern California was conducted. Participants completed a mailed survey consisting of a 22-item Likert scale questionnaire titled "Family Presence Risk-Benefit Scale." Results …

Perceived Social Support Among Chinese American Hemodialysis Patients, Kaklam Wong

Master's Projects

Social support is linked to improved health outcomes both in Western and Asian societies and is a vital factor in a patient's adjustment to end-stage renal disease and its treatment regimen. This study explored perceived social support among 46 Chinese American hemodialysis patients in San Francisco's Chinatown using the Norbeck Social Support Questionnaire plus open-ended questions. Findings unexpectedly revealed low levels of perceived social support and lack of tangible support especially in elder patients. We can no longer assume that traditional family cultural values are providing adequate social support for this population.

Pain Management Through Music Therapy, Dereck H. Ko

Master's Projects

In 1999, approximately three quarters of patients admitted to emergency departments reported pain (Joint Commission on Accreditation of Healthcare Organizations, 2000). Managing pain pharmacologically alone may not be enough because pain perception is a complex phenomenon that consists of both physiological and psychological components (Trauger-Querry & Haghighi, 1999). Music therapy is one of the systematic applications in treatment of physiological and psychological aspects of an illness or disability (Cook, 1981).The objectives of this study were to measure the pain intensity index PPI (Melzack) level before after the intervention with music therapy to investigate if music therapy is effective for pain …

Barriers To Domestic Violence Screening In The Emergency Department, Lisa Yonaka

Master's Projects

Are you in a relationship in which you're being abused? That is not an easy question to answer or ask. Identification of those who are victims of domestic violence is important to prevent further abuse and injury. The purpose of this non-experimental study was to determine barriers of Emergency Department Registered Nurses screening patients for domestic violence. 33 ED RNs completed a short anonymous questionnaire that was developed by Dr. Mary Lou Moore, Wake Forrest University, Winston-Salem, North Carolina. The most significant barriers to screening identified, were the lack of education on how to ask questions about abuse, language barriers, …

Evaluation Of The Effectiveness Of An Anaphylaxis Training Program For Unlicensed Assistive Personnel, Jean A. Litarowsky

Master's Projects

This study evaluated a training program designed to prepare unlicensed assistive personnel (UAP) in high school settings to recognize and respond effectively to an anaphylactic emergency. Subjects included 53 adults employed by a high school district in the San Francisco Bay Area of California. A training model was developed based on Bandura's theory of sources of self-efficacy. Knowledge and perceived self-efficacy of participants were measured before and after the training program to determine if a theory-based anaphylaxis recognition and epinephrine auto-injector training program would increase participants' knowledge and self-efficacy in responding to an anaphylactic emergency. Paired t-tests revealed significant improvement …