Nursing Commons^™

Repositioning Patients To Prevent Pressure Ulcers, Janeth Covarrubias

Symposium of Student Scholars

The purpose of this project is to demonstrate whether alternating between the nurse and certified nurse aid (CNA) to reposition immobilized patient’s every two hours, as opposed to being repositioned solely by one person, will reduce pressure ulcer development.

Background: Nurses and CNAs work together to turn patient’s every 2 hours, but some patients have stated that they have not been turned all day; consequently, they’ve developed new pressure ulcers or are not healing from previous ones. Without interventions, patients are at risk for developing severe infections, lengthening their hospitalization, and increased pain levels.

Literature review: Like the registered …

Uncovering The Benefits Of Naturalistic Blue-Depleted Lighting In Hospitals: A Qualitative Study, Sam P. Cotton

Symposium of Student Scholars

With exponential technological advances, hospitals are tasked with prioritizing which expensive innovations truly impact as many patients as possible to give them the greatest chance of recovering and discharge them earlier. It is no surprise that most of the attention is focussed on pharmaceutical drugs and a variety of different equipment and machinery, but hospital facilities should look into simpler additions that can aid every patient admitted. The use of naturalistic blue-wavelength lighting is something that can benefit each patient’s recovery immensely. Multiple studies have proven positive effects that blue-depleted lighting compared to standard indoor fluorescent lighting has lowered stress …

Long-Term Care In The United States: History, Financing, And Directions For Reform, George A. (Sandy) Mackenzie

Upjohn Press

This book is a concise survey of the development of U.S. long-term care and its financing, with comparisons with other rich countries. It also includes a brief comparative account of the impact of the COVID-19 pandemic in the United States and several other countries. The study finds much that is amiss with American long-term care and proposes three sets of progressively more ambitious reforms.

Use Of Text Messaging For Type Two Diabetes Management In Patients Over Sixty-Five, Charles Head

Master of Science in Nursing Family Nurse Practitioner

Why is there a need for tight glucose control for diabetics sixty-five years old or older? Tight control of glucose which can be trended as a 90-day snapshot of blood sugar control is measured using HgA1C levels(Centers for Disease Control and Prevention, 2019). HgA1c levels under six percent in diabetics have been shown to reduce diabetic complications that be detrimental to health(Krapek et al., 2004). Adults aged sixty-five years old or older are also at greater risk for the development of acute and chronic diseases that are a result of poor blood sugar management(Leung et al., 2018). Adherence to prescribed …

Toolkit For Screening Older Adults Desiring To Age In Place In Independent Living, Sister Raymond Marie Labonte

Seton Hall University Dissertations and Theses (ETDs)

The world is experiencing an increase in the aged population. This increase stimulated the popular theme of aging in place. Much time, effort and research have been channeled into exploring this model as an alternative to assisted living or skilled nursing settings for senior citizens worldwide. Elders desire to age in place. Current, recent, and decades old literature identifies this preferential option of the elderly and supports the need to develop plans and tools to assist elders to be able to successfully age in place. This quality assurance project is the venture to create both a congregate living community and …

Improving Hypertension Self Management In African American Men, Elizabeth C. Felix

Electronic Theses and Dissertations

Hypertension is a cardiopulmonary condition linked to genetic, environmental, and social factors. Left untreated, it can lead to fatal conditions such as heart disease. In the United States, African Americans experience disproportionately high rates of hypertension, earlier onset of symptoms, greater severity, and higher related mortality rates. African Americans also statistically have more difficulty self-managing their hypertension than other demographics. The aim of this project was (a) to identify, define, and measure perceived barriers to self-management of hypertension among African American men and (b) to target these barriers and increase patient engagement through personalized intervention plans. The researcher recruited 24 …

Efficacy, Acceptance, And Feasibility Of Virtual Reality For Chronic Pain Relief In Older Adult Veterans Residing In Long Term Care, Valicia Philibert

Dissertations, Theses, and Capstone Projects

Older adults residing in Long-Term Care (LTC) have a high prevalence of chronic pain. Pain management strategies have primarily focused on pharmacological approaches, but with physiological changes associated with aging, this population is at an increased risk for adverse effects from prescribed medications. More research is needed on innovative non-pharmacological interventions in the LTC setting. This study examined the feasibility, acceptance, and preliminary efficacy of Virtual Reality (VR) for chronic pain among older adult veterans in LTC. In this quasi-experimental, 12 older adult participants living with chronic pain in a long-term care facility received two sessions of VR. Pain intensity …

Trends In Health Outcomes Before And After Long Term Care Federal Regulations Limited Antipsychotic Medication Use: A Secondary Data Analysis, Karen Robson

Electronic Theses and Dissertations

Trends in resident falls did not significantly change, although trends in serious injury from falls declined ten years after regulations restricted antipsychotic medications in long-term care facilities. Trends in functional and continence status worsened after the regulations were implemented.

Preventing Hospital-Acquired Pressure Injury In High-Risk Patients, Sahara Thapa

Master's Projects and Capstones

Hospital-Acquired Pressure Injury (HAPI) can be costly for Skilled Nursing Facilities (SNFs) and painful for the patients. Most pressure injuries are considered preventable, but many patients die each year from complications from pressure injuries. Pressure injury treatment costs millions of dollars annually, which could be spent on other treatments. A quality improvement (QI) project was formulated to address pressure-related injuries and improve patient care outcomes in one skilled nursing facility in Northern California. Based on a review of current evidence, HAPI prevention education was implemented for all patient care staff. The education focused on skin assessment, risk factors, staging of …

Improving Moisture Associated Skin Damage In A Veteran Unit, Beverly Chen

Master's Projects and Capstones

Problem: Moisture-associated skin damage (MASD) has always been a problem, regardless of the setting is an I.C.U., Med-Surg, or long-term care. Evidence suggests prevalence rates can range from 5.2% to 46%, depending on the facility. The highest rates of incontinence-associated damage (IAD) occurred in long-term acute settings (Kayser et al., 2019).

Context: The veterans of the Community Living Center (CLC) have an increased risk for skin breakdown. Currently, of the fifteen residents, six residents (40%) have MASD, two of which have chronic MASD (13%). MASD can be a common occurrence for adults with limited mobility or cognitive diseases. MASD may …

Development Of A Fall Prevention Bundle With Evidence-Based Tools For Hospitalized Adults, Kelly A. Tirone

Master's Projects and Capstones

Problem

One million hospitalized people fall annually in the United States, and up to a third are preventable.

Context

Data from an acute care hospital show one medical-surgical unit reported eight patient falls in 2021, two causing major harm that reached sentinel event criteria.

Interventions

A Clinical Nurse Leader (CNL) leveraged the unique CNL skill set and characteristics of Human-Centered Leadership to engage in horizontal leadership, injury prevention, and team coordination through authentic human connection. The team leveraged documentation for improved fall risk communication. Unavoidable disruptions hindered other planned interventions.

Measures

Outcome measures observe for total fall count and the …

Caring For The Caregiver During Covid-19 Suspended Visitation, Melissa D. Rouse, Lorie K. Shoemaker, Priscilla Kyle, Chris Tenold, Whitney Anthony, Jordan White

Patient Experience Journal

During the 4th surge of COVID-19, August to November 2021, visitation was suspended in a hospital system in North Georgia. The Compassionate Connections Call Center (CCCC) was created to alleviate staff stress and to manage calls and communication. The goal of the initiative was to reduce interruptions to patient care caused by the increased number of calls to the clinical units by patients, families, loved ones and personal caregivers. The CCCC managed all incoming calls and communicated with the patient’s primary nurse through a coordinated process which limited interruptions. By caring for the caregiver, the aim was to improve the …

Addressing Anxiety In Hospitalized Adults Using A Music Intervention, Raina M. Rochon

Student Scholarly Projects

Practice Problem: The practice problem is anxiety related to hospitalization among adults in an acute care setting. Increased anxiety can lead to other issues while hospitalized including disruptive behaviors.

PICOT: The PICOT question that guided this project was: In hospitalized medical-surgical adults (P), how does the implementation of a music intervention as an adjunct to standard distraction techniques (I) compared to standard care (C) affect symptoms of anxiety as observed by the rate of behavior de-escalation team calls (O) within eight weeks (T)?

Evidence: There were five systematic reviews, four systematic reviews with meta-analysis with high level of …

Myasthenia Gravis, Rebecca Wheeler

Nursing Student Class Projects (Formerly MSN)

Myasthenia gravis (MG), a neuromuscular and autoimmune disorder, is not completely understood by clinicians and scientists. The primary cause is thought to be anti-Acetylcholine receptor antibodies that attack the neuromuscular junction, causing destruction of post-synaptic junctional folds and blockade of the receptor. This causes frequent weakness and fatigability of voluntary muscles, making activities of daily living difficult for those living with MG. Although it is not an incredibly prevalent disease, the incidence is increasing in the United States due to better testing and diagnosis. Treatments are available, including cholinesterase inhibitors that raise the concentration of Acetylcholine at the neuromuscular junction …

Evaluating Mindfulness On Loneliness In An Older Adult Population, Jessica Tieskoetter

Dissertations

Problem: Loneliness is a widespread public health concern and has negatively impacted mortality and health outcomes among older adults. This quality improvement project’s purpose was to evaluate mindfulness on loneliness and quality of life among adults aged 65 years and older, participating in a weekly befriending socialization program.

Methods: A descriptive cohort design was utilized to assess loneliness pre-and post-implementation of a mindfulness telephone line over three months. A convenience sample of 22 older adults enrolled in a befriending socialization program was used. The Iowa Model of Evidence-Based Practice framework was applied to guide the implementation of a practice change …

Palliative Care Screening For Persons Living With Dementia In A Nursing Home, Shanika S. Pruitt

Dissertations

Problem: Dementia is rapidly increasing as the people of the world mature and life expectancy increases. As the world ages and the prevalence of dementia increases, nursing home placement will and is the most sought place for care of this population. Dementia is under recognized as a terminal illness and palliative care is underutilized for nursing home residents with advanced symptoms of dementia.

Methods: This quality improvement (QI) initiative utilized a prospective, descriptive design. The Palliative Care Screening for the Elderly tool was administered to a purposive sample of persons living with dementia residing in the nursing home. Qualitative data …

Preventing Falls Using Evidence-Based Interventions In A Long-Term Care Facility, Pibi Bouda

Dissertations

Falls and fall-related injuries are common and significant health issues among older adult patients living in Long-Term Care (LTC) facilities, especially those with memory impairment. The current quality improvement (QI) project aimed to educate staff members and implement a structured 4 Ps hourly rounding (HR) protocol on an LTC facility pilot unit in Missouri. The project was implemented in a memory care unit housing older military veterans patients in a large metropolitan area of Missouri. The project question that guided the intervention was: In older residents living in a memory care unit of an LTC facility, what is the impact …

Comprehensive Pain Assessment For Veterans In Long-Term Care., Christopher Jenkins

Doctor of Nursing Practice Papers

Background Literature supports the need for comprehensive pain assessment (CPA) in long-term care facilities. CPAs provide valuable information for facility providers and health care staff to intervene appropriately regardless of cognitive ability. Without the use of such tools, pain can go undertreated or ignored for this underserved population causing undue suffering and poor quality of life. Chronic pain perpetuates an endless cycle of immobility, falls, injury, functional decline, and eventual death for this population.

Purpose: A CPA was implemented, evaluated, and integrated into the care processes in a long-term care facility for veterans

Method: The IHI improvement model with a …

The Haunted House Experience: Developing A Home Health Assessment Training Utilizing An Interprofessional, Interinstitutional Virtual Simulation, Angel Holland Dpt, Edd, Pamela Degravelles Phd, Rn, Debbie Knight Pharmd, Karen Dickinson Md, Kathryn Neill Pharmd, Duston Morris Phd, Wendy Ward Phd

Faculty Research ​and Publications

To meet the interprofessional education needs of students during the COVID-19 pandemic, universities transitioned to virtual options. For many universities, this transition was challenging and time-consuming. The Arkansas Interprofessional Education Consortium (ARIPEC) combined resources to create a novel learning experience for students with a focus on the skill of home assessment. An interinstitutional, interprofessional faculty project team was developed to create a learning experience, with each institution responsible for a portion of the virtual simulation development. This paper describes the process for creation and implementation of an interprofessional, interinstitutional virtual learning experience to support the growth of healthcare students across …

An Evidence--Based Intervention: Use Of Visual Aids For Patient Education During Bedside Team Rounding, Kristin Clifford, Shay Gruber

Nursing DNP Projects

Abstract Purpose: To increase patient health literacy and satisfaction in hospitalized adult medical-surgical patients through an evidence-based provider intervention (advanced practice providers, APPs, or physicians, MDs) adding visual aids to current verbal patient education methods during daily bedside team rounding (BTR).

Strength of Evidence: A literature review resulted in 15 studies meeting inclusion criteria including two meta-analyses, three randomized control trials, two quasi-experimental studies, five systematic reviews, two descriptive studies, and one clinical practice guideline. Evidence revealed the addition of visual information to verbal and written education methods significantly improves patient knowledge, understanding, and recall of health information and increases …

Correlates Of Health Literacy And Perceptions Of Burden Among Caregivers Of Persons Diagnosed With Chronic Illnesses, Mubarak Aldawsare

Dissertations

Background/Rationale: Greater attention is needed on factors effectively supporting caregivers because poor well-being of caregivers can hamper overall patient outcomes. Lack of awareness of caregiver burden has implications for healthcare systems globally. Caregivers may encounter various levels of burden as a result of providing long-term care to individuals diagnosed with one or more chronic illnesses. Caregivers with inadequate health literacy are more likely to experience feelings of uncertainty, and as a result, caregiver burden. Little is known about the impact of the health literacy of caregivers on the level of burden when providing care to individuals with complex care …

Phenomenological Study Of The Lived Experience Of New Graduate Nurses Caring For Hospitalized Patients Living With Dementia, Geline Buenconsejo

Dissertations

Title. Phenomenological Study of the Lived Experience of New Graduate Nurses Caring for Hospitalized Patients Living with Dementia.

Purpose. This study explored new graduate nurses’ lived experiences in caring for hospitalized patients living with dementia.

Background. The first twelve months of transitioning from student to professional nurse in acute care settings are the most stressful, emotionally challenging, and mentally exhausting for new nurses striving to apply newly acquired skills into practice. Some of the most challenging patients for nurses to care for are hospitalized patients living with dementia (PtLWD). With the projected increase in the number of patients with dementia …

Fall Risk Assessment And Intervention To Reduce Fall-Related Injuries And Hospitalization In Older Adults, Pittawat Emerson

Doctor of Nursing Practice Final Manuscripts

Falls among older adults is a major issue that has become a leading cause of injuries and deaths. This study is an evaluation of fall-risk assessment using the Stopping Elderly Accidents, Deaths & Injuries (STEADI) tool and physical activity intervention in older adults aged 65 and above during their annual wellness visits to reduce fall-related injuries and hospitalizations. The results showed a reduction of fall-related injuries by up to 11.8% after the 12-week intervention. Patients with moderate-to-high fall risk saw a decrease in injury by 12.9%. Patients with moderate-to-high fall risk scores saw a decrease by 12.9%, from 25.9% to …

Early Integration Of Palliative Care With Curative Oncology Treatment For Patients With Advanced Cancer: Implications For Clinical Nursing Practice, Rhea Rughani

Honors Projects

Palliative care, though clinically established to improve health-related quality of life measures for patients with advanced illness, remains underutilized and largely limited to end of life care. This project aims to inform oncology nursing practice through the analysis of literature supporting the early integration of palliative care with standard curative oncology treatment for patients with clinically advanced cancer. Informed by relevant research, clinical practice guidelines, and improved specialty palliative care training, oncology nurses and nurse practitioners are ideally situated to advocate for and initiate early palliative care integration, to holistically improve the standard approach to complex cancer care.

Implementation Of A Primary Care Toolkit To Improve Dementia Diagnosis And Management In A Rural Setting, Meredith George-Wieland

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: There are six million people with dementia living in the United States and this number is expected to rise exponentially due to the aging population. In the United States, it is estimated that only two thirds of dementia cases are recorded during primary care visits and an estimated, one third of cases have been either missed or disregarded.

LOCAL PROBLEM: In a remote primary care clinic on Kodiak Island, off the southeastern coast of Alaska, there is a lack of dementia and related cognitive diagnoses in the primary care setting due to patients’ and families lack access to the …

Transitioning Eating Practices Of Older Adults, Michelle Lajoy Jackson

Dissertations

Purpose: The purpose of this descriptive qualitative study was to explore what factors may have influenced the transition of an individual older adult’s eating practices over a lifespan and the impact participants perceived those factors currently had upon their nutritional health in older adulthood.

Background: The older adult population is recognized as one of the fastest growing populations in the United States. One of many growing concerns for this population is the impact of dietary practices on the morbidity and mortality of this aging population. There is limited research to date that has explored the transitioning of appetite …

Improving Osteoporosis Screening Rates Of Women In A Primary Care Setting, Kristine E. Davis

Evidence-Based Practice Project Reports

Osteoporosis is caused by caused by low bone mass, microarchitecture disruption and increase in skeletal fragility (Rosen & Drezner, 2021). This disease presents as a silent disease without any clinical manifestations and increases risk for bone fracture. The purpose of this Evidence-Based Practice (EBP) project was to increase screening rates for osteoporosis in the female population by mailing a patient reminder letter to the home of qualifying patients in the primary care setting and to determine if mailing a patient reminder letter would increase screening rates. The Johns Hopkins Evidence-Based Practice for Nurses and Healthcare professionals (JHEBP) model was used …

Dnp Final Report: Skilled Nursing Facility Readmissions: An Evidence-Based Telemedicine Innovation Project, Debra B. Graham

DNP Final Reports

Background: Nationally, 20% of patient readmissions occur within the first 48 hours after arrival to a skilled nurse facility (SNF), and 40-68% of these readmissions are potentially avoidable. Since 2016, the Centers for Medicare and Medicaid penalized SNFs when their return to hospital (RTH) percentages was above national benchmarks. The four SNFs in this project experienced rising transfer rates and diminished RTH percentages since 2017, despite using in-house providers Monday through Friday. Furthermore, there was no provision to address patients’ changes in conditions after hours.

Purpose: This evidence-based practice (EBP) project aimed to standardize the care provided to …

Reducing Medication Non-Adherence With Improved Health Literacy Interventions: An Evidence-Based Practice Quality Improvement Project, Unity Wiles

DNP Projects

Introduction

Health literacy is the ability to obtain, process, and understand basic health information and services needed to make appropriate healthcare decisions and follow instructions for treatment. Patients with low health literacy have been predicted to have poor health outcomes. The inclusion of the single-item literacy tool into the admission process of this project involved the patient-centered-care characteristics of improved patient experience, lower health cost, improved clinical experience, and better outcomes.

Purpose

The National Action Plan to improve Health Literacy seeks to engage organizations, professionals, policymakers, communities, individuals, and families in a linked multi-sector effort to improve health literacy. Low …

Effectiveness Of A Frailty Assessment Index To Predict Early Readmission Rates In Frail And Older Adult Renal Transplant Patients, Marilyn Barnett

The Eleanor Mann School of Nursing DNP Capstone Projects

Background: Renal transplantation is a complex intervention integrating both medical and surgical modalities, and is considered the treatment of choice for many individuals with end-stage renal disease. The complicated care of patients undergoing renal transplantation puts them at risk for adverse outcomes including infection, allograft loss, and a greater risk for some types of cancer. Evaluating patients to ensure they have the ability and support to cope with the stress of surgery and recovery, is an important part of determining the most appropriate candidates to receive the limited supply of organs available. Frailty has increasingly been identified as a predictor …