Nursing Commons^™

A Quality Improvement Initiative To Decrease Fall Risk In Community Dwelling Elderly, Michele Shearer

Doctor of Nursing Practice (DNP) Manuscripts

Falls are a health concern for the elderly and are the leading cause of fatal and non-fatal fall injuries in this population (Burns & Lee, 2016). Meijers, et al. (2012) found that one in three community dwelling elderly will experience at least one fall per year with an even higher rate in adults greater than 80 years old. Numbers of falls are expected to increase as this population ages. This increase in falls and their consequences will produce an enormous economic burden on the United States health care system (Burns & Lee, 2016). The purpose of this program was to …

Dnp Final Report: Reducing The Rate Of Falls With A Stuctured Fall Program, Elanda L. Douglas

DNP Final Reports

Background: Fall rates continue to be a significant problem in health care facilities despite all the research and tool kits created to prevent falls. Hospitals that have successfully reduced fall rates find it challenging to sustain a reduction in the fall rates. During hospitalizations, 3%-20% of patients fall, with 30%-50% resulting in injury (Joint Commission, [JC], 2015).

Internal Evidence: Despite Medical City Alliance (MCA) having an evidence-based fall program, the fall rate has not decreased. Falls are one of the quality measures identified at the division level that needs improvement.

PICOT: In adult patients in a progressive care unit (P), …

A Quality Improvement Report: Assessing The Geriatric Population For Anxiety Using The Gad-7, Lirio E. Lopez-Urias

Cohort IX

Working with geriatric patients, I have had a firsthand view of the effects of the COVID-19 pandemic on their well-being. While visiting my patients in their homes, I have become aware of several issues. These were highlighted in my practice review, during which I documented the diagnoses and interventions used in my practice with my geriatric patients in a 10-day reflective log. In particular, reports of anxiety drew my attention. In my practice, I have noticed that I assess anxiety by accepting self-reporting. Within the ten days covered in the reflective log, 15 out of 26 patients reported uncontrolled anxiety. …

Evaluating Va Nurse Acceptance Of Virtual Healthcare Technology During The Coronavirus Outbreak, Francesca Bryan-Couch

Doctor of Nursing Practice Scholarly Projects

At a regional Veterans Administration (VA) hospital, nurses performing case management were unable to perform face-to-face visits with patients due to coronavirus. Care coordination and discharge planning efforts occurred through telephonic case management to preserve personal protective equipment and reduce transmission rates through social distancing. Trust and rapport between patients and nurses were reduced without personal contact. Peplau’s theory of interpersonal relations described six nurse roles and three phases of relationship development required to create therapeutic nurse-patient relationships. Connectedness was a key concept considered to be the path to a successful meaningful therapeutic nurse-patient relationship (Hrabe, 2005).

To evaluate current …

Improving Cognitive Function In Persons With Dementia Through Music Therapy, Jillian Natividad

Nursing | Senior Theses

People diagnosed with dementia experience cognitive alterations that cause overwhelming challenges and lead to distinctive life changes. Declining cognitive function noticeably experienced in dementia not only inflicts difficulty with achieving independent living but increases feelings of agitation and disturbs quality of life. Advanced medical care is widely available for managing mental conditions but may not always be effective in treating cognitive changes like memory loss and confusion. Because the stages of dementia vary from person to person, medical interventions are often patient centered to effectively focus on an individual’s specific needs. With non-pharmacological methods, flexibility in adjusting to an individual’s …

Understanding The Role Of Hospice Care: Reflections From A Service-Learning Project, Avery Mccutcheon

The Eleanor Mann School of Nursing Undergraduate Honors Theses

There is little known about the part end-of-life care plays in patient care. This paper examines the role of end-of-life care in the care of a dying patient and consists of findings from a service-learning project with Circle of Life hospice. To be able to effectively care for those in the end stages of life, healthcare professionals must turn away from the curative aspects of medicine, to treating symptoms and improving quality of whatever life remains for the patient. In order to normalize EOL Care and consequently make it more accessible, we must educate our healthcare practitioners regarding the benefits …

The Changing Face In The Workplace: The Arrival Of The Millennial Generation, Sarah Clonch

The Eleanor Mann School of Nursing Undergraduate Honors Theses

The entrance of the Millennial generation into the nursing workforce signifies a bright future for the nursing profession and the nursing workforce. This study began with a current review of available research that identified the Millennial generation and their views toward job satisfaction and work engagement, as compared with Baby Boomer and Generation X nurses.

PubMed, CINAHL Complete, and Google Scholar databases were employed to find 15 peer-reviewed articles for evaluation. The research findings suggest that Millennial nurses have lower rates of job satisfaction and work engagement, compared to nurses of older generations. Overall, the extracted data results were significant …

Letters Against Loneliness: The Effect Of A Pen Pal Program Uniting Older Adults And College Students On Perceived Loneliness, Allyson Miriani, Caroline Crawford

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Surveys within years and particularly the COVID-19 pandemic have revealed increasing rates of loneliness. More research is also emerging linking loneliness with a myriad of negative health outcomes as well as reduced quality of life. There is little research about effective interventions addressing loneliness. This paper reviews the available literature on the topic and proposes a pen pal program for college students and older adults developed based on available evidence.

Advance Care Planning Protocols And Hospitalization, Rehospitalization, And Emergency Department Use In Home Health, Sharon Bigger

Electronic Theses and Dissertations

Aim. The aim of this study was to examine the relationship of advance care planning protocols with hospitalization, rehospitalization, and emergency department use rates in U. S. home health agencies (HHA).

Background. Since 2003, CMS has required HHAs to report on quality outcomes such as hospitalization, rehospitalization, and emergency department use rates, made publicly available online. Advance care planning (ACP) is a conversation about beliefs, goals, values, future treatment choices, and designation of a surrogate decision-maker, that someone has in advance of a health crisis. Most existing studies on ACP have taken place outside of HHAs among populations with serious …

A Quality Improvement Project To Improve Communication And Reduce Hospital Readmissions, Mackenzie Thomas

DNP Projects

Background: More than 25 million people are readmitted to the hospital within 30 days of nursing home admission. With most nursing home patients receiving Medicare, Medicaid, or other publicly funded services, readmissions significantly burden the healthcare system. Poor communication within nursing homes may contribute to poor health outcomes and unplanned hospital readmissions. Purpose: To reduce readmission rates at two skilled nursing facilities by improving staff communication through consistent use of the INTERACT STOP AND WATCH (SW) tool. Design: The quality improvement project reviewed all admissions, transfers, and readmissions occurring before and during the project to determine the impact of the …

Complementary Alternative Medicine: An Education Of Guided Self-Care In The Elderly Population For Management Of Chronic Conditions, Janice B. Gerber

Theses and Graduate Projects

The elderly population, specifically the residents in the Skilled Nursing Facility (SNF) or nursing homes, suffer from chronic conditions, many of which have a psychological and behavioral component. Conventional medicine treats the chronic conditions from one symptom to another through pharmacological interventions, which resulted in polypharmacy. Gathering evidenced-base practice of Complementary Alternative Medicine (CAM) will maximize opportunities for the elderly population to manage chronic conditions. The application of Parse’s Theory of Human Becoming (HBT) with self-guided education of CAM modalities in SNF explores the significant concepts of personal meaning, rhythmical patterns, and transcendence. Grounded on HBT, the self- guided education …

Compliance In Fall Prevention In Dementia Vs Non-Dementia Nursing Home Units, Garima Shrestha

Merge

The student nurse researcher performed a research study to determine if there was a difference in the compliance of fall prevention interventions between dementia and non-dementia nursing home units. The student nurse researcher hypothesized the dementia nursing home units would be more compliant with fall prevention interventions than the non-dementia nursing home units. In contrast, the null hypothesis stated there would be no statistically significant difference in the compliance of fall prevention interventions between the dementia and the non-dementia nursing home units. The Fall Prevention Intervention Checklist was used to assess environmental fall hazards in occupied resident rooms. Of the …

A Descriptive Study Of Health-Related Risks And Outcome Differences By Loneliness Status In A Sample Of Older Veterans, Rachael Beard

Dissertations

There is a need to understand the influences and outcomes related to loneliness in veterans living with complex illness. Patients require self-care to manage complications and exacerbations associated with complex illness. Deficits in self-care result in negative health outcomes and drive resource utilization upward. The identification of potential factors related to self-care is important. Loneliness may be one factor that influences patients’ ability and desire to care for themselves. Descriptive correlational design was used to evaluate loneliness both as a predictor and outcome in veterans admitted to the hospital for three complex respiratory illnesses (heart failure, chronic obstructive pulmonary disease, …

Incorporating Reminiscence Therapy Into Traditional Ot Practice For Adults With Adrd Residing In A Snf/Ltc, Natasha Menard, Becki Cohill, Susan Macdermott, Karen Park

Spring 2021 Virtual OTD Capstone Symposium

As the population diagnosed with Alzheimer’s disease and related dementias (ADRD) raises from 5.3 to 12.7 million over the next three decades, this calls for a demand for treatments to address this population (Alzheimer’s Association, 2021; Atchinson & Dirette, 2017). While traditional practice often focuses on symptom management, the inclusion of functional activities alone does not fully address the negative side effects of ADRD (Kok et al., 2013; Lepore et al., 2017; Mayo Clinic, 2019). Both occupational therapy (OT) and reminiscence therapy have been shown to be effective methods to treat the ADRD population separately, but there is limited evidence …

Exploring The Lived Experience Of Adolescent Caregivers, Abbigale Laurentius

Honors Theses

In today’s society, the population is aging, and any member of the family could find themselves in the role as an informal caregiver. Adolescents between the ages of 12 and 18 years old may have these caregiving responsibilities, and it is imperative that healthcare professionals recognize and support this change of roles. A literature review revealed a general lack of research from within the last five years regarding adolescent caregivers. Those studies that were analyzed in the review presented themes of depression, anxiety, lack of education, and insufficient social supports for the adolescent. An unfolding case study was then designed …

Life Satisfaction: Aging Female Informal Caregivers Of Persons With Dementia, Deborah Ann Monson

Dissertations

Purpose/Aims

The purpose of this study was to describe the relationship between aging female informal caregivers of persons with dementia (PWD) and care recipients’ PWD demographic factors, aging female informal caregivers of PWD social support factors, positive and negative feelings, a sense of flourishing, stress, and life satisfaction.

Background/Rationale

Older adults with dementia are living longer and the majority are receiving care by aging female informal caregivers. Dementia incrementally worsens over time impacting informal caregiver life satisfaction. Most studies have focused on negative aspects of informal caregiving. Therefore, this study investigated both positive and negative aspects of caregiving.

Conceptual Basis …

Assisting Nursing Students In Their Development Of Empathy: A Guide To Fostering Requisite Skills For The Art Of Empathetic Communication, Susan Mee

Open Educational Resources

This 7-week lesson plan is designed for use in clinical nursing courses. It is designed specifically for use by Nursing faculty teaching in the absence of state required patient facing clinical opportunity due to COVID restrictions. The lesson plan describes pedagogical techniques and provides video and education OER resources designed to help support the development of empathetic communication skills over 7 weeks. Refection and video debriefing techniques will be employed. Role play will culminate in the group presentation project of a brief video modeling effective therapeutic empathetic communication.

How Providing Care For Individuals With Dementia Affects How A Caregiver Changes Their Lifestyle: A Focus On The Positives, Veronica Joy Vodola

Senior Theses

Background/significance Caregivers of individuals with dementia (e.g. Alzheimer’s Disease) may change their day-to-day life, especially self-care, to meet the needs of the person with dementia, which can be detrimental to their health. Caregivers for individuals with dementia experience both primarily negative and primarily positive effects on physical and mental health through exposure to the effects of dementia. Caregivers often report substandard self-care practices and unpleasant impacts on mental health. Others report notable beneficial influences within different aspects of their life. The positive effects have not been widely researched in literature.

Purpose The objective of this research study is to understand …

Improving Caregivers’ Perceived Involvement In Care Through Facilitating Communication With Hospital Providers, Heather Manolas

Student Scholarly Projects

Practice Problem: Involvement of family in care-planning for prevention of delirium in acute care settings is crucial, yet remains underutilized in those who are cognitively impaired. Despite the incidence of delirium in acute care worsening during COVID-19, many factors have led to it being placed on the back burner.

PICOT: In caregivers of cognitively impaired individuals, can implementation of an evidence-based, best practice tool that advocates for evidence-based delirium prevention strategies tailored to their loved-one and facilitates family involvement in care planning for these strategies during a healthcare experience as compared to no other intervention improve confidence in, and …

Preventing Insulin Storage And Administration Errors, Makena Reddick

Scholars Week

■The research problem was discovered when nurses were observed storing and administering insulin improperly. The objectives of this project were to find the correct policies for these procedures, obtain research that backed these policies, and present this information to nurses to create a safer habit. In researching, it was found that reducing the physical distance between a person completing work and the materials required to do so increased compliance (Gibbs & McLernon, 2017). In a second study, the delivery of safe, effective and high-quality care for patients with diabetes in the community is dependent upon (district) nurses having appropriate knowledge …

Understanding The Meaning Of Well-Being In Older Adults: A Mini-Phenomenology, Francesca Ezeokonkwo, Rick Zoucha, Kathleen Sekula

Graduate Student Research Symposium

Title: Understanding the Meaning of Well-being in Older Adults: A Mini-phenomenology

Background and Objective: Loneliness is a major concern in older adults, the fastest-growing segment of society, due to age-related losses. As the aging population continues to rise, so will their vulnerability to loneliness. Previous studies suggest that promoting well-being is a potential strategy to prevent or reduce loneliness. The aim of this mini-study was to explore the meaning of well-being in older adults.

Methods: A qualitative descriptive mini-phenomenological research design was utilized for this study. Four older adults ages 72 to 78 (mean age of 74.3) participated in the …

Addressing Psychosocial Outcomes Of Social Isolation In Older Adults, Megan Friesen, Madeline M. Christensen

Nursing DNP Projects

Purpose and Rationale

The aim of the evidence-based practice (EBP) project is to improve psychological outcomes for socially isolated older adults enrolled in a Homebound Program (HP) through the implementation of an EBP intervention. Social isolation has a multitude of negative consequences, including impacting the psychological health (e.g. depression, loneliness, anxiety) of the older adult population.

Synthesis of Evidence

Meta-analyses, systematic reviews, and randomized controlled trials addressing the clinical problem of social isolation were identified. Through critical appraisal of the evidence, physical activity, psychotherapy, and socialization interventions have shown to decrease depression and loneliness in older adults. There were mixed …

Staff Education Inservice For Preventing Discrimination Against Lgbt, Florence Titilola Eze

Walden Dissertations and Doctoral Studies

Lesbian, gay, bisexual and transgender (LGBT) members live in the community, yet they are prone to various types of oppression, mistreatments, and denial of services from most institutions including health care settings. Concerns, such as being denied access to caregivers or being given a lower quality of care continue despite the community’s fighting for their voices to be heard across the globe and various movements that have been established, especially the United States and the United Kingdom, and laws that call for equitable healthcare. The purpose of this project was to explore whether a change in knowledge and attitudes would …

The Evaluation Of An Amino Acid- Oral Re-Hydration Solution (Enterade®) To Improve Quality Of Life In Solid Tumor Cancer Patients By Reduction Of Chemotherapy Related Diarrhea, Holly Chitwood

DNP Projects

Background: Chemotherapy related diarrhea (CRD) is a common adverse effect of many chemotherapy agents used to treat cancer. CRD negatively affects quality of life (QOL) for cancer patients and often results in treatment delays, hold, dose reductions, and hospitalizations affecting morbidity and mortality. Proper management of CRD with novel therapeutics is needed to improve the quality of life and patient outcomes for this population.

Purpose: The purpose of this study was to evaluate the use of a proprietary amino acid-oral rehydration solution (AA-ORS) known as Enterade® to reduce the severity of CRD, to improve patient reported QOL among patients over …

Can Nurses Predict Transitions Of Care In Assisted Living?, Emma M. Blair

Honors Theses and Capstones

The older adult population is rising exponentially due to medical advances and the aging of the Baby Boomer Population (Wister, 2005). Many of these older adults are choosing to live in assisted living facilities due to the increased independence and decreased cost of living compared to nursing homes (Grabowski, Stevenson, & Cornell, 2012). Since nurses are the primary directors of care for those in assisted living, the question was asked if they can predict a resident’s length of stay based on their knowledge and clinical judgement. A prospective study was performed at an assisted living facility in Oakland, California to …

Evaluation Of A Rural Clinic's Compliance With Bone Density Screening In Women Aged 65 And Greater, Chelsea B. Brincks

Rural Health Professions Projects

Osteoporosis affects over 12 million Americans, leading to fractures, chronic pain, reduced independence, and decreased quality of life (United States Preventative Services Task Force [USPSTF], 2018). Up to 30% of individuals who suffer an osteoporotic hip fracture will not survive 12 months post-fracture, and 71% of all osteoporotic fractures occur in women (USPSTF, 2018). Due to increased risk with age, the USPSFT recommends all women have initial bone densitometry at age 65 or greater (2018). Medicare reimburses DEXA screening, the gold standard bone densitometry, every 24 months in individuals at risk (Centers for Medicare & Medicaid Services [CMMS], 2018). The …

Home Point Of Care Inr Testing In Left Ventricular Assist Device Patients: A Clinical Evaluation, Emily Corsentino

DNP Projects

Purpose: The purpose of this project was to evaluate the complications and adverse events in left ventricular assist device (LVAD) patients when comparing those using home point of care (POCT) international normalized ratio (INR) testing versus lab testing. Additionally, the time in therapeutic window for both these groups was studied. A cost benefit analysis was performed. All this data was compiled into a provider education evaluated by a pre and post-survey design.

Methods: The project is a single-center study that will occur at the University of Kentucky Chandler Medical Center. It is a cross-sectional, pre/post-test design. Data will be collected …

Differences In Smoking Behaviors And Readiness To Change For Patients With Copd And Differing Categories Of Depression, Jessica M. Floyd

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the world. Depression is a common comorbidity of COPD and affects patient outcomes and smoking cessation. The purpose of this study was to explore and describe factors influencing smoking behaviors and readiness to change in patients with comorbid COPD and depression.

Aims: The research question that guided this study was, “What are the relationships among smoking, COPD, and depression?” The following aims stemmed from the research question: to describe the characteristics of a convenience sample of people living with COPD and differing categories of depression who …

Reframing: A Grounded Theory Study Of Postmenopausal Women Following Osteoporotic Fracture, Ashley D. Barber

Graduate Theses, Dissertations, and Problem Reports (ETD)

BACKGROUND: Osteoporosis is a chronic disease resulting in low bone mass and increased bone fragility. Most often seen in women age 65 and older, osteoporosis is usually diagnosed following osteoporotic fracture. Despite numerous treatment options many women continue to remain untreated for osteoporosis and are at increased risk for subsequent fractures and complications. PURPOSE: The initial purpose of this classic grounded theory study was to explore the decision-making process women aged 65 and older experience when considering osteoporosis treatment following osteoporotic fracture. Following the tenth participant interview the researcher discovered a new main concern that emerged from participant interviews. Participants …

ผลของโปรแกรมการให้ความรู้สุขวิทยาการนอนร่วมกับการออกกำลังกายแบบชี่กงวิถีไทย ต่ออาการนอนไม่หลับของผู้ป่วยสูงอายุหลังเปลี่ยนข้อเข่าเทียม, จุติรัตน์ ภูติรักษ์

Chulalongkorn University Theses and Dissertations (Chula ETD)

การวิจัยครั้งนี้เป็นการวิจัยกึ่งทดลอง เพื่อเปรียบเทียบผลของโปรแกรมการให้ความรู้สุขวิทยาการนอนร่วมกับการออกกำลังกายแบบชี่กงวิถีไทยต่ออาการนอนไม่หลับของผู้ป่วยสูงอายุหลังเปลี่ยนข้อเข่าเทียมก่อนและหลังการทดลอง และเปรียบเทียบระหว่างกลุ่มที่ได้รับโปรแกรม ฯ กับกลุ่มที่ได้รับการพยาบาลตามปกติ กลุ่มตัวอย่าง คือผู้ป่วยสูงอายุ 60 ปีขึ้นไปที่ได้รับการเปลี่ยนข้อเข่าเทียม ตั้งแต่ 1 เดือนและไม่เกิน 3 เดือนหลังผ่าตัดเปลี่ยนข้อเข่าเทียม ที่มารับการรักษา ณ ห้องตรวจกระดูกและข้อ หอผู้ป่วยนอก โรงพยาบาลเลิดสิน คัดเลือกกลุ่มตัวอย่างตามเกณฑ์ที่กำหนด จำนวน 40 คน แบ่งเป็นกลุ่มควบคุมและกลุ่มทดลองกลุ่มละ 20 คน โดยจับคู่ให้ทั้งสองกลุ่มมีความคล้ายคลึงกันในเรื่อง อายุ เพศและระดับอาการนอนไม่หลับ โดยกลุ่มควบคุมได้รับการพยาบาลตามปกติ ขณะที่กลุ่มทดลองเข้าร่วมโปรแกรมการให้ความรู้สุขวิทยาการนอนร่วมกับการออกกำลังกายแบบชี่กงวิถีไทยซึ่งผู้วิจัยสร้างขึ้นจากแนวคิดการให้ความรู้สุขวิทยาการนอนของ Irish และคณะ (2015) และแนวคิดการออกกำลังกายแบบชี่กงวิถีไทยของ สุรีพร ธนศิลป์ (2557) เครื่องมือที่ใช้ในการเก็บรวบรวมข้อมูล คือ แบบสอบถามอาการนอนไม่หลับของ Morin (1993) ฉบับที่แปลเป็นภาษาไทยโดย พัทรีญา แก้วแพง (2547) วิเคราะห์ข้อมูลโดยใช้สถิติ ร้อยละ ค่าเฉลี่ย และ t-test ผลการวิจัยสรุปได้ดังนี้ 1. อาการนอนไม่หลับของผู้ป่วยสูงอายุหลังเปลี่ยนข้อเข่าเทียมหลังเข้าร่วมโปรแกรมการให้ความรู้สุขวิทยาการนอนร่วมกับการออกกำลังกายแบบชี่กงวิถีไทยน้อยกว่าก่อนได้รับโปรแกรมการให้ความรู้สุขวิทยาการนอนร่วมกับการออกกำลังกายแบบชี่กงวิถีไทย อย่างมีนัยสำคัญทางสถิติที่ระดับ .05 2. อาการนอนไม่หลับของผู้ป่วยสูงอายุหลังเปลี่ยนข้อเข่าเทียมในกลุ่มที่เข้าร่วมโปรแกรมการให้ความรู้สุขวิทยาการนอนร่วมกับการออกกำลังกายแบบชี่กงวิถีไทยน้อยกว่ากลุ่มที่ได้รับการพยาบาลตามปกติ อย่างมีนัยสำคัญทางสถิติที่ระดับ .05