Nursing Commons^™

Analyzing Organizational Commitment And The Effect On Job Turnover In Nurse Residents, Cory D. Church

Nursing Theses and Dissertations

This dissertation is an exploration of psychosocial concepts related to the experiences of a vital health human resource, newly licensed registered nurses. Newly licensed registered nurses are at risk for leaving their first job within the first year due to the difficulty of transitioning to practice. The pressure to gain competence and deliver quality care, all while navigating the workplace environment, can impact their commitment to an organization and the profession. The reader will notice these concepts threaded throughout the dissertation. While these concepts are explored in other nursing workforce populations, the researcher determined a gap in the research on …

An Experience Of Practitioners Navigating The Role Of Patient/Caregiver, Susan M. Shaw, Rain Lamdin

Patient Experience Journal

This journey involved one of us having (repeat) intraspinal surgery in a country far from home but of a similar culture and with the same first language. The carer travelled across the world to be present during the hospital stay. We kept a journal during our admission, and following discharge realised there were significant differences between how we had documented our experience and the record presented in the clinical notes. The particular examples we present illustrate the relationships, rules and issues that we navigated. We share our experience in the form of moments from our journal, some of them alongside …

Patient Experiences Of Cancer Care: Scoping Review, Future Directions, And Introduction Of A New Data Resource: Surveillance Epidemiology And End Results-Consumer Assessment Of Healthcare Providers And Systems (Seer-Cahps), Michelle A. Mollica, Lisa M. Lines, Michael T. Halpern, Edgardo Ramirez, Nicola Schussler, Matthew Urato, Ashley Wilder Smith, Erin E. Kent

Patient Experience Journal

The shift towards providing high value cancer care has placed increasing importance on patient experiences. This scoping review summarizes patient experience literature, highlights research gaps, and provides future research directions. We then introduce a new resource that links the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) program with the Centers for Medicare and Medicaid Services Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and longitudinal medical claims data. We conducted a scoping review to identify relevant research within the Medicare CAHPS domain that examine factors associated with patient-reported experiences with their cancer care. Gaps indicate a need …

Improving Nursing Attitudes Toward Suicide Prevention In The Emergency Department: The Implementation Of An Adolescent Suicide Risk Screening Tool, Julie A. Simpson

Evidence-Based Practice Project Reports

The Center for Disease Control ranked suicide as the second leading cause of death for American adolescents (2015). This crisis of adolescent suicide warrants evaluation and improvement of current suicide prevention practices. The Emergency Department (ED) offers 24-hour services and may be the only organized healthcare for utilized by some individuals. Nurses are the front-line provider of care in the ED and this role offers opportunity to identify an adolescent with increased suicide risk. The purpose of this EBP project is to evaluate nursing attitudes toward suicide prevention by implementing the best practice screening tool for adolescent suicide risk assessment. …

Improving Patient Safety Through High Reliability Organizations, Jared Padgett, Kenneth Gossett, Roger Mayer, Wen-Wen Chien, Freda Turner

The Qualitative Report

Preventable medical errors result in the loss of 200,000 lives per year with associated financial and operational burdens on organizations and society. Widespread preventable patient harm occurs despite increases in healthcare regulations. High reliability organization theory contributes to improved safety and may potentially reverse this trend. This single case study explored the introduction of a safety culture and subsequent improvements in patient safety in a reliability-seeking organization. Fourteen participants from a subacute nursing facility were selected using purposeful sampling criterion. Data were collected through participant interviews, document reviews, and group observation. Five themes emerged from an analysis of collected data …

How Nurse-Led Practices Perceive Implementation Of The Patient-Centered Medical Home, Rosemary Frasso, A. Golinkoff, Heather Klusaritz, Katherine Kellom, Helen Kollar-Mcarthur, Michelle Miller-Day, Robert Gabbay, Peter F. Cronholm

Communication Faculty Articles and Research

Purpose

The Affordable Care Act (ACA) promotes the Patient-Centered Medical Home (PCMH) model as a way to improve healthcare quality, the patient experience, and has identified nurse-led primary care as a mechanism meeting the increasing demand for quality primary care. The purpose of this study was to investigate the implementation of a PCMH model in nurse-led primary care practices and to identify facilitators and barriers to the implementation of this model.

Methods

Data were collected through in-depth interviews with providers and staff in nurse-led practices.

Results

These data suggest two categories of processes that facilitate the integration of PCMH in …

Education Of Nurse Practitioners And Physician Assistants; What Role, If Any, For Physicians In Determining Their Scope Of Practice?, Joseph I. Shapiro

Marshall Journal of Medicine

Recent changes in legislation allow for non-physicians to independently perform many of the duties previously restricted to physicians. There are potentially benefits to these changes, but the author is concerned that some of the attributes of physicians induced by the long and rigorous training embedded in the profession may be absent in this new, independent health-care work force.

Adult Qdts, Chinese, Marianne E. Weiss, Binghua Wang

Quality of Discharge Teaching Scale

The Readiness for Hospital Discharge Scale, Quality of Discharge Teaching Scale, and Post-Discharge Coping Difficulty Scale were developed by Dr. Marianne Weiss to measure nurse-sensitive discharge care processes and patient outcomes. Three versions of the scales were developed concurrently for different patient populations – Adult medical-surgical patients, Parents of hospitalized children, and Postpartum Patient mothers (see Weiss & Piacentine, 2006, Weiss et al., 2007, and Bobay et al., 2018 for description of the development and initial testing). Additional scales and information about translation rights are located at Marquette Nursing.

PERMISSION TO USE

The Readiness for Discharge Scale, Quality of Discharge …

Losing New Graduate Bedside Nurses, A Practice Improvement Initiative, Beverly Elaine Miller

Walden Dissertations and Doctoral Studies

New graduate nurses (NGNs) at bedside are faced with numerous challenges, which prompt them to leave jobs in their first year. The transition from being a student to competent nurse requires a NGN to have the necessary skills and experience. Subsequently, hospitals continue to face shortages of staff because of high turnover and low retention levels. Nonetheless, evidence from reviewed literature has indicated that the use of residency programs can increase NGNs' stay at bedside, improve retention, reduce costs of operations, and return employees' turnover. The purpose of this quality improvement project was to identify the likelihood of NGNs remaining …

Implementation Of An Early Progressive Mobility Program In The Intensive Care Units, Rene Merced Rodriguez

Walden Dissertations and Doctoral Studies

In the United States, adult ICU patient care consumes $90 billion annually, or 1% of the gross national product. In the ICU, about 40% of the patients are mechanically ventilated resulting in an 11% greater length of stay (LOS) that requires 35% more resources. And, an estimated 60% of these patients are adversely impacted for as long as five years following discharge. Patient immobility while ventilated contributes to poor quality and financial outcomes. The Institute of Healthcare Improvement (IHI) reports on average early patient mobility (EPM) reduces a 4.5-day LOS by as much as 1.3 days; and reduces the risk …

Nursing Leadership Influence On Evidence-Based Practice Culture And Integration, Natalie Kay Lenhart

Walden Dissertations and Doctoral Studies

Translating research to practice takes 10-20 years or more and evidence-based practice (EBP) integration remains at 10%-20%, despite recommendations requiring EBP-guided decisions. EBP integration has been associated with up to 30% decreases in healthcare system spending, improved quality outcomes, and increased staff satisfaction. Nurse leaders are accountable for EBP enculturation, yet rate quality and safety as the highest priority and EBP as the lowest. This knowledge gap perpetuates low EBP integration rates and hinders EBP enculturation. Asking whether EBP facilitative interventions for nurse leaders increase scores on organizational culture and readiness, beliefs, and EBP use scales addressed the knowledge gap …

Graduate Bulletin, 2017-2018, Minnesota State University Moorhead

Graduate Bulletins (Catalogs)

No abstract provided.

The Relationship Between Nurse Manager Leadership Style And The Enculturation Of Shared Governance, Anna Elizabeth Keane

Walden Dissertations and Doctoral Studies

Shared governance, a participative model of governance, implemented by healthcare organizations for more than 30 years has been associated with empowerment, job satisfaction, and retention of registered nurses. Recent studies document a lack of participation in shared governance by registered nurses; the reason for the change is unknown. The nurse managers' role in this change is unknown. The purpose of this non-experimental, cross-sectional survey design study was to test Bass' theory of transformational leadership that examines the relationship between the leadership style of the manager and the enculturation of shared governance in acute care hospitals in the United States. A …

Strategies For Managing The Shortages Of Registered Nurses, Jody-Kay Mcfarlane Peterson

Walden Dissertations and Doctoral Studies

The purpose of this multiple case study was to explore strategies that healthcare facility leaders in Central Minnesota use to recruit and retain qualified nurses. Participants were 6 healthcare facility leaders including 2 nursing directors, 2 human resource personnel, 1 nurse supervisor/administrator, and 1 nurse recruiter who had the knowledge and experience in recruitment and retention of Registered Nurses (RNs) in healthcare facilities in Central Minnesota. The Herzberg 2-factor theory was the conceptual framework. Semistructured interviews were used to collect data. Data were analyzed using Morse's 4 steps data analysis process. The major themes were recruitment strategies and retention incentives. …

How Does Organizational Culture Impact Rn Engagement, Veronica Anntionette Ruffin-Ellis

Walden Dissertations and Doctoral Studies

Lack of RN engagement in the acute care setting can result in poor staffing, nursing shortages, increased stress levels for nurses and decreased morale. When nurses are not engaged in their work setting, quality of care suffers. A wide range of literature focuses on the importance of RN engagement; however, few health care organizations have taken the initiative to implement programs that foster RN engagement, demonstrating a gap in practice. This study examined the relationship between the levels of RN engagement and their perceptions of their organizational culture. Kolcaba's humanistic approach to meeting the needs of RN staff was used …

Primary Care Nurse Practitioners And Organizational Culture, Leanne Christine Rowand

Walden Dissertations and Doctoral Studies

Nurse practitioners (NPs) were introduced to the British Columbia healthcare system 12 years ago. Integration challenges related to infrastructure and relationships between administrators and physicians continue. The purpose of this project was to understand how nurse practitioners, working in primary care roles, experience the organizational climate within their healthcare agency. Kanter's empowerment theory guided this project. Data were collected using the Nurse Practitioner Primary Care Organizational Climate Questionnaire. A total of 64 NPs relayed their degree of perceived organizational support. NPs scored highest on Autonomy and Independent Practice (Mean [M] = 3.54, Standard Deviation [SD] = 0.59). Organizational Support and …

Nonprofit Pay In A Competitive Market: Wage Penalty Or Premium?, Christian King, Gregory B. Lewis

Department of Nutrition and Health Sciences: Faculty Publications

Two competing theories argue that the nonprofit sector pays differently: Nonprofit employees may accept lower pay to be able to do meaningful work for a good cause, or they may earn higher pay due to nonprofit organizations’ tax exemptions and weaker incentives to hold down wages. To test these opposing expectations, we use the 2005-2013 American Community Surveys to examine pay differences among registered nurses working for nonprofit, for-profit, and public hospitals. We also test hypotheses that public and nonprofit hospitals have smaller pay disparities by gender, race, and relationship status. We find that pay is highest in nonprofit hospitals, …

Performance Improvement Data And Staff Responsibility, Tabitha Anne Bentley

Walden Dissertations and Doctoral Studies

Improving the role the nurse plays in health care delivery should be embodied in the performance improvement initiatives to successfully improve the quality of care that is delivered. The purpose of this evidence-based practice project was to collect performance improvement data and present it to staff who, in turn, used the information to improve practice and influence patient safety outcomes. The practice-focused question addressed what would occur if a tool that allowed frequent data trending was used to measure effectiveness of care and thereby influence key outcome measures. Duffy's quality caring model provided a framework for the study to support …

Effects Of Authentic Leadership Style And Nurse Engagement On Patient Satisfaction, Kimberly Dawn Washburn

Walden Dissertations and Doctoral Studies

Ineffective leadership and disengaged nurses reduce the quality of care and patient satisfaction in healthcare organizations. Healthcare leaders can benefit from understanding the factors that improve leadership ability and nurse engagement to improve healthcare outcomes. The purpose of this correlational study was to examine the relationship between the demonstration of authentic leadership characteristics and nurse engagement. The study's population comprised acute care registered nurses in a rural hospital in central Washington State. Authentic leadership theory and engagement theory constituted the theoretical framework. Independent variables were the 4 constructs of authentic leadership theory, self-awareness, balanced information processing, relational transparency, and internalized …

Leadership Development For The Formal Nurse Leader, Lori Neu

Walden Dissertations and Doctoral Studies

Nurse leaders are essential to the advancement of healthcare because of their ability to bridge the gap of knowledge between clinical practice and the business of healthcare. Developing nurse managers is imperative to the future of nursing given their influential role in healthcare. The central topic of exploration in the project was how nurse managers use the American Organization of Nurse Executives (AONE) Nurse Manger Inventory Tool to assess their management skills after exposure to the leadership development program currently available to them. In this project, the novice to expert theory was used to evaluate the existing leadership development program …

The Patient-Centered Medical Home And Diabetes Mellitus Outcomes: A Systematic Review, Lisa Sullivan Mcmanus

Walden Dissertations and Doctoral Studies

Ineffectively managed chronic diseases such as diabetes mellitus (DM) increase overall health care expenditures and negatively affects health outcomes such as exacerbations, functional decline, disability, and death. The purpose of this systematic review (SR) was to review the DM outcomes reported by patient-centered medical homes (PCMHs). The goal was to determine how care coordination and evidence-based clinical management impacted financial and health outcomes. The SR followed the Cochrane protocol and complied with the PRISMA evidence-based minimum set for reporting. Overall, DM management in the PCMH demonstrated statistically significant completion rates for essential screenings and preventive care, including HgA1c (p = …

Frequent Fall Risk Assessment Reduces Fall Rates In Elderly Patients In Long-Term Care, Omokhele Rosemary Aliu

Walden Dissertations and Doctoral Studies

Falls are a serious issue for the elderly living in long-term care facilities, as falls contribute to signiï¬?cant health problems such as increased dependence, loss of autonomy, confusion, immobilization, depression, restriction in daily activities, and, in some cases, death. An estimated 424,000 fatal falls in elderly patients residing in long-term facilities occur annually in the United States costing $34 billion in direct medical costs. One way to reduce falls among elderly patients in long-term care is to assess for fall risk frequently and implement evidence-based strategies to prevent falls. Patients in this project site facility had been assessed for fall …

Strategies To Reduce Effects Of Organizational Stress In Health Care Workplaces, Kate Chinyere Mbidoaka

Walden Dissertations and Doctoral Studies

Workplace stress has become a frequent occurrence in the race for competitive business advantage. This stress leads to negative physiological consequences in the workplace, causing productivity and profitability to suffer. The purpose of this single case study was to explore the stress management strategies that some health care business leaders used to reduce the effects of work-related stress on their employees to improve productivity. The interview process included 3 managers employed at a health care institution in Houston, Texas, with records of implementing successful strategies for mitigating the effects of workplace stress. The conceptual framework was job demands-resources model, pertinent …

Hospital Administrators' Strategies For Reducing Delayed Hospital Discharges And Improving Profitability, Sheree Boyd

Walden Dissertations and Doctoral Studies

Inefficiencies in leadership and limited leadership strategies in hospitals contribute to delayed hospital discharges and an increased financial burden on a hospital. Three administrators from 2 hospitals who are part of a hospital conglomerate in Chicago, Illinois were selected for interview in this qualitative multiple case study to explore how hospital discharge strategies reduce delayed hospital discharges and improve profitability. Contingency was the primary theoretical theory for this study. The purposive sampling consisted of the selections of individual who were knowledgeable and had experience to organize, manage, and implement processes in an organization. Data collection occurred using face-to-face semistructured interviews, …

A Systems Approach To Moral Distress In Long Term Care, Margaret Lemley

Electronic Theses and Dissertations

Abstract: The question that this dissertation seeks to answer is whether or not a Systems Approach to Moral Distress can serve to positively address issues of moral distress within the Long-Term Care setting. Because moral distress has largely been understood as a phenomenon of the individual, efforts to address and reduce incidents of moral distress have focused almost entirely on the individual and his or her reaction to specific triggers. Building upon the existing literature this dissertation argues that previous efforts to understand moral distress within the healthcare setting have been limiting in two very important aspects. The first …

Practicing Sacred Encounters: A Narrative Analysis Of Relational, Spiritual, And Nursing Leadership, Margaret Woodrow Mark

Antioch University Dissertations & Theses

This research examined one large health system that has, through a stated mission outcome that every encounter is a sacred encounter, sought to enhance relationships occurring within the health care environment. Seeking to understand the lived experience of sacred encounters through the lens of nurse leaders in one acute care hospital settings this study examined how nurse leaders experienced their leadership role in realizing sacred encounters. Participants were defined as nurse leaders from one hospital setting and included nurse managers, directors and one vice president. A narrative thematic analysis framed by situational analysis was the method of inquiry. Data was …

Improving Employee Engagement Through The Development Of An Enterprise Performance Management System, Carlton D. Abner

Doctor of Nursing Practice (DNP) Projects

There is ample evidence of our health care delivery system relying heavily on value-based outcomes. The increased focus on outcomes has required health care organizations to adjust how they approach data and how they successfully implement performance management systems. These performance management systems help the organization identify, measure, and report the organization’s performance at an enterprise level using key performance indicators clearly linked to the organization’s overall strategy. As one organization began implementing an enterprise performance management system, the goal of this project was to show how participating in projects with that level of strategic impact can lead to improved …

Improving The Adherence Of Providers To The American Academy Of Sleep Medicine Guidelines For The Evaluation, Treatment, And Management Of Obstructive Sleep, Heather Miles

Doctor of Nursing Practice

The purpose of this project is to increase the adherence of clinic providers to the American Academy of Sleep Medicine’s Clinical Guidelines for the Evaluation, Management, and Longterm Care of Obstructive Sleep Apnea in Adults. OSA is a chronic condition that effects from 2% to 10% of the U.S. adult population. Implications of undiagnosed OSA include excessive daytime sleepiness, fatigue, irritability, difficulty controlling chronic diseases including diabetes and hypertension, heart arrhythmias, gastroesophageal reflux disease, mood disorders, attention deficit disorder, and an increased potential for dementia if left untreated. A protocol was created to align providers with the clinical guidelines. Provider …

Interventions To Increase Vaccination Rates In Homeless Adults Aged 50 Years And Older In A Shelter-Based Clinic, Rubeena Smith

Doctor of Nursing Practice

Pronounced disparities in adult immunizations exist across the country. In homeless adults over 50 years of age with chronic diseases, coverage rates for influenza and pneumococcal vaccinations falls at 30% as compared to the 60% coverage rate found in the general public. Hepatitis B immunization rates are also significantly lower in the elderly homeless population. Increased prevalence of chronic diseases in the elderly homeless shelter residents’ increase their risk for severe complications following influenza, hepatitis B and meningococcal infections. To prevent disease epidemics and further disability in the homeless population, the need for appropriate and timely vaccinations is critical. Attitudes …

An Initiative To Improve Primary Prevention Of Heart Disease In Adults With Type Ii Diabetes Based On The Acc/Aha (2013) And Ada (2016) Guidelines, Litzie Garza

Doctor of Nursing Practice

Heart disease is the leading cause of death in the United States and in Texas. Hyperlipidemia is a precursor to cardiovascular disease and is a highly manageable and treatable acute and chronic disease in the outpatient primary care setting. This project is designed to increase clinicians’ adherence to the American College of Cardiology/American Heart Association (2013) and American Diabetes Association (2016) clinical practice guidelines for the prevention of heart disease in 40 to 75 year old adults with type II diabetes through interactive education, an electronic alert, and quality improvement sessions on the treatment and management of cholesterol in a …