Nursing Commons^™

Utilization Review And Utilization Of Evidence-Based Guidelines, Rosetta E. Hairston

Doctoral Projects

The quality improvement project focused on determining why utilization review nurses submitted epidural steroid injection treatment requests within evidence-based guidelines to peer review. The study reviewed six months of data from June 2022 through December 2022 to develop a pre-training baseline for the number of epidural steroid injection treatment requests approved by the nurse and approved by peer review. Deming's method for quality improvement was identified as the framework for implementing changes. The UR nurses were provided four weeks of refresher training on applying evidence-based guidelines to epidural steroid injection treatment requests. Post-group training sessions reflected a 91% increase in …

Implementation Of Web-Based Patient Education In Newly Transplanted Kidney Recipients, Tabo Mwikisa-Kelly

Doctoral Projects

Kidney transplantation is the preferred treatment for patients suffering from kidney failure. It is a complex process that is intended to improve one’s quality of life by adhering to a lifelong treatment plan of immunosuppressant therapy. Therefore, it is essential for patients or their caregivers to have adequate knowledge to care for themselves following post-transplant, which can contribute to better patient outcomes. In a metropolitan Bay area hospital in Northern California, the current state of practice involves educating newly transplanted kidney recipients through face-to-face interactions with the patient and handing out a transplant booklet during their initial transplant hospital stay. …

Nursing Professional Development Practitioner’S Experience Of Use Of Instructional Design Industry Standards, Denise Renfro

Doctoral Projects

Instructional design (ID) is a critical skill for nursing professional development practitioners (NPDs). Instructional design seeks to solve gaps in knowledge or skill by identifying both the educational issue and the outcomes by designing how to achieve the outcomes. There are complex and advanced instructional design needs for problem solving that requires an educational foundation in instructional design and experience. The purpose of the quality-improvement project was to assess the changes in NPD practitioners’/nurse educators’ adaptation to industry standards for ID pre- and post-implementation of a standardized instructional design model. The Nurse Educator Self-Assessment in Measuring Learning survey was developed …

Implementation Of An Online Suicide Prevention Training Program With Undergraduate And Graduate Students At A California State University, Cheryll May P. Villamor

Doctoral Projects

Background: One of the leading causes of death in the college age population is suicide. While colleges provide opportunities in the acquisition of knowledge and skills for future careers; those same opportunities can also bring about challenges that put students at risk for suicide such as: dealing with their mental health issues, finding and maintaining support system, financial costs, and the pressure from ensuring academic success. One of the ways to help student at risk for suicide is by early intervention by connecting them with mental health support system such as crisis counselors. Question, Persuade, and Refer (QPR) is a …

Speak Up For Hand Hygiene And Decrease Healthcare Associated Infections, Bernadette Priya Pandya-Orozco

Doctoral Projects

Background: Hand hygiene (HH) is one of the most cost-effective and simplest ways to reduce healthcare associated infections (HAIs). Incorporating Speak Up for hand hygiene enables healthcare workers (HCW) to communicate without fear when they observe noncompliance with HH requirements.
Objective: To increase HH compliance by utilizing Agency for Healthcare Research and Quality (AHRQ) TeamSTEPPS education to encourage Speak Up for HH and lead to reduction in HAIs.
Methods: The researcher provided educational training on “Speak Up for Hand Hygiene” and performed regular audits to examine its effects on one hospital unit in a California Bay Area healthcare system. A …

An Evaluation Of A Structural Competency Training For School Nurses, Rachel J. Torres

Doctoral Projects

The aim of this quality improvement project was to use structural competency as a tool to highlight the broad social, political, and economic structures that influence health and subsequent inequities and disparities. A one group, pre-and post-design quality improvement project was used to determine whether the Structural Competency Working Group curriculum influenced school nurses’ thought processes regarding the factors that influence health outcomes. The curriculum was adapted to a 1.5-hour training and delivered to a group of school nurses from a highly populated and socially, economically, and culturally diverse urban county in northern California. The results showed that after the …

Culturally Tailored Diabetes Self-Management Educational (Dsme) Program And Its Impact On Motivation And Self-Efficacy Among Hispanic Adults With T2dm: A Pilot Study, Andrellie P. Van Wageningen

Doctoral Projects

Type 2 diabetes mellitus in the United States is an epidemic that disproportionately affects Hispanics in the state of California. Many factors have been attributed to this phenomenon because of their unique characteristics. As recent studies have pointed out, their social determinants of health, cultural influences, and genetic predisposition often lead to poor health outcomes and impaired quality of life. A targeted approach is critical in promoting increased diabetes knowledge, enabling skills to master self-care activities, and positive self-care behaviors to avert poor outcomes. The purpose of this doctoral project is to examine whether culturally tailored DSME influences an individual’s …

Improving Readiness For Nursing Practice Via Simulation In Workplace Violence Mitigation, Paul J. Weingartner

Doctoral Projects

Workplace Violence (WPV), a significant problem in health care in the United States and worldwide, causes emotional and physical harm to nurses, negatively affects quality care delivery, and contributes to burn out, job dissatisfaction, and attrition. Clinical simulation was used to educate registered nursing students about WPV and train them in mitigation techniques in an effort to improve their awareness and readiness for professional nursing practice. Data from 37 students in their final semester of nursing school were collected anonymously prior to and after reviewing online materials about WPV and attending a 3-hour simulation experience in which two scenarios were …

How Implementing A Digital Competency Management System Reduced Nurse Training Cost And Improved Npd Practitioner Satisfaction In A Pediatric Hospital, Dionne Margallo

Doctoral Projects

Healthcare organizations must have high-quality nursing staff to deliver optimal patient care. Educators and managers evaluate nurses by their performance through nursing competencies, or “knowledge, skills, [and] abilities” (KSA) (American Nurses Association, 2015, p. 86). Traditional competency evaluations and manual tracking posed a problem within one pediatric hospital. Leaders did not have a transparent way to see the knowledge and skills of their nursing staff. This resulted in increased organizational costs due to retraining and increased workload and job dissatisfaction among educators. The purpose of this quality improvement (QI) project was to evaluate how implementing a digital competency management system …

Evaluating The Impact Of An Evidence Based Practice Education Program In A Nurse Residency Program On Evidence Based Practice Beliefs, Implementation And Competency, Amy Hu

Doctoral Projects

For organizations to ensure that they are providing safe and quality patient care, they must promote a culture of care based on Evidence Based Practice (EBP). To improve healthcare quality nurses must make care decisions based on the most current scientific evidence. In fact the Institute of Medicine set a goal that 90% of clinical decisions be evidence based by 2020 (Institute of Medicine, 2008). Unfortunately it can take up to 15-20 years for newly discovered treatments to be implemented into patient care (Institute of Medicine, 2001). Healthcare providers continue to base healthcare decisions on outdated practices derived from tradition …

Preparing Nurses For The Transition To Practice With Virtual Simulation, Jennifer Holm

Doctoral Projects

This project assessed the clinical reasoning objectives of first-semester nursing students who had up to 75% of their clinical time using virtual simulations compared to those who primarily had traditional direct-care clinical experiences with up to 12% of their time in simulation. The principal investigator reviewed clinical reasoning measures within student evaluations from the Fall 2019 and Fall 2021 cohorts of an Associate Degree in Nursing (ADN) program. The results of a two-tailed independent samples t-test demonstrated a slight reduction in the clinical reasoning abilities of the cohort with a higher proportion of simulation. However, there were several possible confounding …

Asthma Care By Unlicensed Personnel In The Elementary School Setting: A Training Program, Teresa Eligio

Doctoral Projects

This Quality Improvement project (QI) aims to improve the competence and confidence of unlicensed school health staff in identifying asthma symptoms, reading an asthma action plan, asthma care, emergency response, medication delivery tools, and trigger reduction in the school setting. The QI project transpired in an Elementary School District in Los Angeles County, CA. The Project Manager, an asthma instructor trained by the American Lung Association, provided evidence-based Asthma-Basics training for health clerks (HCs), substitute health clerks (SHCs), licensed vocational nurse health clerks (LVN HCs), school office coordinators (SOCs), school office attendance clerks (SOAs), and substitute school office staff (SDO). …

The Effects Of Telehealth On Patient Satisfaction And Information Recall For Breast Cancer Survivors During Covid-19, Stacey Teicher

Doctoral Projects

The coronavirus (COVID-19) pandemic has changed how cancer survivorship care is delivered. (Al‐Shamsi, 2020). To protect vulnerable breast cancer patients, health care providers are moving towards telecommunication such as telephone, video, and secure messaging (electronic mail) versus in-person visits to connect with their patients (Segelov et al., 2020) during this pandemic. Breast cancer survivorship visits can be safely deferred from in-person visits to telehealth visits (Dietz et al., 2020). This doctoral project examines the impact of transitioning from in-person to telehealth (telephone or video) visits on patient satisfaction and recall of information for breast cancer survivors reviewing their Survivorship …

Promoting Civility In The Workplace: Addressing Bullying In New Graduate Nurses Using Simulation And Cognitive Rehearsal, Sandy Phan

Doctoral Projects

Bullying continues to be a widespread, devastating problem in nursing. Research indicates that bullying has a negative, rippling impact on nurses, organizations, and patient care. This evidence-based practice project aimed to enhance new graduate nurses’ abilities to identify and respond to bullying behaviors. The intervention used a mixed educational methodology of didactic, simulation role-play, and cognitive rehearsal. The project was implemented at a large academic healthcare system in Northern California. Outcomes were evaluated using Kirkpatrick levels 1-4 and the Clark Workplace Civility Index (CWCI). Participants reported that the educational intervention met intended learning objectives, enabled them to apply learned behaviors …

The Effects Of Virtual Reality On Symptom Distress In Patients Undergoing Hematopoietic Stem Cell Transplant, Colleen Vega, Robin Whitney, Josef Hannah, Grant Smith

Doctoral Projects

The purpose of this QI project was to evaluate the effects of virtual reality (VR) on symptom distress experienced by individuals receiving an allogenic stem cell transplant. Allogenic transplants are associated with a moderate to high risk for distressing symptoms such as depression, anxiety, and pain. VR targets multiple sensory modalities, including auditory, visual or haptic experiences, by using computer-generated scenarios, which can interact with an individual and possibly diminish unpleasant symptoms. Twenty individuals aged 19 to 70 years (median age of 56.5 years) who were hospitalized in an academic setting received VR up to two sessions a week for …

Ntchs© Health Literacy Intervention Pilot Study, Genevieve Evenhouse

Doctoral Projects

This pilot study explored the effectiveness of a validated curriculum called, “Navigating the Health Care System” (NTHCSÓ) in improving the health literacy of high school-aged adolescents in response to the national call to promote knowledge and skills in all ages, and socio-economic and cultural groups to achieve healthier lives. Low health literacy has been shown to greatly affect the quality of lives, health outcomes, and health spending of individuals with and without health conditions across social demographics. High school-aged adolescents are the population of interest of this study due to their developmental milestones which allows for knowledge and skill building …

Respiratory Distress Observation Scale Implementation For Comfort Care Patients In The Acute Care Setting, Marianne Wachalovsky

Doctoral Projects

One of the most common symptoms at the end of life is respiratory distress. Respiratory distress or dyspnea is a subjective symptom and therefore challenging to assess, especially when the patient is unable to communicate. Controlling symptoms depend on the knowledge and assessment skills of the clinicians and their willingness to administer the necessary pharmacological intervention. Assessment and treatment of this symptom presented a gap in the quality of care for the patients in the hospital of the author. An exhaustive literature review established that this existed also in other clinical settings and led to the Respiratory Distress Observation Scale …

The Collaborative Health Objectives In Combatting The Effects Of Diabetic Peripheral Neuropathy (Choice): A Second Chance To Change Diabetic Destiny, Alishia A. Claibourn

Doctoral Projects

The Collaborative Health Objective in Combatting the Effects of Diabetic Peripheral Neuropathy (CHOICE); A Second Chance to Change Diabetic Destiny, is a research pilot study that will test the validity of The Diabetic Foot Book. Diabetic peripheral neuropathy (DPN) affects 60-70% of the diabetic population. The CHOICE project will use The Diabetic Foot Book, a patient education booklet, created explicitly for the DPN population. The goal of the pilot study is to evaluate the effectiveness of The Diabetic Foot Book to increase health literacy and affect behavior change in the DPN population.

Nurse Practitioners’ Perceptions Of Telehealth Behaviors, Michelle Austin

Doctoral Projects

Problem: NP’s must be proficient in the behaviors that are required for a successful patient encounter to provide the full benefit of nurse practitioner (NP) telehealth. Consequently, it is imperative for NPs to understand telehealth etiquette behaviors which include the technical and non-technical skills that are necessary for an effective NP-patient patient telehealth encounter (Haney, Kott & Fowler, 2015). Telehealth has been incorporated into healthcare delivery and its use is expanding. In the United States, it is predicted to be used by seven million patients in 2020 (US Department of Health and Human Services, 2018). Appropriate access to health care …

The Mental Health Experience Among Parents Of Children With Autism, Thao Tran

Doctoral Projects

Parents of children diagnosed with autism spectrum disorder (ASD) face challenges, stress, and mental health issues than parents of children without autism. Mental health experience of parents in underserved communities are not adequately studied. This qualitative study used a phenomenological approach to understand the mental health experience of eight parent caregivers residing in San Joaquin Valley, California. All parents reported the journey was stressful but not all parents described the point when they received the diagnosis as being more stressful than before and after the ASD diagnosis. Parents’ responses to the semi-structured interview that assesses for the degree of ambiguous …

Understanding The Skills Necessary For Advanced Practice Nurses In Oncology To Deliver Bad News To Patients With Cancer: The Results Of A Delphi Analysis, Matthew Michael Burke

Doctoral Projects

Overcoming the dichotomy of providing bad news in a compassionate, empathetic manner that strengthens dialogue and enhances a caring environment is the ultimate challenge advanced practice nurses (APN) face in oncology. This study aims to understand the skills necessary for APNs in oncology to deliver bad news to patients with cancer.

Using a Delphi analysis, an established method of developing a consensus, a novel, patient-centered survey tool has been developed designed to extract as much information as possible about the present issue from an expert panel. Oncology APNs were recruited via Facebook. The survey tool was administered using a web-based …

The Effect Of Basal Bolus Insulin Administration Vs. Sliding Scale Insulin On Glycemic Control In Patients With Type 2 Diabetes Mellitus At A Community Hospital, Meriam Signo

Doctoral Projects

Evidence of effective insulin delivery by nurses can help prevent fluctuating plasma glucose levels of Type 2 diabetes mellitus (T2DM) in the hospital setting. Information leading to better diabetes care using either basal bolus insulin administration (BBI) or sliding scale insulin (SSI) is essential for safe blood sugar values. The purpose of this project was to measure patient glycemic control after the implementation of BBI vs. SSI during a patients’ stay in the hospital. This study was a quantitative, retrospective exploratory chart review of T2DM in medical-surgical units at a Northern California community hospital. The data were collected from routine …

Barriers In Health Care In Hmong Men And Women With Cardiac Diseases, Ying Thao

Doctoral Projects

Lauver’s theory of care seeking behaviors is applied to identify perceived barriers to accessing healthcare in Hmong men and women that may influence care seeking behaviors. The purpose of this study is to identify barriers in accessing health care among Hmong men and women ages 50 to 80 with cardiovascular heart disease (CHD) and risk factors for CHD (e.g., diabetes, hyperlipidemia, and hypertension). A quantitative descriptive analysis was used to look at demographic characteristics while a multiple regression analysis was used to statistically compare correlations between barriers to care, risk factors for CHD, sex, and access to health care. The …

Advanced Informatics Competencies Of Nurses At Sutter Maternity And Surgery, Jessica Liston

Doctoral Projects

Today, the profession of nursing requires the integration of many sciences and skill sets in order to care for the increasing acute and chronic illness in our patient populations. In order for nurses to safely care for patients in highly technological environments, they must integrate knowledge from Nursing Informatics (NI), to advance the profession, deliver safe high-quality patient care and effective documentation that drives improvement in patient outcomes. When nurses have an understanding of advanced NI skills, they are better equipped to become super users that train and lead teams in optimization of electronic health records (EHRs) to support them …

Promoting Self-Efficacy Among Head And Neck Cancer Patients, Lily Lam

Doctoral Projects

Current survivorship visits at the Stanford head and neck oncology program are not standardized to address ongoing post-treatment sequelae. The objectives of this study help to address whether current non-standardized visits actually help to empower patients to self-manage their chronic diagnosis of head and neck cancer by measuring their self-efficacy levels before and after their post-treatment survivorship visit.

Given the convenience sampling method, 17 patients were enrolled in this quasi-experimental pilot study. Demographic information was collected for each patient: gender, ethnicity, smoker status, and age. Head and neck cancer patients would first be surveyed before and after their follow up …

Perceptions Of Adult Patients Accessing Telehealth In An Urban Medical Group, Katharine Shepherd West

Doctoral Projects

Problem: Although implementation of in-patient electronic healthcare records is nearly complete in the United States, this achievement has not translated into consumer-to-business telehealth in the primary care setting. Because there are few studies that describe how and why patients select telehealth, the aim of this study was to learn about perceptions of adult patients in an urban setting when telehealth options are available. Research questions included a) How do patients select any type of appointment? b) How do patients perceive and use telehealth options? c) How and when might telehealth be useful in the future?

Methods: A qualitative study design …

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. …

Complete Care Model Impact On Glycemic Control In California State Prisons, Diane M. O’Laughlin

Doctoral Projects

The Complete Care Model (CCM) is a health care delivery model based on the well-studied and internationally validated chronic care theory. Since the integration of the chronic care theory into California Department of Corrections and Rehabilitation (CDCR) patient care in 2008, steady improvement in health care related mortality has been seen, and there have been no unavoidable health care related deaths in CDCR since 2012 (Gransee, 2018). However glycemic control in CDCR diabetic patients has made no statistically significant change since the implementation of the CCM in 2015 when comparing the two years before and the two years after implementation …

Outcomes Of Communication, Workflow Efficiency, & Patient Care Quality Resulting From A Hands-Free, Wireless Communication Device, Hyacinth Flores Carreon

Doctoral Projects

Purpose: Failures in communication have long been identified as one of the root causes of preventable medical errors. The purpose of this quality improvement project was to assess staff perceptions on the outcomes of communication, workflow efficiency, and patient care quality after the implementation of a hands-free, wireless communication device in a federal acute care setting.

Methodology: Replicating the quantitative component of a 2012 study by De Grood et al., a 10-item survey using a 5-point Likert scale was administered within a 4-week period to healthcare team members from two inpatient units composed of monitor technicians, nurses, nursing assistants, and …

Is There A Relationship Between Limited English Proficiency (Lep), Medication Adherence Behaviors, And Adverse Asthma Outcomes In Hispanic Adults With Moderate To Severe Persistent Asthma?, Archana Kartik Chandra

Doctoral Projects

The effects of LEP are well documented in the literature. LEP decreases medication adherence, causes ineffective communication between patients and providers, and reduces health outcomes. Asthma is known to be misdiagnosed and under-treated in Hispanic adults. There are discrepancies in the literature about the effects of LEP in Hispanic adults with persistent asthma.

The purpose of this study was to determine if the presence of LEP is associated with medication adherence behaviors and adverse asthma outcomes in Hispanic adults with moderate to severe persistent asthma. Hispanic adults with LEP were assessed for asthma outcomes and medication adherence behaviors.

The results …