Nursing Commons^™

Nurse Leader Rounding: A Stellar Strategy To Improve The Patient Experience Of Care In The Emergency Department, Polina Shishkina

Master's Projects and Capstones

Abstract

Many clinical outcomes that occur in the emergency room determine the patient’s continued care and experience in the hospital and beyond as well as influence the organizational reputation in the community. Mack and Fill emphasize that “an ED visit is a significant encounter between a patient and a hospital and one that affects ‘repurchase’ decisions for future health care” (as cited in Welch, 2010, p. 65). Thus, patient experience in the emergency department necessitates continued quality improvement efforts. The emergency room, or “the front door to the hospital”, provides equitable and affordable care to patients who need urgent medical …

Thoughts Of A Palliative Care Nurse In Times Of Pandemic, Angela L. Simões

Patient Experience Journal

This narrative presents a series of stories (interactions) lived by a palliative care nurse during the time of COVID-19, a time when we tirelessly prepare to help the services that need us, but we have little preparation of ourselves for the changes that we will have to face in the care of our patients and families. It shares the lived experiences, difficulties, emotions lived by me but shared by so many around the world. It also tries to show that despite the scarcity of physical presence, creativity and commitment to patients and families make us go beyond ourselves and continue …

Beyond Platitudes: A Nurse’S Journey Of Self-Reflection And Vulnerability, Monica Friesen

Patient Experience Journal

The efforts taking place in healthcare organizations and communities globally should represent what is best in humanity, perhaps even more so in this unprecedented time of COVID-19. This short personal narrative is the acknowledgement that “best” needs to start with “me” and my story of self-reflection and journey of vulnerability.

Experience Framework

This article is associated with the Staff & Provider Engagement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework)

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Qualifications Of Executive Nurses For Service On Hospital Boards, Michelle Lee Foxx

Electronic Theses and Dissertations

Abstract Healthcare governing boards have responsibility for the legal and financial stability of the organization. They are assuming more responsibility for quality care and outcomes. Nurse leaders have valuable insights into key shared governance issues such as quality of care, financial performance, legal requirements, and regulatory oversight. Yet, only 5% of the 3.2 million nurses in the U.S. health workforce hold a seat on hospital governing boards in the United States. The purpose of this study was to explore how nurses with executive experience perceive their own leadership qualities in the context of established requirements for executive hospital boards. Fifty …

Diversity In Pre-Nursing Majors And Nursing Program Applicants, Christel Fehr

Dissertations

Problem: The population of the US has become increasingly ethnically diverse. This diversity has not been reflected in the nursing workforce with approximately 70% being Caucasian and 85% being female, resulting in a disparity in healthcare delivery by minorities. The purpose of this project was to perform an analysis of race, ethnicity, and gender diversity in undergraduate nursing applicants at a rural midwestern university.

Method: A retrospective review of nursing applications, enrollment reports, and graduation rates were examined for three academic years.

Results: 326 students (N=326) applied to the nursing program from Fall 2016 through Spring 2019. Of …

A Strategic Plan To Thread Genomics Competencies Into Undergraduate Curriculum, Holly Mathis

Dissertations

Problem: Genomics in undergraduate nursing education has experienced slow adoption in the United States. Various approaches have been proposed but do not address barriers to successful implementation.

Methods: A strategic plan was developed to increase the amount of genetics and genomic content in the curriculum of an undergraduate nursing program. A gap analysis was performed on the curriculum revealing a paucity of content. A SWOT analysis informed the strategic plan, which included a faculty education program using the ANA/ISONG’s Essentials of Genetic and Genomic Nursing: Competencies, Curricula Guidelines and Outcome Indicators (2^nd ed.) (2009) as a foundation.

Results: Faculty …

Ct-Nib Taxonomy For Nursing Information Behavior: Ko In The Pandemic, Elizabeth Milonas, Sergey Zherebchevsky, Richard P. Smiraglia

Publications and Research

As COVID-19 emerged on the world stage a challenge arose to help inform the knowledge base in home health-care nursing. Connecting current experience with the Pajarillo theory "The Nub of Nursing Information Behavior (NIB" was a first step. To provide a taxonomy of NIB, standard domain analytical tools for ontology extraction were employed using Pajarillo's text. Analysis generated frequency distributions of terms and phrases which were then sorted and disambiguated to generate a list of phenomena. Co-word analysis generated visualizations to suggest regions that might constitute facets and sub-facets. Facet analysis yielded six major facets and 17 sub-facets. The NANDA …

Family Behaviors As Unchanging Obstacles In End-Of-Life Care: 16-Year Comparative Data, Renea L. Beckstrand, Jasmine B. Jenkins, Karlen E. Luthy, Janelle L. B. Macintosh

Faculty Publications

Background Critical care nurses routinely care for dying patients. Research on obstacles in providing end-of-life care has been conducted for more than 20 years, but change in such obstacles over time has not been examined.

Objective To determine whether the magnitude scores of obstacles and helpful behaviors regarding end-of-life care have changed over time.

Methods In this cross-sectional survey study, questionnaires were sent to 2000 randomly selected members of the American Association of Critical-Care Nurses. Obstacle and helpful behavior items were analyzed using mean magnitude scores. Current data were compared with data gathered in 1999.

Results Of the 2000 questionnaires …

A Case For Delirium Risk Prediction Models To Aid In Triaging Resources To Those Most At Risk An Integrative Literature Review, Tammy Perttula

Nursing Masters Papers

Abstract

Delirium is a complex syndrome resulting from compounding effects of acute illness, comorbidities, and the environment. It results in adverse outcomes: elevated mortality rates, length of stay, readmissions, institutionalization, long-term cognitive changes, and diminished quality of life. The rate of iatrogenic delirium is astounding, ranging from 10%-89%. There are no curative treatments; thus, primary prevention is the key. The purpose of this literature review is to identify and critique the research for the accuracy of risk stratification and feasibility in practice. Support for interventions that prevent delirium is mounting; however, interventions are resource-intensive and often not implemented. Researchers have …

An Innovative Approach For Type 2 Diabetes Education, Rachel Domagala

Nursing DNP Projects

Objective: To improve self-efficacy in patients with type 2 diabetes and a Hemoglobin A1c (HbA1c) of 8% (64 mmol/mol) or greater using an innovative education multidisciplinary approach in a group setting.

Research Design and Methods: Out of 248 patients that were contacted with type 2 diabetes, who had a HbA1c of 8% or greater, five patients from a large clinic in the Midwest agreed to participate in group education. The primary outcome of interest was lowering HbA1c levels to increase the number of patients with type 2 diabetes who meet the community standard of care.

Results: Patients …

Revisiting Cauti Prevention: A Multifaceted Approach Using Lean Six Sigma, Lisa Ann Behrend

Student Scholarly Projects

This project identified gaps in policy and processes to improve patient outcomes related to workflow in the catheter-associated urinary tract infection policy and process at a 400-bed hospital in southern California. Even with an evidence-based infection prevention bundle in place, the current process was not working, as demonstrated by high catheter-associated infection rates for the last two years.

This project answers the question: Does the use of a comprehensive evaluation of the current policy and process using the Lean Six Sigma quality improvement model influence a reduction in infection rates in patients who have an internal urinary catheter over 15 …

Motivators And Barriers Associated With Intent To Complete A Bsn For Hispanic Associate Degree Nurses, Marissa Jimenez

Nursing Theses and Dissertations

Hispanics who are registered nurses (RNs) are more likely to enter the nursing profession through an associate degree nursing program and are less likely than any other racial/ethnic groups to complete advanced degrees. The purpose of this study is to explain the relationship between motivators and barriers associated with the intent to complete a bachelor’s degree in nursing (BSN) for Hispanic associate degree nurses (ADNs). The research question for this study was, “how much variance in intent to complete a BSN do Hispanic associate degree nurses attribute to motivators and barriers to returning to school for RN to BSN?”

Ajzen’s …

Approachability Of The Nursing Clinical Instructor: Psychometric Assessment Of A Scale Development, Angela Collier

International Journal of Health Sciences Education

Approachability of nursing clinical instructors is largely unknown and misunderstood, yet critical for millennial students which currently comprise 82% of nursing students (National League for Nursing, 2014). Nursing education consists of both a didactic and a clinical component. Clinical education is dynamic and allows the student an experiential learning opportunity. Therefore, clinical nursing educators are vitally important. Approachability has been identified in many studies as a leading characteristic of an effective instructor. Although the importance of approachability of the instructor is established, currently no scale exists to measure this concept. The purpose of this study was to examine the validity …

Commencement Program 2020 (School Of Nursing), Loma Linda University

Commencement Programs

CONTENTS

2 | Message from the President

3 | Message from the Dean

4 | University History Highlights

6 | Candidates for Degrees

Factors Predicting Sustainability: A Correlational Study Of One Multi-Site Program, Meredith L. King Jensen

Dissertations, Theses, and Capstone Projects

Healthcare organizations invest significant economic, physical, and human resources to implement changes and expect sustained benefits for their investments in the long term. Yet, few studies have examined long-term sustainability and factors contributingto sustainability. The primary aim of the study was to gain a better understanding of sustainability and five factors (champions, leadership support, policy, resources, and training and education) that might predict long-term sustainability within the context of one Safe Patient Handling and Mobility (SPHM) program implemented in a large, nationwide system more than 7 years ago. The secondary aim was to examine the number of nursing staff injuries, …

Nurse Practitioner Occupational Burnout: A Focus On The Variables And Themes, Tanya G. Schlemmer

Nursing Faculty Publications and Presentations

Purpose: The prevalence of occupational burnout is high amongst service professionals and the nursing profession is no different. The rate of occupational burnout amongst nursing professionals and medical professionals is high. The themes or impact of occupational burnout amongst Nurse Practitioners is not well described in the literature. Herein this article describes the investigation into the issue of nurse practitioners and occupational burnout.

Data Sources: Scientific literature review, CINHAHL Complete and other online literature databases and resources. A State of the Science systematic review was conducted to further examine this issue to identify the prevalence of the problem amongst nurse …

Veteran Specific Risk Factors For Delirium, Allison Perkins

Dissertations

Purpose/Aims: This study explored the relationships between military characteristics such as combat experience, mental health issues such as post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), depression, anxiety and substance use disorder (SUD), physical comorbidities such as coronary artery disease (CAD), other risk factors, and delirium diagnosis among hospitalized veterans.

Background: Delirium is a common disorder experienced by 25% of all hospitalized adults 65 years and older. No published studies to date have examined whether combat, TBI and PTSD are associated with the incidence of delirium in the hospitalized veteran.

Methods: A retrospective cross-sectional cohort design with a sample size …

Pain And Spiritual Distress At End Of Life, Kathryn Lee Robinson

Dissertations

Purpose: The purpose of this study is to examine the relationship between unmanaged pain and spiritual distress in adults newly admitted to hospice.

Background/Rationale: Current evidence supports the presence of a positive relationship between increased physical pain and spiritual distress for those with advanced cancer and/or receiving palliative care services. Nonetheless, spiritual distress remains a relatively understudied area; anecdotally, assessment and management of physical symptoms often take precedence over interventions for spiritual distress in patients at end of life (EOL) on hospice. Research is needed to examine the relationships between physical pain, spiritual distress, and other relevant variables specific to …

Measuring Learning And Engagement During Debriefing: A New Instrument, Shelly Jensen Reed

Faculty Publications

Background: Debriefing is considered to be where the bulk of learning takes place. Examination of debriefing is needed to help determine if facilitation methods effectively contribute to the learning process. More instruments are needed to evaluate all key debriefing elements, and no tools exist that evaluate participant engagement in the learning process.

Method: Kolb’s experiential learning theory was used to inform tool development. The focus of the new instrument is behaviors that indicate engagement with the learning process as the learner moves through Kolb’s learning cycle. A qualitative study of debriefing facilitators was performed, and a behaviorally anchored instrument was …

The Relationship Between Race And Ethnicity And Serious Safety Events In Hospitalized Patients, Samantha Crandall

Dissertations

Purpose. This study explored the association between patient sociodemographic characteristics and the occurrence of serious safety events (SSE) in hospitalized patients. Specific aims were to describe among patients who have experienced an SSE: 1) patient sociodemographic variables (age, gender, race, ethnicity and language spoken), health insurance coverage, patient zip code, payer mix, site of care location, and severity of event; 2) the relationships between the select patient sociodemographic variables, health insurance coverage, patient zip code, payer mix, site of care location and SSE level of harm; and 3) what factors increase or decrease the odds of experiencing higher levels of …

Dnp Final Project: Implementing Teamstepps Training: Using Evidence To Impact Teamwork In An Acute Care Hospital, Nana Baah Adjei

DNP Final Reports

Background: Medical errors are the third leading cause of death in the United States. Patient morbidity and mortality will decrease when institutional efforts result in the implementation of action plans which reduce medical errors. Teamwork, education, and training through structured initiatives are the most effective mechanism to improve patient safety. Purpose: The project aims to impact the perception of communication among newly hired medical surgical nursing and support staff. The acute care hospital is a 200-bed tertiary care hospital. Intervention: The intervention consists of the registered nurses and support staff participating in an innovative, six-hour, interactive TeamSTEPPS fundamentals course. Results: …

Understanding Nursing Students' Attitudes And Knowledge In Caring For People With Disabilities, Cassidy Kaczor, Ashley Mcdanald

Undergraduate Research and Scholarship Symposium

This study focused on exploring the knowledge, attitudes, and comfort level of undergraduate nursing students in caring for people with disabilities (PWD). Inclusion of disability content in nursing curricula is limited. Smeltzer and colleagues (2010) discovered an absence of disability-related content in pre-licensure nursing textbooks. PWDs have indicated four areas of concern regarding their care by nursing staff: poor communication, lack of competence, negative attitudes, and quality of care received. We hypothesized, if education on the health care of PWD and standardized patient experiences are implemented into nursing school curriculum then nursing students will have an increase in knowledge and …

Evaluation Of A New Nurse Mentor Program, Corinne Romano, Diane Whitehead

Walden Faculty and Staff Publications

Novice nurses in a 160-bed inpatient rehabilitation hospital had a turnover rate of 32% in 2017 and 2018, despite participation in a novice nurse residency program. This quality improvement project was a 3-month process evaluation of a 1-year mentor program designed for novice nurses. The purpose of the process evaluation was to explore whether the organization had (a) successfully implemented the program as identified, (b) successfully recruited and retained participants to date, (c) maintained projected timelines, and (d) provided all participants the opportunity to provide feedback at the 3-month mark of the program. The process evaluation provided an opportunity for …

The Role Of Extracellular Vesicles In Cancer-Related Fatigue And Its Co-Occurring Symptoms, Dilorom M. Sass

Theses & Dissertations

Cancer survivors report many debilitating symptoms associated with cancer and its treatments. About 30% will report long-term cancer-related fatigue (CRF) which often co-occurs with depressive symptoms, sleep disturbances, cognitive fatigue, and poor overall health-related quality of life. The underlying causes of these co-occurring symptoms have been related to systemic processes such as inflammation. Extracellular vesicles (EVs) contain systemic markers such as genetic and protein materials that inform about cell-to-cell interactions that influence immune signaling and inflammatory processing. No study to date has explored the associations of EVs with cancer-related symptoms. So, the purpose of this dissertation was to investigate the …

Coping Behaviors Of African Americans With Inflammatory Bowel Disease: A Focused Ethnography, Patricia Scott

Electronic Theses and Dissertations

Background: Increasing numbers of African Americans are being diagnosed with inflammatory bowel disease (IBD) in the United States (Dahlhamer, Zammitti, Ward, Wheaton, & Croft, 2016). Little is known about the influence of culture on coping with the disease. Method: Twelve African American adults with IBD were interviewed and observed using a focused ethnography. Results: Data analysis resulted in four major themes: (1) spending time living in the bathroom; (2) time and food restricted eating practices and cultural food avoidance; (3) dealing with a life full of stress; and (4) the practice of seclusion to promote health. Discussion: Participants described coping …

Improving End-Of-Life Care On Navajo Through Education, Johanna G. Bahe

Doctor of Nursing Practice Scholarly Projects

End-of-life care (EOLC) is an essential component of comprehensive healthcare and has been shown to improve the quality of life of patients and their families by preventing and relieving pain caused by physical, psychosocial, and spiritual complications. Many rural communities lack access to EOLC, specifically certified palliative and hospice services. The lack of this specialty in rural areas directly affects the experience of healthcare staff. The absence of education for rural healthcare staff and the importance of culturally sensitive care among indigenous people are key concepts in this study.

The purpose of this study was to measure the knowledge, confidence, …

Stress And Burnout In Nurse Leaders, Laura E. Johnson, Kiersten J. Nichols, Jayme A. Sakhitab

Nursing Masters Papers

Problem: Nurse leaders commonly experience stress and self-reported burnout. The associated negative consequences are compelling, yet few studies to date consider the nurse leader population. Stress is “a multidimensional phenomenon determined by a person’s perceptions and may be assessed as harm, loss, threat, or challenge” (Udod, Cummings, Care, & Jenkins, 2017a, p. 160). Burnout is a lack of professional fulfillment caused by emotional, physical, and psychological stress (Nurse Burnout, 2019). Drivers are associated and contributing factors which lead to stress and self-reported burnout.

Purpose: The purposes of this correlational study are to (a) identify drivers from the literature and …

Diffusion Of Precision Health Phenomenon Into An Undergraduate Nursing Research Course, Mary Anne Schultz, Mary Anne Schultz

Q2S Enhancing Pedagogy

This 15-week course layout for NURS 4222 (Nursing Research & Evidence-Based Practice), illustrates the adoption of threads from an emerging phenomenon, Precision Health, into an undergraduate Nursing Research course.

Hereditary Cancer Syndrome Recognition And Testing: Beyond Brca, Deborah O. Himes, Hanford B. Shuman

Faculty Publications

Hereditary cancer syndromes, resulting from mutations of tumor suppressor genes, can significantly increase the risk for breast cancer. Although hereditary breast and ovarian cancer syndrome caused by BRCA1/2mutations is well-known, less well-known hereditary cancer syndromes also exist. This article focuses on 3 other syndromes, including Li-Fraumeni, Cowden, and Peutz-Jeghers. This article will help prepare nurse practitioners to recognize key clinical features of these syndromes and understand testing criteria. Additionally, this article discusses barriers to diagnosing hereditary cancer syndromes and the role of primary care nurse practitioners in ordering genetic tests and making genetic referrals for optimal patient care.

Poster: The Beat Stops Here: A Nurse-Driven Protocol To Manage Telemetry Orders, Holly Dripps, Kirk Hummer

Doctor of Nursing Practice Scholarly Projects

At a large midwestem healthcare organization, cardiac telemetry monitoring orders are not aligned with clinical guidelines developed by the American Heart Association (AHA). A nurse-driven protocol, based on AHA guidelines, to manage cardiac telemetry orders may reduce telemetry usage. Donabedian' s quality improvement framework of strnch1re-process-outcomes was utilized as the theorical framework for this project, with the purpose to reduce telemetry days within 30 days on a selected acute care unit utilizing AHA guidelines. Project objectives included developing an assessment tool based on AHA guidelines, educating pe1iinent stakeholders on the nurse assessment tool, and implementation of the tool on the …