Nursing Commons^™

Using Home Telehealth To Reduce Hospital Readmission Rates In Heart Failure Patients In The Emergency Room, Margaret Ashby

Student Scholarly Projects

Practice Problem: In one hospital, the readmission rates and emergency room visit for patients who are diagnosed with heart failure (HF) was increasing.

PICOT: Among veterans who are hospitalized for HF (P) does the enrollment into a care coordination program for these veterans (I) compared to current practices (C), reduce the hospital readmission rates and emergency department visits (O) within 10-weeks (T)?

Evidence: The literature supports the idea that home telehealth as a home monitoring program for patients who have chronic diseases such as heart failure (HF) and has had success in patients with hypertension amongst patients. Transition strategies from …

Using An Evidence-Based Practice Nurse Recognition Practice To Improve Job Satisfaction, Hali Bianchi

Student Scholarly Projects

Practice Problem: The project targeted low job satisfaction and high nurse turnover in a Central Florida bone marrow transplant unit, impacting patient care and costs.

PICOT: (P) For registered nurses (RNs) on the bone marrow transplant unit, (I) does implementing an evidence-based practice employee recognition program (C) compared to no employee recognition program, (O) lead to an increase in job satisfaction (T) over 10 weeks?

Evidence: The evidence supported the effectiveness of meaningful recognition programs, such as personalized verbal acknowledgment from leadership, in boosting job satisfaction among nurses.

Intervention: The intervention involved nurse managers using a weekly employee recognition …

Non-Cognitive Factors Influencing The Development Of Clinical Judgment In Undergraduate Nursing Students, Kathryn Robinson

Graduate Theses, Dissertations, and Capstones

A nurse’s ability to form sound clinical judgments is directly related to safe patient outcomes. Pre-licensure nursing programs are focused on developing students’ clinical judgment ability; however, an academic-practice gap continues to exist. The Implicit Theory of Intelligence and Achievement Goal Theory provide insight into how mindset beliefs and goal orientation impact the teaching and learning environment. The performance goal orientation, ineffective learning strategies, and avoidance of challenging tasks associated with a fixed mindset may negatively impact the development of clinical judgment. This exploratory study sought to determine if there is a relationship between the non-cognitive factors, mindset beliefs and …

Improving Mental Health Outcomes For Amputees, Zachary Elmore

Dissertations

Problem: depression, anxiety, and other mental health disorders are more commonly diagnosed in the amputee population related to changes in mobility, activities of daily living, and quality of life (Turner et al., 2020.) As the amputation population is projected to reach over 3 million Americans in the next 25 years, additional screening is imperative to identify patients at high-risk for mental health deterioration (Ziegler-Graham et al., 2018).

Methods: this was a project that included screening all patients with the Personal Health Questionnaire for Depression (PHQ-8) meeting the inclusion criteria of being admitted to 7500 Vascular Surgery at Barnes-Jewish …

Implementation Of The Process Improvement Toolkit For Hospital Acquired Pressure Injuries, Christina Bearden

Dissertations

Problem: Approximately 2.5 million people within the United States receiving inpatient medical care will develop a pressure injury each year (Padula & Demarmente, 2018). Pressure injuries (PI) are a multifactorial complication that can often be avoided with general prophylactic measures. Despite this, inpatient settings around the United States continue to see a rise in PIs.

Method: The quality improvement initiative utilized a descriptive, observational design. The turn team toolkit was implemented and monitored over a two-month period. Patient descriptors and quantitative data were collected through a retrospective chart review. The primary data collected was on pressure injury rates and staff …

The Implementation Of Comfort Medication Kits In Hospice Patients’ Homes To Reduce Hospice Revocations, Brandi J. Parker

Doctor of Nursing Practice Projects

Background: When hospice patients experience a symptomatic crisis at the end of life, unmanaged symptoms can lead to unwanted hospitalizations and the revocation of their hospice benefits. Strategies to reduce the incidents of hospice revocation are needed to improve patient care and quality of life.

Purpose: The quality improvement project aimed to reduce hospice revocation rates by implementing comfort medication kits in eligible hospice patients’ homes.

Methods: The project’s intervention included identifying patients at high risk for revocation, patients with a cancer diagnosis, and patients with a prognosis of two weeks or less. Comfort medication kits were placed in the …

Implementation Of A Mobile-Based Mindfulness Intervention To Lower Perceived Stress Levels In Undergraduate Nursing Students, Wendy S. Carley

Electronic Theses and Dissertations

This project analyzed the effect of the daily use of a mindfulness-based mobile application on associate degree nursing undergraduate prelicensure students’ perceived stress levels. Nursing students experience elevated stress levels that may be reduced through mindfulness behaviors. Undergraduate, prelicensure nursing students participated in establishing the impact of mindfulness on perceived stress levels in a quantitative pre/postintervention study. The evidenced-based studies chosen for this review consisted of randomized controlled trials, pilot studies, pre/posttest designs, systematic reviews, and quantitative and qualitative studies. The investigator collected presearch data using a pre/posttest design to evaluate the effectiveness of a stress management program in reducing …

A School-Based Asthma Initiative To Improve Student Self-Management Behaviors, Jenni R. Newland

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: In a Midwest public school system, students received robust academic education. Health education programs, specifically asthma management, were not offered. Over 400 elementary students with asthma lacked the knowledge and skills to effectively recognize and manage their asthma symptoms resulting in increased school clinic visits and absences, highlighting the urgent need for targeted intervention.

Aim of the Project: The aim of this project was to improve students’ asthma self-management skills by providing education based on the Open Airways for Schools (OAS) curriculum. Improving asthma self-management skills reduces student absences and time away from the classroom.

Review of Evidence: A …

Ultrasound Guided Piv Insertion Implementation, Blake Hotchkiss, Beth O'Donnell, Miles Merwin, Billie Jo Senecal, Ronica Smith, Eric Alan, Bryan Tavary, Chelsea Harkins, Taylor Archard, Leslie Geissinger, Lauren Remington

Operations Transformation

Observed high number of unsuccessful peripheral IV insertion attempts. This increases waste (cost and time) and decreases patient satisfaction.

A Review Of Socially Responsible Hrm Practices In The Lebanese Healthcare Sector, Maya Issam Houri, Abdul Rahman Beydoun

BAU Journal - Creative Sustainable Development

This study reviews the existing literature on Socially Responsible Human Resource Management practices on both nurses' performance and their intention to stay which constitute important factors of nurses’ decisions to stay in the healthcare sector in Lebanon. It also focuses on the current knowledge about existing literature in socially responsible HRM. This literature review highlights on the current knowledge about the determinant factor and the importance of socially responsible HRM practices and key outcomes for nurses. It suggests that socially responsible HRM practices, covering initiatives such as training, performance evaluation, compensation, work-family balance and occupational health and safety practices, may …

Reducing Maternal Morbidity From Peripartum Hemorrhage In Cesarean Delivery, Jennie Lee

Dissertations

Background/Purpose: Maternal hemorrhage is the second highest cause of direct maternal death and the leading cause of morbidity and mortality in the United States. This public health crisis is highlighted by the economic burden of over $30.8 million annually in the United States. The greatest tragedy in the review of maternal mortality is that 84% of pregnancy-related deaths were determined preventable. Identifying trends of factors that predispose women to hemorrhage can mitigate rates of severe maternal morbidity and mortality. This study describes relationships among demographic factors (maternal age, race, and ethnicity), clinical and physiologic factors, which include coexisting medical conditions …

Optimization Of Triage Documentation In A Large Urban Emergency Department, Monica Reynoso-Prieto

Master's Projects and Capstones

Problem California ranks ninth nationwide in terms of longest emergency department wait times. The project aims to reduce patient triage times by refining the workflow of triage documentation, achieved through strategic rearrangement of triage documentation questions. Context This quality improvement project took place in the emergency department of a large urban Bay Area hospital. Intervention The intervention was implementation of changes to the triage documentation based on staff feedback from an opinion survey, such as: elimination of redundant questions, consolidation of related categories, and logical reorganization of triage topics. Measures Measures used in the project were triage times and pre …

Refining Triage Documentation Practices In A Metropolitan Emergency Department, Jack A. Moody

Master's Projects and Capstones

Problem California ranks ninth nationwide for its lengthy emergency department wait times, presenting a pressing challenge for healthcare facilities. Context This quality improvement project, set in the emergency department of a large urban hospital in the Bay Area, aimed to address this issue by targeting workflow efficiency through the reduction of triage times. Intervention The intervention centered on implementing changes to the triage documentation, informed by staff feedback obtained through an opinion survey. Proposed modifications included the elimination of redundant questions, consolidation of related categories, and a logical reorganization of triage topics. Measures Key measures utilized in the project included …

Application Of Lymphedema Education Toolkit For Nurse Coordinators, Julian K. Miranda

Master's Projects and Capstones

Problem: There is approximately one in five breast cancer survivors affected by breast cancer-related lymphedema (BCRL), a potentially debilitating condition affecting the physical, emotional, social, and financial well-being of individuals. Context: This Quality Improvement (QI) project was conducted at an outpatient facility of Hospital X’s Women’s Cancer Center. Within this microsystem, there are 24 permanent clinical nurse coordinators and advanced practice providers, with 15 nurse coordinators dedicated to care for patients with breast cancer or gynecological conditions. Intervention: The intervention aims to evaluate if a standardized educational tool improves early interventions for patients with lymphedema and knowledge among healthcare providers …

Enhancing Pain Documentation In Medical Surgical Units: Integrating Supportive Tools With Pain Nursing Education, Mariana Arias

Master's Projects and Capstones

Problem: Pain management in in-patient care, particularly involving opioids, is critical due to the associated risks. Proper pain assessment is essential to ensure safe medication administration and mitigate adverse effects.

Context: This quality improvement (QI) project aimed to improve opioid assessment and documentation rate above 90% compliance in two medical-surgical units, focusing on bedside nurses who play a crucial role in patient safety and effective pain management.

Interventions: A baseline survey provided nurses' understanding on compliance criteria and assessment timing. Interventions included visual reminders, informational posters, and instructions on how to access individual compliance reports.

Measures: A post intervention survey …

The Impact Of Electronic Health Record Unintended Consequences On Quality Of Care Within A High Complexity Healthcare Organization, Joetta Powell

ATU Theses and Dissertations 2021 - Present

“Unintended consequences are unexpected, and unwanted outcomes that can limit the value of EHR implementation and adversely affect quality of care and patient safety” (Lee & Kang, 2021, p. 898). Few organizations have redesigned the EHR to improve usability to mitigate potential patient safety concerns. This study aims to identify unintended consequences in patient care workflows and determine educational needs related to EHR usability. A mixed method approach was used to investigate unintended consequences in deidentified patient safety reports submitted Jan 1, 2020, through December 31, 2023. The data was analyzed to identify error types and educational deficits. The Acute …

Barriers, Facilitators, And Competencies In Advocating For Adults With Intellectual Disabilities With Health Disparities, Carol Adams

Electronic Theses and Dissertations

Background: Nurses working in the specialty of intellectual disabilities are positioned to advocate for individuals with intellectual disabilities and other health disparities. This study explored nurses’ perceived competencies, barriers, and facilitators when advocating for improved health status in adult patients with intellectual disabilities.

Methods: Twenty-five nurses working in the specialty of intellectual disabilities were interviewed using semi-structured interviews, and the data were analyzed using thematic analysis.

Results: Barriers identified in advocacy were: Funding, Communication, Negative Perceptions and Misperceptions, Lack of access, and Diagnostic Overshadowing. Nurses were also facilitated in advocating for improved health status in people with intellectual disabilities. Facilitators …

Improving Mental Health Support For Nursing Students Through Mental Health First Aid (Mhfa) Training Of Clinical Faculty, Amy Sands

Graduate Theses, Dissertations, and Capstones

This project aimed to implement a process improvement program at the Louisville campus of Galen College of Nursing to improve the mental health support for nursing students through the training of Clinical Instructors (CIs) in using adult Mental Health First Aid (MHFA) and the ALGEE actions described within that program.

Dnp Final Report: Central Line Dressing Change Regimen To Decrease Central Line-Associated Bloodstream Infections, Ann Campbell

DNP Final Reports

Central line associated bloodstream infections (CLABSI) are dangerous and costly occurrences in healthcare facilities. This evidence-based project's purpose is to implement interventions to reduce CLABSIs in a healthcare facility that has higher than the national average of reported cases. The practice problem PICOT question is: In inpatients with indwelling central venous access devices at the facility, (P) how does implementation of evidence-based guidelines for central line dressing changes every seven days and as needed (I) compared to the current practice of dressing changes on Fridays (C) affect CLABSI rates over a three-month period (O). The body of evidence obtained in …

Dnp Final Report: Effects Of Open-Access Scheduling On Patient No-Show Rates In An Outpatient Clinic, Maria Aileen A. Wilkinson Msn, Mba, Rn

DNP Final Reports

No-show rates in a South Texas outpatient clinic have been as high as 16% to 20% which increases wait times to be seen in the clinic and decreases patient access to outpatient care. This no-show rate data has continued despite multiple interventions that have been implemented in an academic health science center. Physical, socio-economic, geographic, and health/lifestyle factors affecting no show or missed appointments are crucial to determining the most appropriate interventions to alleviate this issue. No-show rates are important metrics to improve because it directly affects the organization's revenue, access to care, and appointment wait times. Research evidence regarding …

Addressing Stroke Care Disparities Through Patient Education, Christina Annerino

Honors Capstones

It has been found across current studies and evaluations of stroke care and patient outcomes that there is a disparity in disability and mortality between male and female patients who have experienced stroke. The aforementioned studies did not identify the cause of this disparity, although a number of hypotheses for this phenomenon were provided. This study then conducted a preliminary survey of 130 participants, both men and women, aged 18-80 years old, to evaluate potential barriers to accessing stroke care and receiving treatment effectively. Preliminary survey data demonstrated consistent gaps in knowledge related to stroke risks, stroke symptoms, and when …

Home Based Primary Care Program Evaluation Of Loneliness, Depression, And Multimorbid Conditions Of Older Midwest Veterans, Renee R. Sullivan

Doctor of Nursing Practice Projects: College of Nursing

Objectives: This program evaluation of Veteran Administration’s (VA) Home-Based Primary Care Program (HBPC) measured the differences in loneliness, diagnoses of Major Depressive Disorder (MDD), Post Traumatic Stress Disorder (PTSD), Anxiety, and Traumatic Brain Injury (TBI) and multimorbid conditions in rural and urban older adult veterans compared with older adult community-dwelling veterans. The correlations of loneliness using the 11- Item Revised University of California Los Angeles (R-UCLA) Loneliness Scale will describe the relationship of loneliness to mental health diagnoses, multimorbid conditions, demographic data, caregiver presences and the number in-person and phone contacts with the HBPC providers of a Midwestern Veterans Administration …

Incorporating A High Fidelity Transgender Simulation Into Undergraduate Nursing Curriculum, Kacee Child, Jenniepearl Spencer

Doctor of Nursing Practice Projects: College of Nursing

Purpose

The purpose of this study was to evaluate the knowledge and attitudes of nursing students participating in a high-fidelity transgender patient simulation. The aims were to increase student knowledge and confidence to improve communication and provide more inclusive and equitable care.

Healthcare providers are not adequately prepared to manage the unique health needs of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community. Nurses are ideally positioned to address gaps in LGBTQ healthcare by providing culturally competent care. Yet, LGBTQ health education is lacking in most undergraduate nursing school curriculums.

Methods

62 undergraduate nursing students participated in a post-surgical …

Experiences Of Registered Nurses Returning To Practice After A Career Break, Jill V. Scott

Theses & Dissertations

This dissertation explores the complex experiences of Registered Nurses (RNs) returning to practice, with a particular focus on the impacts of self-efficacy, recruitment strategies, and regulatory barriers. The first article, a literature review, examines the self-efficacy of RNs returning to practice, emphasizing the importance of refresher programs and support to facilitate this transition. This review also evaluated the preparedness of RNs re-entering the workforce, and evaluated the role of self-efficacy in successful reintegration into clinical practice. The second manuscript delves into the challenges of reaching and recruiting health professionals who have left the profession, identifying community partnerships, social media, and …

Second Victim Syndrome: Nurses Suffering In Silence, Matthew Riehm

Dissertations

Medication errors are inherent in health care due to human fallibility and inherent systemic complexities. Nurses are often unjustly blamed after committing a medication error despite the multitude of contributing factors. Formal education and healthcare organizations focus on preventing medication errors, but little has been done to support nurses involved in these tragic incidents. Recent cases, including RaDonda Vaught and Kimberly Hiatt, demonstrated the victimization of nurses after committing medication errors that plague the healthcare system potentially causing profound psychological trauma, often known as Second Victim Syndrome, SVS. There is limited research on the phenomenon of SVS in nursing due …

The Association Between Emotional Intelligence, Empathy, And Social Determinants Of Health Among Accelerated Bachelor Of Science In Nursing Students: A Multi-State Cross-Sectional Descriptive Study, Kwanza Thomas

Dissertations

This study investigated the association between emotional intelligence (managing and understanding), empathy, and social determinants of health (SDOH) among accelerated Bachelor of Science in Nursing (ABSN) students. Despite the exponential increase in ABSN programs in the United States, little is known about the association between these variables among this nursing student population. A cross-sectional, correlational descriptive design was used to survey 104 students completing ABSN programs in Georgia, Mississippi, Philadelphia, and Texas. Participants self-reported their socioeconomic and programmatic characteristics using a researcher-developed questionnaire. Emotional intelligence (managing and understanding) was measured using two instruments, including the Situational Test of Emotional Management …

Utilization Of The Reproductive Justice Framework In Contraceptive Counseling With Black And African American Women: A Comparison Of Patient Satisfaction And Provider Knowledge, Simranjeet K. Tagore

Doctoral Projects

Current practice in contraceptive counseling is characterized by great variation in both content and implementation. The literature indicates that African American women desire contraceptive counseling based in respect, trust, and equity. Conducted over 8 weeks, this quality improvement project compared satisfaction in African American and Black patients receiving contraceptive counseling by a provider trained in the Reproductive Justice Framework (RJF) versus those receiving contraceptive counseling by a provider not trained in the Reproductive Justice Framework. This project also evaluated the effects of Reproductive Justice Framework training on clinician knowledge. Inclusion criteria for the patients included identifying as Black and/or African …

Mentorship Program Including Alumni, Nicole Brainin

Doctor of Nursing Practice Projects

The landscape of advanced education in nurse anesthesia presents considerable challenges for Student Registered Nurse Anesthetists (SRNAs), accentuated by demanding clinical hours and the transition from experienced ICU nursing to novice learners. This study explores the implementation of alumni mentorship within Nurse Anesthesia Programs (NAPs) to alleviate these stressors. An initial survey gauged alumni interest in mentorship roles, while a follow-up survey assessed the program's impact on student satisfaction and communication. Findings suggest that engagement and communication frequencies are lower than optimal, while alumni mentorship is perceived positively. Recommendations for enhancing the program include diversified communication channels, structured interactions, and …

Educating Anesthesia Providers On The Physiological Effects And Anesthesia Implications Of Cannabis, Carmel Loud

Doctor of Nursing Practice Projects

In the U.S., currently 37 states have legalized cannabis for medicinal use prescribed by qualified medical professionals (National Conference of State Legislatures [NCSL], 2022). In 2012, the legalization of recreational cannabis began; as of 2022, 19 states have legalized the recreational use of marijuana (NCSL, 2022). This project aimed to optimize care for patients using cannabis by increasing anesthesia provider knowledge about cannabis. The project's aim was accomplished through a thorough review of the current medical literature and implementation of education to anesthesia providers about the physiological effects and anesthesia implications of cannabis. Thirteen CRNAs took a pre- and post-quiz …

The Lived Experience Of Nurses In Caring For Patients With Covid-19, Jessica Barre

Electronic Theses and Dissertations

Limited research exists about the experiences of nurses’ caring for patients during the COVID-19 pandemic post hoc. To understand nurses’ realities of caring for patients with COVID-19, I aimed to understand the lived experience of nurses caring for patients with COVID-19 in the United States. A qualitative design with a hermeneutic phenomenological methodology was used. Sixteen participants were recruited via purposive sampling, augmented with snowball sampling. Data were collected through unstructured interviews and were analyzed using Braun and Clarke’s Reflexive Thematic Analysis. Nurses’ experiences of caring for patients with COVID-19 in the U.S. were consolidated into four themes: “a living …