Nursing Commons^™

Decreasing Caregiver Stress, Dexter Ramos

Doctoral Dissertations and Projects

Stress is both critical and personal experience and has significant effects on caregivers’ physical, mental, and social well-being. The nature of caregiving and the responsibility to work and serve individuals at their illness conditions are very personal encounters that often result in adverse effects on the health and well-being of caregivers (Frederick, 2016). A decrease in stress experience can lead to the satisfaction of caregiver roles and improvement of patient’s quality of life (Choi, Jisun & Boyle, Diane, 2013; Yada, Nagata, & Inagaki, 2014). This scholarly project determined that evidence-based stress management interventions have decreased the perceived stress in caregivers. …

A Patient-Centered Medical Home Model For Improvement Of Healthcare For The Homeless Population: An Integrative Review, Dale Ellen Strickland

Doctoral Dissertations and Projects

The homeless population is surrounded by many obstacles while trying to obtain the essentials of life including food, water, shelter, clothes, medical care, and safety. In many areas of the United States and other countries homelessness is becoming an increasing problem. Compared to standard healthcare, the Patient-Centered Medical Home Model is offering a better experience for homeless patients. This integrated review provides a selection of published studies and information on the homeless population and the beginning of the Patient-Centered Medical Home Model to improve access and healthcare to many homeless patients. As the model is accepted by more medical professionals, …

A Hepatitis C Screening Tool For An Uninsured Population, Kimberly Belle Babcock-Nobles

Doctoral Dissertations and Projects

Hepatitis C virus (HCV) is a public health epidemic effecting 3.5 million people in the United States alone. The uninsured, underserved residents of a rural county in North Carolina have limited access to screening and early detection for HCV. Through collective efforts, a free medical clinic partnered with a grant funded, nonprofit organization to provide free hepatitis C testing by use of a mobile medical unit. The aim of this study was to determine if use of an HCV screening tool would increase the number of patients screened for testing as compared retrospectively to the number of patients screened without …

Raising Awareness Of Compassion Fatigue Among Healthcare Providers In The Coronary Care Unit, Keri Tifft

Doctoral Dissertations and Projects

Compassion fatigue is a pressing issue in critical care units across the healthcare field. There is a sincere desire by nurses to give the best care possible to each of their patients; however, many obligations split the nurse’s attention so they do not feel as if they are providing the best care to their patients. When nurses stop viewing their patients as humans and start viewing them as tasks, the compassion that the nursing profession prides itself on, is no longer there to the degree that is needed for quality care. Increasing awareness of compassion fatigue and teaching nurses and …

A Practical Understanding Of Preeclampsia For A Nurse In A Third World Setting, Anna Lovin

Senior Honors Theses

Preeclampsia is a disease of pregnancy that affects approximately 3-5% of women with child. It is one of the primary causes of mortality in mothers and babies across the globe. The exact cause, pathogenesis, or disease progression is unknown. Therefore, there is no definition of which patients are at risk for developing preeclampsia and what can work as a preventative measure. In high socioeconomic settings where there is good healthcare, standard treatment is established to manage the symptoms and decrease the progression of preeclampsia to eclampsia. However, in more rural, third-world settings of developing countries, caring for patients with preeclampsia …

Extracorporeal Cardiopulmonary Resuscitation, Emily Carr

Senior Honors Theses

Extracorporeal cardiopulmonary resuscitation (ECPR) is a method of resuscitation in which venoarterial (VA) extracorporeal membrane oxygenation(ECMO) is initiated during refractory cardiac arrest. ECPR promises to enhance outcomes after cardiac arrest by minimizing neurological deficits, stabilizing the patient for early reperfusion and hypothermia, and serving as a bridge to treatment or transplant. ECPR must be initiated according to structured guidelines and protocols, which are based on the patient’s age, comorbidities, code status, neurological baseline, no flow time, and low flow time.

If a patient achieves return of spontaneous circulation on ECMO, the patient will receive post cardiac arrest care which includes …

Unleashing Top-Of-License Registered Nurse Practice: An Integrative Review, Michelle Dickerson

Doctoral Dissertations and Projects

In light of a well-renowned report, “The Future of Nursing” released by the Institute of Medicine (2010), recommendations were suggested that nurses should practice at, and to, the full extent of their licensure, also referred to as top-of-license nursing practice. Transforming nursing care models coupled with strong leadership support is critical to fostering an environment where top-of-license practice can be fully achieved and sustained. This integrative review provides a compilation and synthesis of the available published evidence regarding the best practices for fostering environments conducive to top-of-license nursing practice. Results of these studies strongly supports the notion of nurses practicing …

Facilitating Transition To Practice For Millennial New Graduate Nurses, Tiffani Marie Wise

Doctoral Dissertations and Projects

Despite the growing nursing shortage and the dire need for a full nursing workforce, attrition rates among new graduate nurses (NGNs) continues to be of concern. One answer to the nursing shortage includes the next generation of nursing graduates: millennials. It is vital that nursing administrators and educators collaborate to develop a transition-to-practice process that meets the unique needs of millennial NGNs to increase job satisfaction, thereby increasing intent to stay in the profession. The MSPM was implemented in an NGN medical-surgical residency as a means of maintaining job satisfaction, perceptions of support, and intent to stay, among NGNs. A …

A Phenomenological Study Of Graduated Nursing Student Athletes' Experiences Balancing Academics And Athletics, Robert E. Steed

Doctoral Dissertations and Projects

The purpose of this transcendental phenomenological study is to describe the lived experiences of eleven graduated nursing student athletes who completed traditional, four-year nursing programs while concurrently finishing four years of athletic eligibility in their respective sport at three private, Christian, Midwest universities and across three different competitive collegiate athletic divisions. The theories guiding this study are Tinto’s Theory of Individual Departure from Institutions of Higher Learning, Astin’s Theory of Student Involvement, and Lazarus and Folkman’s Transactional Model of Stress Response, as they relate to student athletes’ persistence to graduation and to nursing students who reportedly experience higher levels of …

Addressing Health Literacy And Collaboration In Mobile Clinics Utilizing Teach-Back Methodology And Healthcare Provider Training, Mark Robert Drye

Doctoral Dissertations and Projects

Focused healthcare provider teaching was used to increase health literacy sensitive care and to improve interdisciplinary collaboration between providers in a mobile clinic setting that serves significantly underserved and socioeconomically challenged populations. The teach-back method was selected as one of the tools to help providers help their patients overcome health literacy challenges by increasing compliance and helping providers engage their patients in collaborative care. Multidisciplinary providers working in a large university clinic system in the southern United States (N = 20) were surveyed, provided focused training, and resurveyed to determine if provider practices addressing health literacy and interdisciplinary collaboration could …

An Education Implementation Project In An Emergency Department To Increase Awareness And Referral For Trafficked Person Encounters, Stacey Lynn Alderman

Doctoral Dissertations and Projects

Human trafficking impacts sufferers on a global scale with serious and lifelong health issues associated with the illegal practice. Interventions for these victims’ extensive health issues must ignite healthcare staff education and expert clinical interventions. Due to these health problems, healthcare staff function on the front lines to identify and help trafficked persons. This study focused on the scope of trafficking and health staff awareness, identification strategies to help recognize trafficked persons, techniques for interviewing, best practice strategies for intervention and referral, and new coding guidelines. During the intervention, health staff received a human trafficking pre-education questionnaire, a research supported …

Increase In Pneumococcal Immunization In Adults Over 65 Years Of Age In A Federally Qualified Health Center, Mara J. Dominguez

Doctoral Dissertations and Projects

Pneumococcal disease is a healthcare concern with increasing financial and societal burden for adults over the age of 65 years and their caretakers. The Center for Disease Control and Prevention (CDC) recommends the use of pneumococcal vaccines in this population as a preventive measure helping minimize the mortality and morbidity. This project aimed at increasing the rate of pneumococcal vaccines in a Federally Qualified Health Center (FQHC). The interventions implemented included the use of audit, feedback and provider educational intervention aimed at increasing the knowledge and the intent to change and improve their practice. The key results indicated an increase …

Comparing The Causal Implications Of Clinical Unit Placements On Senior Bachelor Of Science In Nursing Students' Cognitive Decision-Making Processes, Shelley Layne Blackwood

Doctoral Dissertations and Projects

Evidence suggests that new nursing graduates entering the workforce struggle with decision making. Poor clinical decisions often lead to undesirable patient outcomes. Utilizing quantitative, causal-comparative, pretest-posttest design, this research explored the effect of four categories of clinical unit placements (specialty units, acute care, critical care, and emergency departments) on senior bachelor of science in nursing (BSN) students’ cognitive decision-making processes to explore which type of unit, if any, significantly changes nursing student cognitive processes while making decisions. A convenience sample of 30 senior BSN students from a private, faith-based university completed both a demographic survey and the Nurse Decision Making …

Increasing Registered Nurse Retention Using A Mentorship Program, Krystle Lynette Forlines

Doctoral Dissertations and Projects

To address the nursing shortage, it is imperative that healthcare organizations understand the reasons for nurse turnover and develop programs to retain high quality nurses. A program that has been utilized by healthcare organizations is mentoring. Mentor programs have been found to improve job satisfaction thus improving nurse retention. In addition to focusing on orientation programs for new graduate nurses, mentorship programs can be utilized to assist with experienced nurse retention. The purpose of this evidence-based practice project was to pilot a three-month mentorship program with registered nurses with one to three years of experience.

Diabetic Ketoacidosis (Dka) Insulin Infusion Protocol Update Using Evidence-Based Practice: A Quality Improvement Project, Susan K. Lacey

Doctoral Dissertations and Projects

Diabetic Ketoacidosis is a life-threatening side effect to Diabetes Mellitus. Standards of treatment and recommendations are made by the American Diabetes Association. The project was to evaluate and provide the latest evidence-based practice to update the hospital policy for the treatment of DKA in the Intensive Care Unit and Emergency Department. Retrospective chart reviews were conducted to review the number of patients admitted with diabetic ketoacidosis and treated on the DKA Insulin Infusion Protocol before and after the update. Rapid correction of blood glucose levels proved to be an issue at this facility both before and after the updates were …

Addressing Barriers To Medication Adherence: An Evidence-Based Screening Instrument Validation Study, Donna Jean Washburn

Doctoral Dissertations and Projects

Adherence to a prescribed medication regimen is often critical to successful disease management. Cancer diagnoses often further complicate control of the comorbid diseases. Older cancer patients with multiple comorbidities receiving chemotherapy treatment are at increased risk for adverse health outcomes from uncontrolled disease when nonadherent to their medication regimen. The intent of this pilot study was to test the validity of an evidence-based screening instrument designed to identify patients at risk for medication nonadherence and uncontrolled illness. The W-BMA (Washburn-Barrier to Medication Adherence) screening criteria were applied to retrospective data of cancer patients with multiple co-morbidities. SPSS was used to …

The Incorporation Of Evidence-Based Simulated Activities In An Existing Nurse Residency Program, Wendy Partin Thompson

Doctoral Dissertations and Projects

As new graduate nurses are challenged with caring for patients with complex disease processes, nurse residency programs are designed to ease the transition into practice. A community based hospital, in the southern United States has recently implemented such a program. However, the organization continues to have problems with nursing turnover. This problem is especially evident in nurses with less than one year of clinical experience. Research has shown that nurse residency programs without simulative activities eliminate vital critical thinking activities which prepare novice nurses for clinical practice. The purpose of this project was to design evidence-based simulative activities to increase …

Building Resilience To Combat Symptoms Of Moral Distress And Burnout In Nurses: Is It Effective? An Integrative Review, Julia M. Mcauley-Gonzalez

Doctoral Dissertations and Projects

Background: Moral Distress (MD) is an experience of painful feelings and/or psychological imbalance that occurs when a person’s moral integrity is seriously compromised, either because one feels unable to act in accordance with core values and obligations, or attempted actions fail to achieve the desired outcome (Hamric, 2014). The consequences of repeated episodes of moral distress have been linked to nurses reporting symptoms of low job satisfaction, caregiver burnout, compassion fatigue, emotional exhaustion, poor work engagement, and nurses leaving their positions. Problem: There is evidence that makes the connection between an existing high level of resilience and a low level …

Knowledge And Attitude Of Nurses In A New Rn Graduate Residency Program Regarding Pain Management, Kathryn Lee Wampole

Doctoral Dissertations and Projects

Most people have encountered pain at some point in their lives. It is a very common complaint nurses hear from patients. When assessing patients, nurses are taught to take what the patient says as his or her pain level as fact. Pain is not a vital sign that can be measured with medical equipment like temperature or blood pressure. Therefore, many nurses find assessing pain challenging. Adding to the complexity of pain management is the current opioid crisis. To help combat some of these issues, the project leader worked with healthcare administrators at a regional teaching hospital in the southeastern …

Improving The Practice Model In A Military Clinic, Kristina Marie Zuccarelli

Doctoral Dissertations and Projects

Military members and their families face numerous stressors due to the unique lifestyle of this career (Lester, 2011). The occupational impact on these members creates a highly stressful and physically demanding environment with low morale, chronic medical complaints, and poor mental health for these individuals. This project incorporated the current patient-centered medical home (PCMH) model and fused it with the operational medical model for all the active duty members in this unit. The combination of models allowed the provider to have a better understanding of the population’s needs. By embedding in the units, the provider developed a team approach to …

The Relationship Between Test Of Essential Academic Skills And Nursing Final Course Grades For Sophomore Students In A Residential, Undergraduate, Pre-Licensure Bachelor Of Science Nursing Program, Tracey Milton Turner

Doctoral Dissertations and Projects

In light of the national nursing shortage, there is a heightened need to admit students to schools of nursing who are likely to persist through graduation. The purpose of this quantitative predictive correlational study was to determine if Test of Essential Academic Skills (TEAS) subscale testing scores could predict the final course grade in a fundamentals of nursing course for sophomore students in a residential, undergraduate, pre-licensure Bachelor of Science in nursing (BSN) program at a private university. Archival data consisting of information related to sophomore, residential, undergraduate, pre-licensure BSN students at a private university during the 2015-2016, 2016-2017, and …

Increasing Hcahps Scores By Scripting Of Hourly Rounding, Katherine Rivera

Doctoral Dissertations and Projects

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a standardized national report on patient perceptions of care and is now linked to hospital reimbursement by both government and now some independent insurance companies. Healthcare systems are therefore very interested in ways to increase patient satisfaction within their facilities. This evidence-based practice pilot project was based on the Iowa Model of Evidence and used a quasi-experimental process to ascertain if adding scripting to the hourly rounding process was able to increase patient satisfaction scores on the HCAHPS. The increase in patient satisfaction, in the area of perceived responsiveness …

Pain Management: A Flowsheet For Providers, Lisa Swezey

Doctoral Dissertations and Projects

Many different factors led to the trend of providers prescribing opioids for chronic pain. However, the misuse of and many deaths related to opioid prescriptions have caused the trend to reverse its direction. National organizations call for providers to stay clear of opioid medication and increase the use of nonpharmacological pain management, but also to treat pain adequately. There are still many barriers to decreasing the use of opioids and increasing the use of nonpharmacological methods. This scholarly project hoped to use an educational flowsheet to assist providers in meeting the demands from national organizations to decrease the use of …

Pediatric Primary Care Concussion Evaluation And Management, Kaitlyn Layman

Doctoral Dissertations and Scholarly Projects

Concussions are an important and timely subject, especially within the pediatric population, as they are the most involved in extracurricular contact sports and are susceptible to concussions and their sequelae. The researcher performed a quasi-experimental pilot study in a pediatric primary care office where the researcher educated 15 providers on the HEADS UP concussion screening tool and management approach. The researcher gave providers pre- and post-intervention surveys to determine if providers’ comfort and knowledge regarding assessing and managing concussions within the pediatric primary care setting changed. Four providers participated in the study. The researcher conducted a chart review two months …

Implementation Of A Screening Protocol To Improve Provider Assessment Of Depression In Patients With Psoriasis, Marlee Bryant

Doctoral Dissertations and Scholarly Projects

Patients with psoriasis are at an increased risk for depression. Despite this risk, many dermatology care providers do not screen for depression in practice, including providers at the target practice for this project. This evidence-based practice pilot project was purposed to increase dermatology providers’ assessment of depression in patients with psoriasis. This project involved implementing a depression screening protocol at one private dermatology practice and educating providers on the use of the protocol including the embedded depression screening tool, the Patient Health Questionnaire-9. The project leader used a quasi-experimental design and collected data utilizing retrospective chart reviews completed pre- and …

Increasing Advance Care Planning In The Primary Care Setting, Nicole Marie Coffey

Doctoral Dissertations and Scholarly Projects

Evidence shows the many benefits of advance care planning (ACP) discussions, including; giving patients peace of mind, decreasing healthcare costs, increasing quality of care, and decreasing distress at the end of life. Due to the many proven benefits of ACP, the United States Department of Health and Human Services as well as many leading national health organizations are promoting ACP, even tying it to reimbursement. The best setting and time to initiate ACP is in the primary care setting as early as possible, before patients have any cognitive decline. In this context, patients have an established relationship with their provider, …

Telehealth And Diabetes Self- Management Education And Support For Improving Health Outcomes In Adults With Type 2 Diabetes: An Integrative Review, Monica Allen

Doctoral Dissertations and Scholarly Projects

With the increasing problem of access to health care, telehealth is an evidence-based service that uses a variety of technologies to provide quality healthcare. The use of telehealth services improves self-efficacy, self-management, and glycemic control in adults with type 2 diabetes mellitus after adults receive Diabetes Self-Management Education and Support (DSMES). Type 2 diabetes is the most common form of diabetes. If not self-managed, adults with type 2 diabetes are at increased risk of complications, which can be serious, costly and deadly. This integrative review provides an appraisal of the evidence published regarding the use of telehealth for the management …

Nursing With The Heart Of Christ, Gwen E. Boda

Senior Honors Theses

Within the nursing profession it is necessary for the nurse to learn to have love, compassion, joy, peace, patience, humility, and integrity within his/her character. After reviewing numerous peer reviewed journals and personal examples, the following paper reveals how these traits – love, compassion, joy, peace, patience, humility, and integrity – are beneficial within the nursing profession. The paper defines the mentioned characteristics, shows how they can be used and implemented within the nursing practice, demonstrates how their implementation leads to greater patient care, and then compares these traits and actions to the character and person of Christ.

The Impact Of Diabetes Mellitus On Burns And Standard Burn Treatments, Emma Shepard

Senior Honors Theses

Burns are complex injuries that trigger the stress response and result in increased blood glucose. Diabetes mellitus, an endocrine disorder with abnormal glucose regulation, can significantly alter the risk for burns and the treatment of burns. Pre-existing diabetes mellitus complicates burn treatments and healing ability. Diabetes mellitus may also develop directly from an unregulated stress response to the burn. The consideration of diabetes mellitus affects wound care, medications, and nutrition for burn patients. As patient advocates, nurses are responsible for caring for burn patients with awareness of endocrine complications. This paper provides a detailed overview of the pathophysiology, complications, and …

Maternal Obesity And Fetal Macrosomia: An Integrative Review Of The Literature Regarding Interventions, Charity Stalcup

Senior Honors Theses

Research suggests pre-pregnancy obesity is associated with an increased risk of macrosomia in the newborn. Since women are expected to gain weight during pregnancy, the standard recommendation of weight loss for obesity is not ideal for this population. In this systematic review of the literature regarding interventions for maternal obesity to reduce fetal macrosomia, 149 articles were screened using three different databases to identify recent randomized controlled trials related to this topic. A total of 11 full text articles were analyzed and included in the review. The articles addressed nutritional, lifestyle, and pharmacological interventions. The results indicated there is currently …