Nursing Commons^™

Reducing Inpatient Falls Utilizing Multimodal Standardized Patient Education: An Evidence-Based Practice Project, Sheryl Almandrez

Doctor of Nursing Practice Final Manuscripts

Purpose of Project: This project aims to utilize multimodal standardized patient education as an evidence-based practice intervention to reduce inpatient falls.

Background: In 2022, Kaiser Foundation Hospital (KFH) San Diego had 116 falls. Inpatient falls with injury account for the second-highest Joint Commission (TJC) sentinel event and California Department of Public Health (CDPH) adverse events. These injuries include lacerations, subdural hematoma, subdural hemorrhage, hip fractures, and wrist fractures. The Centers for Medicare and Medicaid Services (CMS) have also stopped reimbursing hospitals for the care provided after patients have sustained a fall with injury.

The project was implemented at KFH-San Diego …

Lost In Interpretation: The Lived Experience Of Nurse Interpreters In The Clinical Setting, Byron Batz

Dissertations

The use of language interpreters in the health care setting constitutes a vital part of provider-patient communication but remains a relatively unexplored phenomenon. Registered nurses (RNs) are often called upon to serve as interpreters when linguistically diverse patients constitute a large segment of the patient population. That RNs serve simultaneously in an interpreter role – in addition to clinical and advocacy roles – is a complex facet of contemporary nursing practice in a diverse U.S. culture. The purpose of this qualitative descriptive study was to examine the lived experience of RNs serving as interpreters in health care institutions in Southern …

Implementation Of Clinical Institute Withdrawal Assessment: Alcohol Revised (Ciwa-Ar) Education Program In A Crisis Stabilization Unit, Amanda Dehart

Doctor of Nursing Practice Final Manuscripts

Background: At this time the crisis stabilization Units do not currently utilize the Clinical Institute Withdrawal Assessment: Alcohol Revised tool with patients who may experience Alcohol Withdrawal Syndrome. Patients with alcohol use disorders have a high comorbidity rate with psychiatric disorders (Butterfield, et al, 2020). The Clinical Institute Withdrawal Assessment: Alcohol Revised or CIWA-Ar is currently the most widely used assessment tool in the psychiatric setting when assessing patients who may be experiencing Alcohol Withdrawal Syndrome (Pribék, et al, 2021) .

Purpose of Project: The purpose of this project is to measure pre and post -education knowledge of the registered …

Remifentanil Patient Controlled Analgesia Use In Laboring Women: A Feasibility And Acceptability Study, Joshua Carr

Dissertations

Background/Purpose: Interest in remifentanil patient controlled analgesia (RPCA) as a treatment for labor pain has increased due to its unique pharmacodynamics and effectiveness on pain control among parturients. Despite its promise, RPCA remains infrequently used in the US. The purpose of this study was to 1) examine the implementation and acceptability of a new RPCA protocol in the labor and delivery ward of a mid-sized hospital, and 2) identify the attitudes and beliefs of healthcare workers in a real-world clinical setting.

Theoretical/Conceptual Framework: The holistic nature of Comfort Theory can account for the proposed mechanisms contributing to the …

Econsent Forms On Ancillary Applications With Electronic Medical Record Integration – Reducing Consent Error, Lilian Chan

Doctor of Nursing Practice Final Manuscripts

Purpose of Project: The purpose of this project is to utilize electronic consents (eConsents) with ancillary applications as an evidence-based intervention to reduce consent errors.

Background: Studies show that paper-based handwritten forms have an error rate of up to 50%. Consent errors, especially in the preparation of surgery, are not merely documentation errors but patient safety pitfalls that allow for incorrect surgeries or financial loss due to aborted or delayed interventional cases. Internal organizational evidence indicates the implementation of an evidence-based opportunity as there was no use of electronic tools for consents utilized in the inpatient setting.

Methods: Inpatient departments …

When "First, Do No Harm" Fails: A Restorative Justice Approach To Workgroup Harms In Healthcare, Pedro L. Flores

Dissertations

In healthcare, workgroup mistreatment is a pervasive problem that begins during medical education (medical and nursing school) and becomes embedded in the “hidden curriculum of professionalism,” which dissuades and even punishes learners for talking about abuse they witness. Furthermore, the mistreatment of healthcare providers (HCPs) pervades all disciplines in the healthcare delivery chain due to a combination of cultural factors, systemic pressures, dysfunctional hierarchies, and leadership’s tolerance of intimidating and disruptive behaviors. Not surprisingly, 18% of U.S. HCPs have left the medical field since the start of the COVID-19 pandemic, and burnout, stress, anxiety, and increased workloads have been identified …

Efficacy Of Telehealth Modalities In Medication Adherence For Older Adults, Mitchell Adrian C. Siy

Doctor of Nursing Practice Final Manuscripts

About half of the geriatric population who take at least one medication find medication adherence challenging. Average adherence of an elderly patient taking one medication a day is about 80%. This adherence decreases to about 50% for patients taking medications four times a day. Nonadherence can lead to a myriad of preventable adverse effects that can reduce the quality of life and even result in death. In the United States, $100-300 billion could be saved in health care costs due to adverse effects of poor medication adherence. The purpose of this evidence-based project (EBP) is to improve medication adherence in …

Establishment Of Best Practice Skills For Advanced Practice Nurses, Leslie Kendrick, Tara Hughes, Joseph Burkard Dnsc, Crna

Doctor of Nursing Practice Final Manuscripts

Over the past two decades, nursing researchers have defined nurses’ perceptions of evidence-based practice as well as facilitators and barriers to its implementation . This project seeks to take the next step through a current assessment of registered and advanced-practice nurses’ assimilation of evidence-based practice as well as a current literature review of the research to clinical use gap. This is a cross-sectional, retrospective project. Through analysis of two self-administered questionnaires to both registered and advanced-practice clinical nurses as well as literature review findings, five recommendations for advanced-practice nurses were created. Ultimately, the goal of this project seeks to establish …

Utilization Of Peer-Led Education To Enhance Advance Care Planning And Advance Directive Completion, Jenna Juenger

Doctor of Nursing Practice Final Manuscripts

Background: The integration of advance care planning (ACP) and palliative care (PC) into oncology plays a critical role in symptom management and quality of life. Studies reveal a large subset of oncology patients with unmet needs regarding ACP and advance directive (AD) completion. Successful ACP helps to promote congruent medical treatment with patients’ values and preferences and motivates patients to complete ADs.

Objective: An evidence-based practice project was conducted to assess the effectiveness of peer-led education to nursing staff to improve ACP and AD completion among inpatient oncology and PC patients

Design: A standardized survey created from the …

The Use Of Clinical Decision Support To Improve Nursing Practice, Kathleen Klimpel

Dissertations

Healthcare information technology is solidly entrenched in most acute care hospitals but the need to demonstrate its positive impact on patient outcomes persists. Clinical decision support (CDS) is an informatics tool that is highly customizable to promote patient improvement activities. Despite its high potential, studies have had mixed results regarding the impact of CDS and it has not been widely studied in the realm of nursing practice. One aim of this dissertation was to analyze the concept of CDS in order to inform the examination of the relationships between CDS implementation and nursing interventions. The determining factors of nurses use …

Older Adults’ Implementation Of Discharge Instructions Following An Acute Care Hospital Stay, Brenda Miller

Dissertations

Discharge instructions are a self-care guide for patients after discharge from an acute care hospitalization. The discharge process starts on admission to the hospital and continues until discharged. Many patients rely on informal caregivers to provide support after a discharge. However, it is often unclear whether the patients or caregivers completely understand instructions provided during the discharge process. Key concepts related to how discharge instructions were implemented following discharge to home have been understudied from the patient’s and informal caregivers’ perspectives. Developing effective discharge instructions based on study findings may assist in reducing 30-day hospital readmission rates.
This study was …

Timing Is Everything: Discharge Teaching To Parents In Pediatric Outpatient Surgery, Kate Boulder Dnp Candidate, Ccrn, Joseph Burkard Dnsc, Crna

Doctor of Nursing Practice Final Manuscripts

Background: Over 50 years of literature support the nursing “golden rule” that discharge teaching begins upon admission. Parents’ poor understanding of pediatric post-operative instructions following outpatient day surgery can put their child at risk for some preventable complications after arriving home.

Purpose: To improve parents’ understanding of discharge education using earlier initiation of post-operative teaching to best meet the needs of adult learners caring for a child under age 18 after surgery.

Process Used: Parents were educated using four cardinal strategies: early initiation of instructions, reinforcement of key points throughout the length of stay, optimal timing in a distraction-free environment, …

Onsite Integrative Clinics: Acupuncture, Positive Patient Outcomes, And Frequency Of Provider Office Visits, Sherry Shoemaker Phd

Dissertations

Purpose and Aims. There is limited information about outcomes of care, resource utilization, and associated costs for patients who receive acupuncture in integrative health settings. The purpose of this study was to address this gap through the following aims: To examine: (1) changes in patient pain levels pre/post acupuncture treatments; (2) relationships between receiving acupuncture treatments (number of treatments, length of time, select demographic factors, (age, gender), pain level pre and post acupuncture treatments; (3) relationships between number of treatments, length of time, age, gender, pain level (pre/post acupuncture treatments) and provider visits (pre/post acupuncture treatments); and (4) relationship between …

Exploring A Diabetic Registry For Cardiovascular Risk Factors, Mary C. Anziano Phd

Dissertations

Background: Cardiovascular disease is the leading cause of death in the United States. There were over 18 million people diagnosed with diabetes in 2002. These disease processes together combine for significant health burden on society (American Diabetes Association, 2008). The purpose of the study was to describe the relationship between select demographics, and clinical characteristics to determine risk factors for cardiovascular disease in a diabetic population. Methods: A retrospective descriptive study was conducted using a diabetic registry database containing patients diagnosed with diabetes from January 1, 2011 to December 31, 2012. Study variables included age, gender, socio-economic status, glycosylated hemoglobin …

The Case Of Reintegration Of Women Post Incarceration, Deana Raley Noble Phd

Dissertations

Women released from prison or jail face particular obstacles and challenges on reentry to the community, many of which are related to their childhood and to gender roles as women and mothers. This study relates the lived experience of one woman's successful transition to economic and mainstream societal reintegration and family reconnection after release from prison and the insights gained by the researcher. Case study methodology congruent with Miller's Relational-Cultural Theory philosophical framework was utilized in this in-depth, single case design and represents a unique case. The overall purpose of this descriptive and explanatory research was to explore precursors to …

Relationship Between Age And Pre-End Stage Renal Disease Care In Elderly Hemodialysis Patients, Rubette Harford Phd, Msn, Rn

Dissertations

Purpose: The primary purpose of this dissertation was to examine the relationship between age and receipt of three components of pre-end stage renal disease care prior to first initiation of hemodialysis, and to explore the implications of differences in interpretation of funding policies for dialysis services in Puerto Rico and the U.S. mainland. Background: The growing burden of chronic kidney disease (CKD) is a national public health concern, particularly within the aged population. It is estimated that more than 25 million Americans are living with some level of kidney disease, with an increasing prevalence noted with increasing age (Coresh et …

Symptom Burden And Healthcare Utilization In Pulmonary Arterial Hypertension, Catherina Anne Madani Phd

Dissertations

Background: Pulmonary arterial hypertension (PAH) is a rapidly progressive disease. There is currently no cure; thus treatment is aimed at prolonging survival, improving functional status (FS), and symptom mitigation. Symptom burden (SB) can impact quality of life (QOL), and lead to increased healthcare utilization. Palliative care (PC) has been associated with higher QOL, decreased depression, aggressive care, and mortality. The Institute of Medicine's (IOM) recent report supports earlier integration of PC for people living with serious illness. Detection of patients at high risk for heavy SB may help to identify patients who could benefit from earlier integration of PC into …

Depressive Symptomatology And Perceived Social Support In Adolescents With Type 2 Diabetes, Kristiana Gay Huffman Cullum Phd, Cpnp

Dissertations

Type 2 diabetes has increased dramatically in the pediatric population in the last decade. One of the comorbidities of diabetes is depression. In the presence of depression, diabetes may be mismanaged by patients and lead to a decline in health. Diabetes with comorbid depression may have better disease management outcomes in the presence of higher levels of social support. Defining childhood depression, which encompasses adolescence, and the subtleties of this disorder compared to the adult counterpart, was needed to better delineate important variables for this research study. There are several instruments that evaluate adolescents' perceived social support, but a fairly …

Patients With Advanced Lung Cancer: Quality Of Life And Perception Of Dyspnea, Barbara A. Roces Phd, Msn, Np, Rn

Dissertations

Background: Dyspnea perception can be defined as a multidimensional experience of breathing discomfort, influenced by physiological, psychological, social, and environmental factors, that includes secondary psychological and behavioral responses and cannot be defined only by physical objective abnormalities (Mularski et al., 2010). Dyspnea is the most common and distressing symptom in patients with advanced lung cancer and decreases one's quality of life (QOL) (Smith et al., 2001). Furthermore, dyspnea has been found to interfere with physical activities such as walking, work, and psychological activities such as disposition, taking pleasure in life, relationship with others, and sleep (Tanaka, Akechi, Okuyama, Nishiwaki, & …

Patient Care Technology And The Nurse-Patient Relationship, Belinda M. Toole Phd, Msn, Rn

Dissertations

Background: Technological devices are increasingly used in healthcare and their proliferation has providers questioning the impact on the patient-provider relationship. Technological device integration has been studied in the primary care setting, less extensively in the acute care setting. The impact of device use on the nurse-patient relationship in acute care setting required further study, particularly with nursing's history of holistic practice incorporating caring and presence. Objectives: The study purpose was to explore the patient's perceptions of nurse caring and presence when technological devices were used in care delivery in the acute care setting. Specific aims were: 1) to describe the …

Skin Cancer Risk Perception And Sunscreen Use In Adolescent Female Soccer Athletes, Cheryl L. Butera Phd, Msn, Aprn, Fnp-Bc, Np-C, Phn

Dissertations

Over 3.5 million cases of skin cancer are diagnosed annually in the United States. In adolescent females ages 15-19, melanoma is the second most common form of cancer. The greatest risk factor for skin cancer is ultraviolet rays from the sun. Research has shown that sunscreen use is protective of all skin cancers, especially melanoma. The purpose of this study was to obtain perceptions about risk of skin cancer and sunscreen use among 13- to 18-year-old adolescent female club soccer athletes as a basis for effective interventions to improve sunscreen use in this population. The Health Belief Model was employed …

Nurse Practice Environment And Peripheral Intravenous Infiltrations In A Pediatric Hospital On The Magnet Journey, Jannise Topacio Baclig Phd

Dissertations

Background: Characteristics such as quality patient care, excellence in nursing, and innovations in professional nursing practice shape a health care organization into a "magnet" organization. Magnet designation is a key aspect of nursing, which places pressure on healthcare organizations to commit to nursing excellence and patient care should they take the challenge of attaining this prestige. With growing focus on quality and safety, nursing needs to remain diligent in ensuring a healthy work environment that not only supports the profession, but also sustains exceptional patient outcomes. The purpose of this research study was to describe the relationship of the nurse …

Is Combat Exposure Predictive Of Higher Preoperative Stress In Military Members?, Eric J. Bopp Phd

Dissertations

Since September 11, 2001, the United States has been engaged in large-scale combat operations exposing numerous military service members to stressful, traumatic, and threatening environments. As a result, many of these individuals have experienced significant psychological problems, such as anxiety, depression, and posttraumatic stress disorder (PTSD), as well as physiological alterations, such as cardiovascular changes and neuroendocrine disturbances. The preoperative experience may be perceived as stressful, often increasing in magnitude as the patient progresses through the preoperative period. Military anesthesia providers frequently provide anesthetic care to military members with a history of combat exposure. Anecdotally, it is not uncommon for …

Gestational Weight Gain Patterns, Hope R. Farquharson Phd

Dissertations

Background: Managing gestational weight gain (GWG) remains a global health priority as obesity among women of childbearing age and their children have been linked to excessive GWG. Excessive GWG has been linked to increased rates of cesarean sections, preterm births, hypertensive disorders, gestational diabetes, large for gestational age newborns, postpartum weight retention, long-term obesity for the woman and her children. Conversely, adverse outcomes resulting from weight gain below recommendation could potentially include preterm births, increased rates of neonatal intensive care admission, and newborn morbidity and mortality. Previous studies indicate the need for healthcare providers to help women gain within the …

Efficacy Of Mantram Repetition Program On Sleep In Veterans With Posttraumatic Stress Disorder, Lindsay Cosco Holt Phd

Dissertations

Posttraumatic Stress Disorder (PTSD) affects over seven million (3.5%) of the US adult population. In 2011, 476,515 veterans were currently seeking treatment for PTSD. Statistics show that 87% of veterans with PTSD report sleep disturbances and 52% experience frequent nightmares, making sleep the second most common reason why veterans seek mental health care upon return from deployment (Germain et al., 2006). Studies have sought to find a link between PTSD and sleep, and the importance of sleep in the recovery process, but there is a gap in the research on sleep disturbances and interventions for improvement in veterans with PTSD. …

Transitioning Adolescents With Type I Diabetes To Adult Care, Kathyann Kenny Marsh Phd

Dissertations

Background: Care transitions, defined as hospital discharge or movement from one healthcare setting to another, are currently a major concern for healthcare providers and policy makers alike. These care transitions are occurring in the context of increasingly fragmented care and have been known to result in hospital readmissions, adverse events, and medication errors. The adolescents' transition between pediatric and the adult care system is not only fragmented but occurs at a time when they are most vulnerable and ill equipped for change. Objectives: The purpose of this research was to conduct a feasibility study to examine if the use of …

Delirium Rate And Risk Factors In Palliative Care Outpatients And Caregiver Coping Strategies, Sarah Deur Livermore Phd, Fnp

Dissertations

Background: Delirium causes suffering and in terminal illness undermines important goals to die at home. Improved knowledge about delirium among palliative outpatients can lead to improved patient outcomes through early identification and treatment in the home. Conversely, a missed diagnosis leads to costly hospital admissions, and is the most common reason to seek long-term care placement (Breitbart & Alici, 2008). Medicare stresses the importance by listing it as a common cause of falls among non-reimbursed hospital events. Prior evaluation of outpatient delirium rate was 14% among demented community dwelling elders (Steis, Evans, et al., 2012a). It is hypothesized that frail, …

Identification Of Posttraumatic Stress Disorder Symptoms In Post-Icu Patients, Heather Warlan Phd, Rn, Ccrn

Dissertations

Background: Patients receiving critical care are experiencing post-traumatic stress syndrome (PTSS) as a result of life-saving interventions received in the intensive care unit (ICU). PTSS is associated with poor patient outcomes and decreased quality of life compared to post-ICU patients without PTSS. Personal and clinical characteristics that place patients at higher risk for PTSS are still being examined. It is also unknown to what extent patients are being screened for ICU-induced PTSS. Objectives: This body of work aims to examine the risk factors associated with ICU-related PTSS and describe the screening experiences of patients who recently received care in an …

Fetal Heart Monitoring, Nursing Surveillance, And Cesarean Birth, María Del Carmen Colombo Phd

Dissertations

Purpose: Birth by cesarean delivery is a major public health issue with nearly one in three births delivered by cesarean section. Cesarean birth may be necessary to save mother or baby, but the rapid rise since 1996 without concomitant reduction in maternal and neonatal morbidity and mortality may indicate this mode of delivery may be over utilized. Cesarean births pose significant maternal and newborn health risks. Identification of factors that may contribute to reduction in the first cesarean birth in low-risk women who are nulliparous, term gestation, with single fetus in head down position (NTSV) is a health priority. The …

Professional Quality Of Life And Emergency Department Nurses' Communication Patterns, Elvira Dominguez-Gomez Phd

Dissertations

The purpose of this mixed methods embedded design study was to examine relationships between compassion satisfaction, burnout, compassion fatigue/secondary trauma, and perceived levels of communication difficulty in emergency room nurses employed at a health care system. Quantitative data was collected from a purposive sample of 43 emergency room nurses using the Professional Quality of Life Scale (ProQOL), the Silencing Response Scale, and a demographic form. The study's embedded qualitative component was participants' experiences with traumatic cases in the emergency room. Qualitative data was collected via telephone interview with 10 emergency room nurses obtained from a subset of the original sample …