Nursing Commons^™

Critical-Care Pain Observation Tool Benchmark Project, Rachel Lutz

MSN Capstone Projects

Background: Pain in the nonverbal adult patient is often misdiagnosed and undertreated. Patients who are unable to communicate pain does not indicate that pain is not present. With the majority of critical-care patients being hemodynamically unstable leaving pain untreated can have detrimental effects on already unstable hemodynamics thus affecting patient outcomes. Research has indicated that patients who have accurate pain management with appropriate analgesia and minimal sedation can help decrease ventilator days, improve patient’s mobility, and help decrease the rate of delirium and length of stay in the intensive care unit (ICU) (Bourbonnais et al., 2016).

Aim: This benchmark project …

Oncology Nurse Compassion Fatigue Benchmark Project, Jessica R. Hayward

MSN Capstone Projects

Oncology nurses provide care to patients during some of the toughest times in their lives. This care places nurses at risk of developing compassion fatigue which can have negative long-term health impacts. There is currently no formal compassion fatigue education offered to oncology nurses. This lack of training leaves nurses vulnerable to the impacts of unmanaged stress, burnout, and compassion fatigue. This benchmark project was completed to bring awareness to the need for a mindfulness-based compassion fatigue course. This course will provide oncology nurses with the knowledge and skills necessary to manage these difficult emotions.

Managerial Competence Of First-Line Nurse Managers In Public Hospitals In Indonesia, Joko Gunawan, Yupin Aungsuroch, Mary L. Fisher, Anna M. Mcdaniel, Colleen Marzilli

Nursing Faculty Publications and Presentations

Purpose: Working as a first-line nurse manager requires high managerial competence as an essential component in the delivery of health care. Therefore, factors that influence managerial competence warrant examination. The aim of this study was to identify factors associated with managerial competence of the first-line nurse managers using the best-fit model of human resource management framework. Methods: A cross-sectional study was conducted. A total of 247 first-line nurse managers from 18 public hospitals in Indonesia participated. Data on managerial competence and its related factors were collected via validated questionnaires. Results: The five factors of managerial competence were identified - performance …

The Influence Of Empowerment On The Development Of Compassion Fatigue In Oncology Nurses, Franklin J. Wynn

Nursing Theses and Dissertations

Compassion fatigue is a growing issue in the oncology nursing population that has implications on outcomes such as job satisfaction and intention to leave a job. With an increased need for nurses nationally, compassion fatigue needs to be further studied to identify solutions that support the retention of the oncology nursing workforce. The concept of empowerment has been favorable in leading to proactive workplace behaviors and attitudes. However, literature showed underrepresentation of this variable in relationship to compassion fatigue. A program of research in connection to these variables is provided. A comparative concept analysis on burnout and compassion fatigue is …

"Fish In A Barrel": Workplace Violence And Posttraumatic Stress Symptoms Among Psychiatric Nurses, Sheila M. Herrera

Nursing Theses and Dissertations

This work explores the psychiatric nurses’ experiences of workplace violence perpetrated by psychiatric patients. Working with patients with psychiatric disorders can be challenging. Violent behaviors can sometimes escalate and lead to coercive measures such as physical restraint or seclusion. The first manuscript in this portfolio, To Use or Not to Use: Physical Restraint in Adult Psychiatry, will present evidence for and evidence against the nurse’s conscientious objection to follow the doctor’s order to restrain the patient after the patient immediately stopped the aggressive behavior. The second manuscript, Workplace Violence Interventions for Psychiatric Nurses, discusses different interventions for psychiatric …

Promoting Recognition And Rescue: Human Trafficking Screening, Erin E. Pittman

MSN Capstone Projects

The exploitation of human beings is a serious public health concern (Centers for Disease Control [CDC] 2018). The United States Department of Justice (2018) defines human trafficking as an act of coercing a person’s labor services or commercial sex acts. Family Nurse Practitioners play a significant role in the identification of victims, especially those practicing in emergency departments. A majority of healthcare providers have yet to establish a standardized screening tool and there is little evidence regarding the impact these screening tools have in recognizing victims of human trafficking (Emergency Nurses Association, 2018). This alarming information brings about the clinical …

Nurse Practitioner Intervention In Palliative Care Settings, Lacie N. Harris

MSN Capstone Projects

Palliative care is a specialty of healthcare that focuses on chronic and severe disease. As chronic disease continues to rise annually related to genetics, sedentary lifestyle, and environmental factors, the need for interventions will increase to meet demands of patients, families, and organizations. Therefore, implementation of a nurse practitioner in the palliative care setting is ideal for optimal patient outcomes.

Non-Physician Led Hypertension Management, Poupak Moshayedi

MSN Capstone Projects

The importance of controlling and better management of hypertension cannot be overemphasized, and the need for task sharing and multidisciplinary approach has never been more significant than in chronic conditions like hypertension. With many complications that it causes and with the many classes of drugs that we have in controlling blood pressure, having only 24 percent of people being controlled shows a break in knowledge and patient care. The gap can be filled with nurse involvement and taking more ownership and responsibility in tackling high numbers with interventions that are proven to work. Getting patients involved and following up with …

Massage Therapy For Agitation In Dementia Benchmark, Ashley Salyer

MSN Capstone Projects

Dementia is a progressive disease that eventually results in cognitive and functional decline as well as behavioral and psychological symptoms. Age is a significant risk factor for dementia and due to an increase in longevity, the number of people with dementia is rising. Expanding research on dementia and management interventions should be a priority due to the nature of the disease, its impact on healthcare, and its emotional effect on both the individual and family. Over prescription of medication for behavioral and psychological symptoms in dementia has been identified as problem in long-term care facilities. The current practice at many …

Decreasing Bias And Improving Education On Non-Invasive Colorectal Screening Methods, Sara H. Hughes

MSN Capstone Projects

It is estimated that in 2020, nearly 148,000 Americans will be diagnosed with colorectal cancer and 53,200 Americans will die from colorectal cancer (Siegel et al., 2020). One- half of all cases and deaths are due to modifiable risk factors such as diet and smoking and it has been shown that early screening and detection can greatly decrease the morbidity and mortality of colorectal cancer yet colorectal cancer related deaths still ranks among the leading causes of cancer-related deaths in the United States and the world. Early detection of colorectal cancer is crucial to reducing mortality and although this is …

Understanding End-Of-Life Care Experiences Of Baccalaureate Mexican American Nursing Students: An Interpretive Phenomenology Study, Shalla M. Copeland

Nursing Theses and Dissertations

Although education is an important factor regarding competent end-of-life care, varying educational strategies occur within pre-licensure nursing curricula without evidence as to what strategy is most effective for the learner. The aim of this study was to generate a holistic understanding of Mexican American baccalaureate nursing student experiences of providing end-of-life care and to solicit experience-based approaches to adequately prepare those students to care for dying persons. An integrative review of the literature was completed to summarize the current evidence of pre-licensure nursing educational strategies that affect nursing students’ attitudes toward care of the dying. A concept analysis of a …

Music Therapy In The Nicu, Chandler Tice

MSN Capstone Projects

This paper discusses the importance of implementing the use of music therapy in the NICU. Preterm infants experience procedures that cause stress, overstimulation, and a change in vital signs. The use of music therapy aids in protecting preterm infants. This paper discusses the implementation and evaluation process and the benefits, cost, and literature associated with this change.

Intravenous Catheter Antiseptics To Prevent Infections, Tiara Ford

MSN Capstone Projects

This presentation focuses on finding the most effective antiseptic to preventing intravenous catheter related infections (CRI). There have been many antiseptics used over the years for cleaning the site before insertion, during maintenance, and removal. But there still have been cases of CRI that are costly to hospitals, outpatient settings, and patients. In this benchmark study there have been 12 research articles that have been intensely reviewed to come up with own conclusion, the best antiseptic. Chlorhexidine has been found to be the most effective according to the 12 research articles compared with other antiseptics. The presentation is comparing chlorhexidine …

Patient Controlled Fluid Restriction Monitoring, Christina Tindel

MSN Capstone Projects

Patients are often placed under non-pharmacologic orders such as fluid restrictions during their hospital stay. The following article will discuss a plan to implement a change to have patients take a more active role in their plan of care by being the main ones to monitor their fluid intake.

Structured Discharge Education: A Benchmark Study, Michaela E. Place

MSN Capstone Projects

Patient satisfaction is a topic of interest in many clinical settings. There are many ways healthcare providers can attempt to promote patient satisfaction. One of the most important is to ensure comprehensive discharge instructions are given to patients, especially in the emergency department (ED). One particular study found that in patients discharged from the emergency department, approximately one-fifth experience negative health-related issues that result in readmission or return visits to the ED in the month post-discharge (Campione, Smith & Mardon, 2017). “To reduce the readmission rate, various discharge planning and patient education programs have been provided to the patients preparing …

Start Stop-Bang, Valerie D. Reeve

MSN Capstone Projects

Currently standard of care in the perioperative unit is not conducive when caring for patients with obstructive sleep apnea (OSA). OSA is highly prevalent and often undiagnosed. Screening patients with a STOP-Bang questionnaire is quick, effective, and cost efficient. OSA is linked to poor postoperative outcomes. Patients at high risk for OSA often encounter complications such as: additional airway management, respiratory complications, cardiovascular complications, and increased length of stay. Screening creates awareness and identification of patients at risk for postoperative complications.

Physical Activity For Rheumatoid Arthritis Patients: Benchmark Study, Lauren Nicholson

MSN Capstone Projects

Rheumatoid arthritis (RA) is an autoimmune inflammatory condition that affects the joints; without proper treatment and management, RA leads to the destruction of joint function. The standard of care for RA includes medications such as biologic therapy and disease-modifying anti-rheumatic drugs. An often-overlooked area of disease management is the implementation of exercise programs for patients with RA. Exercise is known to decrease systemic inflammation, symptoms of depression, and combat fatigue – all common symptoms reported by patients with RA.

Standard of care for patients with RA does not currently include lifestyle management factors such as diet, exercise, and cessation of …

Pcos Lifestyle Management Change Project, Elizabeth King

MSN Capstone Projects

This paper proposes the Lifestyle Modification Change Project to help fulfill this lack of education and emphasis on lifestyle modifications that occurs with patients diagnosed with PCOS. This change project would include a 16-week lifestyle modification program that would evaluate pre- and post- participation data including: BMI, weight, inches, testosterone levels, menstrual cycle regularity numbers, and quality of life questionnaire.

Honey For The Diabetic Foot Ulcer: Alternatives In Wound Care, Hannah Esther Campbell

MSN Capstone Projects

A literature review was conducted over the available articles surrounding the use of honey in wound care for chronic diabetic foot ulcers. Medical-grade honey bandages have been found to have many properties that can enhance wound healing, and honey dressings were found to promote faster healing times than several alternatives. A benchmark project was conducted to delineate the process for application of research and implementation of practice change in a healthcare facility.

New Graduate Nurses Experiences During Their Transition From Novice To Competent And How Mentorship Post Residency Affect Their Experiences, Kelsey N. Murphy

MSN Capstone Projects

Staffing competent nurses in specialized areas poses a unique challenge to hospitals across the country. Competent and experienced RNs are leaving the bedside for a multitude of reasons including dissatisfaction in workplace environment, retirement, and hospitals are facing a shortage of skilled nurses in acute care (Valdez, 2008). To address this growing concern and meet increasingly complex health care demands, hospitals are relying on nursing schools to produce competent graduate nurses (GNs) (Valdez, 2008). Hospitals recruit and hire GNs for highly specialized roles in acute care areas despite the stressors accompanied with these roles. Clinical educators have the opportunity to …

Therapeutic Hypothermia, False Hope In Cooling, Katherine Zuniga

MSN Capstone Projects

According to the American Heart Association (2018), every year 356,000 people suffer from cardiac arrest. In the vast majority of these cases, the patient is unable to be resuscitated. However, for the individuals for whom Return of Spontaneous Circulation (ROSC) is achieved, the AHA recommends targeted temperature management or therapeutic hypothermia. TH is the process of cooling a comatose person in hopes of preserving neurological function. However, despite this intervention, many still perish or do not retain their prior level of function. In post cardiac arrest patients, what is the effect of therapeutic hypothermia compared to maintaining normothermia on patient …

Workplace Violence In The Emergency Department: Screening With The Stamp Assessment, Adrienne Wilson

MSN Capstone Projects

Health care workers experience significantly more injuries at work due to violence than workers in all other industries, with a particularly higher risk to health care workers in Emergency Departments (EDs) (Copeland & Henry, 2017, p. 65). Following a violent event, 94% of nurses experienced one or more symptoms of post-traumatic stress disorder, which have a significant relationship with work productivity (Gates et al., 2011, p. 59). Workplace violence (WPV) events are linked to poor staff retention, poor quality of care, increased staff burnout, and patient/visitor dissatisfaction (Renker et al., 2013).

These issues can be addressed with a simple screening …

Awareness Of Dying And Conflict Resolution: Texas Asian Perspectives, Gloria Duke, Charlotte Wood, Lobsang Tenzing

Nursing Faculty Publications and Presentations

Individuals in the end-of-life (EOL) period may not be fully aware of their prognosis or know they are facing a terminal illness. As Asian beliefs and cultural tendencies intersect with Western values, health care practitioners may find their assumptions about disclosing an EOL prognosis differs from patients and their family members. Disagreements among family members regarding the disclosure of EOL to their terminally ill loved one can result in conflict--making difficult and sensitive times more burdensome. Little scientific evidence is known about first generation Asians who live in the United States (US) regarding their practices with disclosing EOL and how …

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 …

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 …

Patients' Disclosure Of Sexual And Gender Minority Status: A Comparative, Multiple Case Study, Damon B. Cottrell

Nursing Theses and Dissertations

This work explores the healthcare and related experiences of sexual and gender minority (SGM) people. This population faces unique challenges in addressing their health needs. In the context of these challenges, the health outcomes are often poorer than those of heterosexuals. SGM subpopulations experience unique disparities making healthcare needs more complex and necessitating an understanding of SGMs’ being. Essential to addressing SGMs’ healthcare needs is the healthcare provider’s (HCP’s) knowledge of sexual and gender minority status. The first manuscript in this portfolio dissertation, Fostering Sexual and Gender Minority Status in Patients, provides an overview of the issues surrounding disclosure to …

Dnp Final Report: Pressure Injury Prevention Patient Initiative (Pippi), Melissa A. De Los Santos

DNP Final Reports

Background: Pressure injuries have been known to affect approximately 2.5 million patients each year, with roughly 60,000 patients dying as a direct result of a pressure injury. Associate healthcare costs are between $9.1-$11.6 billion per year in the United States. The cost of individual patient care was estimated between $20,900 and $151,700 per pressure injury. During the last three years, pressure injury prevalence has risen within the local long-term care organization. Pressure injury prevention interventions have been developed to improve healthcare outcomes, cut costs, and increase revenue for long-term care organizations.

Purpose: Deliver evidence-based educational intervention that incorporates strategies for …

Dnp Final Report: Sedation Protocol Compliance For Improved Outcomes In Intensive Care, Sonya M. Grigsby

DNP Final Reports

Background: Current evidence-based practice guidelines show that lighter sedation reduces mechanical ventilator days (MVD) and intensive care (ICU) length of stay (LOS). Guidelines (2018) for the management of pain, agitation, delirium, immobility, and sleep were released to direct appropriate high-quality care to achieve positive outcomes. However, studies demonstrated there were barriers to compliance of these guidelines.

Objective: To improve compliance with an existing evidence-based sedation protocol in an intensive care, and, thereby, improve patient outcomes (MVD and ICU LOS).

Methods: The three-month quality improvement (QI) project evaluated processes leading to compliance with the guideline. First, nurses were surveyed to determine …

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: …

Dnp Final Report: The Flipped Classroom: An Evidence-Based, Course Redesign To Increase Retention Rates In A Vocational Nursing Program, Jennifer P. Hauger

DNP Final Reports

Over the past three decades, Vocational Nursing has been taught using a conventional didactic method that is content heavy and lecture focused. Despite having a group of highly qualified professors and an excellent student pass rates on the National board examinations, student retention in a Vocational Nursing Program in central Texas remains below the National benchmark. With a unique student demographic that is identified as non-traditional (over 21, full-time working adults, English Second Language and single parents), we embarked upon the redesign of a Medical-Surgical Nursing course using the flipped pedagogical framework to increase retention rates. Therefore, in 2019 we …