Nursing Commons^™

Evidence-Based Practice Guideline: Breastfeeding Support Of The Active Duty Servicewoman, Heidi A. Koslo

Walden Dissertations and Doctoral Studies

There is no policy on breastfeeding support of the active duty military servicewoman at the targeted military treatment facility, and no global policy serving active duty personnel applicable at the Department of Defense and Defense Health Agency (DoD/DHA) level to span across branches of the U.S. military. Nurses, as members of the most trusted profession, are often expected to know how to assist a mother in meeting her feeding goals. Creation of an evidence-based practice guideline (EBPG) for support of the active duty servicewoman in the military health system was the purpose of this project. The project was conceptualized within …

Education Toolkit On Restraint Reduction In The Intensive Care Unit, Sharon Watkins

Walden Dissertations and Doctoral Studies

The use of physical restraints in hospitals has been in practice for the better part of a century despite the many adverse effects it can have on patients. Socially, restraint use can strip the patient of their dignity in addition to their freedom. This evidence-based project was to build a toolkit to educate intensive care unit (ICU) nurses regarding the negative effects physical restraint use can have on their patients and to present alternatives to their use. Tools developed from prior research were included in the toolkit, and the Neuman systems model was applied to the overall education project. The …

Tool Kit To Address Communication On A Mental Health Unit, Carol L. Barclay

Walden Dissertations and Doctoral Studies

Effective communication by newly graduated, hired nursing staff is a significant issue affecting patient care on mental health units. The rising prevalence of mental illness in the United States has not only increased the healthcare burden, but has also affected the overall economy. The lack of training of new nursing staff regarding communication diminishes the effective recovery rate of patients, further increasing the burden to the healthcare field and the economy. A tool kit for newly graduated mental health nurses working on mental health units may help to improve communication skills and enhance patient safety and quality of care. Therefore, …

Addressing Bullying And Incivility Among Nurses, Caroline Holland Combs

Walden Dissertations and Doctoral Studies

For decades, nurses have experienced some form of bullying and incivility throughout their careers. Incivility contributes to behaviors that constrain the sense of empowerment among nurses and directly encroach upon Provision 6 of the American Nurses Association code of ethics, which addresses sustaining a moral environment and the need to create a contagious culture of respect that is free from uncivil behavior. The nature of this staff education project was to bring awareness to the bullying behaviors and incivility that exist within an organization’s culture by assessing for the incidence of bullying and by providing an educational program for the …

Evidence-Based Pediatric Diabetic Ketoacidosis Education, Sonya Sandhu

Walden Dissertations and Doctoral Studies

Pediatric patients with diabetic ketoacidosis (DKA) are a unique subset of patients who arrive to the emergency department (ED) for care, and differ from adults regarding symptomology, treatment, and adverse effects. Nurses who will encounter this patient population must have adequate knowledge and confidence to care for them, yet research continues to show a gap in practice. The purpose of this doctoral project was to determine if a staff education project would increase ED nurse knowledge and confidence in caring for pediatric emergency patients with DKA. Utilizing Kirkpatrick’s evaluation model, an evidence-based staff education program was formulated, reviewed by an …

Systematic Review Of Loss-Frame Messaging And Change In Health Behavior, Eddie Jean Simmons

Walden Dissertations and Doctoral Studies

Recent analysis estimates Type II diabetes affects 23.4 million people in the US. Approximately 30% of these patients are not in optimal control of their diabetes, raising risks for blindness, amputation, and cardiac disease. A gap in diabetes education practice is that traditional positive-framed messaging has not persuaded many patients to modify their self-management behaviors. There is a need for alternative ways to communicate the risks of not managing the disease to patients who may have different health beliefs. The purpose of this systematic review was to examine the best available evidence regarding the efficacy of loss-frame messaging when used …

Nurse Leaders’ Perspectives On Animal-Assisted Interventions, Samantha Vita Abate

Walden Dissertations and Doctoral Studies

Knowledge deficits and unfavorable attitudes are commonly cited barriers that prevent adoption of animal-assisted interventions (AAIs). Nurse leaders’ (NLs’) knowledge of and attitudes toward AAIs have not been well documented in the literature. The purpose of this study was to identify NLs’ perspective on AAI, including their usage, knowledge, and attitudes. This information may be helpful in overcoming common barriers to AAI usage. The theory of transformational leadership guided this 3-manuscript dissertation study, which included 3 studies on NLs’ use of AAIs, the relationship between NLs’ knowledge of AAIs and NLs attitudes toward AAIs, and the potential impact of AAI …

Improving Suicide Prevention In The Emergency Department, Crystal Hartis Andrews

Walden Dissertations and Doctoral Studies

Suicide is a leading cause of death and a significant public health problem in the United States, especially among the youth population. The wide variability of screening practices and limited educational programs for nurses in terms of identification and management of individuals at risk for suicide exists. The purpose of this project was to conduct a systematic review to identify evidence available in support of adequately preparing nurses to conduct suicide screening and inform suicide prevention efforts for youth in emergency departments. Results from the literature review were correlated to formulate recommendations for improving suicide screening practices through the provision …

Evaluating An Incentive Program To Improve Teamwork And Productivity In The Operating Room, Christopher Bejil

Walden Dissertations and Doctoral Studies

The operating room (OR) is a complex system that must run efficiently to remain profitable and of value to its multiple stakeholders who include the patient, surgeon, OR staff member, and hospital administration. The OR at the practice site struggled with teamwork and efficiency in the areas of first-case on-time starts, turnover time, and last-case out times, resulting in a less than favorable impact on the organizational bottom line. The practice-focused question asked if a performance-based incentive bonus program can improve OR efficiency in the department’s three major problem areas. Using Gittell’s relational coordination theory as a framework, the practice …

Pain Assessment Strategies For People With Cognitive Impairment In Nursing Home Settings, Meskelo Tsegaye Bobo

Walden Dissertations and Doctoral Studies

Assessment of pain in patients with a diagnosis of dementia or cognitive impairment continues to be underdiagnosed as there are no objective ways of assessing their pain. Available evidence also indicates that these patients are not receiving satisfactory pain management. Due to a lack of self-reporting of pain, accurate assessments of pain are challenging. This systemic review aimed to find a pain assessment strategy effective in identifying pain in patients with a diagnosis of dementia. Kolcaba's theory of comfort was used as the theoretical framework for the study. The databases of Medline, Cochrane Database of Systematic Reviews, Embase, and Cumulative …

Hiv/Sti Screening, Testing, And Prophylaxis Among Sexual Assault Survivors In U. S. Emergency Departments, Elizabeth A. Cita

Walden Dissertations and Doctoral Studies

Use of HIV screening/testing and prophylaxis has been found to be low in the general emergency department (ED) population. Less is known about the use of HIV/sexually transmitted infection (STI) screening, testing, and prophylaxis among sexual assault survivors who present to EDs. The main research questions asked whether there was a relationship between race, socioeconomic status (SES), geographic region, or age, HIV/STI, treatment, and prophylaxis among sexual assault survivors that present to U.S. EDs. This study was a secondary analysis of data collected in the NHAMCS years 2010 to 2016 and included 112 geographic primary sampling units, about 480 hospitals. …

Educating Registered Nurses On Decreasing Missed Care Events, Marie St. Clair Dixon-Brown

Walden Dissertations and Doctoral Studies

Abstract

Missed care or partially completed nursing care is a prevalent problem in healthcare with negative consequences for patients, nurses, and healthcare organizations. This project was developed to address a gap in practice by providing staff education regarding the current evidence about missed care along with practical evidence-based strategies to decrease missed care events. Kalisch’s missed nursing care model framed the project. The staff education program used a PowerPoint presentation with interactive discussion and role-play opportunities for nurse participants to engage in and employ strategies to prevent missed care events. A 10-item multiple-choice post-education quiz and 4-point Likert-type program evaluation …

A Guide For Effective Home Health Education, Dianne M. Nissen

Walden Dissertations and Doctoral Studies

Older adults afflicted with chronic conditions present a unique set of challenges for home health nurses. In addition to caring for many of the patient’s physical problems, patient education is needed to enable patients to manage themselves. Patient education focuses on complicated medication and treatment adherence, safety, and preventing complications. The purpose of this oral presentation and supplemental guide was to increase the knowledge and skills of home health nurses by formally preparing them for the responsibility of patient educator. The practice-focused question was whether the provision of education and a supportive guide for individualizing patient education would improve the …

Use Of The Smoking Cessation Power Plan In An Observation Unit, Joycelyn Kennedy Land

Walden Dissertations and Doctoral Studies

Of 34.2 million adults who use tobacco, nearly 50% of the population living in the United States, or 16.5 million people, have a smoking-related disease. The purpose of this DNP project, conducted on an observational unit located in an acute care hospital, was to address the evidenced-based practice gap of the limited use of assessing tobacco use and the initiation of a readily available smoking cessation power plan (SCPP) intervention by nurses and healthcare providers. The practice-focused questions were whether an educational intervention for nursing staff would increase use of the 3As assessment (Ask and record smoking status; Advise patient …

Improving Sedation Management In Mechanically Ventilated Patients, Jannette Lord

Walden Dissertations and Doctoral Studies

Abstract

In the intensive care unit (ICU), sedation management of the critically ill, mechanically

ventilated patient is a source of concern. Optimal sedation management is integral to

critical care practice, yet optimal levels of sedation are not consistently applied.

Suboptimal sedation carries significant risks for patients, as inadequate sedation or

oversedation may lead to prolonged ventilator days, ventilator-associated pneumonia

(VAP), extended length of ICU stay, and costs. The purpose of this quality improvement

(QI) project was to improve sedation management of mechanically ventilated patients by

improving staff nurses’ knowledge of and attitudes toward sedation management,

ultimately achieving a zero-ventilated associated …

Effects Of Short-Term Intensive Insulin Therapy In Type 2 Diabetes Mellitus Management, Ernest Mwathi

Walden Dissertations and Doctoral Studies

Diabetes is a chronic illness affecting millions of individuals in the United States and is the seventh leading cause of death. Most of the Type 2 Diabetes Mellitus (T2DM) patients manage their illness with non-insulin therapies resulting in inadequate glycemic control but there are times when they experience inadequate glycemic control and require short-term intensive insulin therapy (SIIT). Despite proven effectiveness of SIIT, there is a lack of research focusing on the effectiveness of clinical practice where providers revert their clients to non-insulin therapy after SIIT. The focus of this quality improvement (QI) project was to evaluate pre/post data and …

Professional Development For Nurse Educators, Samdaye Ramdial

Walden Dissertations and Doctoral Studies

At a large university on the outskirts of Toronto, Canada, there was an influx of students entering the nursing program. Therefore, the need arose for an updated, restructured, and professional development training guideline with current knowledge for nurse educators to achieve high quality learning and critical thinking. The purpose of this study was to explore professional development leaders’ perceptions of quality training guidelines for nurse educators. The conceptual framework of this study was Knowles’s adult learning theory. The research questions were centered on what professional leaders perceive to be quality professional development. A qualitative case study design was used in …

Staff Education On Depression Screening In An Outpatient Psychiatric Setting, Naiga Dohnji

Walden Dissertations and Doctoral Studies

Depression is among the common mental illnesses in the United States affecting 1 in 10 Americans. The U.S. Preventive Services Task Force recommended screening for depression irrespective of the risk factors. Yet, providers struggle to implement depression screening. Inadequate use of Patient Health Questionnaire-9 (PHQ-9) screening tool to identify and manage depression can lead to poor patient outcomes. PHQ-9 is valid and reliable tool used to diagnose depression and monitor treatment response. The purpose of this project was to develop, deliver, and evaluate an educational program for providers on the use of the PHQ-9 screening tool for the identification of …

Alternative Therapy For Veterans Diagnosed With Post-Traumatic Stress Disorder, Shannon Rae Hill

Walden Dissertations and Doctoral Studies

An increasing number of veterans diagnosed with post-traumatic stress disorder (PTSD) has led to an increased demand for treatment within the Veteran Affairs health care system. Presently, veterans diagnosed with PTSD receive psychotropic medications and intermittent therapy sessions. Nurses are challenged to educate veterans about other health care issues based on verbalized side effects from prescribed PTSD medications limiting veterans’ ability to focus. Identifying alternative treatment options may improve treatment choices, reduce side effects, and promote positive outcomes for veterans with PTSD. This systematic review provided evidence-based practice information by addressing whether alternative therapy such as biofeedback would improve the …

An Educational Activity For Primary Care Providers Treating Older Veterans With Sexually Transmitted Infections, Beatrice Fannie Grant

Walden Dissertations and Doctoral Studies

AbstractComprehensive sex education is an effective method of promoting sexual health. Because primary care providers conduct the initial health need assessment of veterans, it is important that providers understand how to approach the subject of sexual health and the prevention of sexually transmitted infections. The purpose of this evidence-based project was to implement and evaluate an educational activity for primary care providers. The health belief model was used as theoretical framework. This project was introduced to a federal primary care clinic in the Mid-Atlantic United States. Twenty-five participants completed a pretest prior to the start of the educational activity that …

Increasing Compliance With Sequential Compression Devices To Reduce Venous Thromboembolism, Randy Mcclain

Walden Dissertations and Doctoral Studies

Venous Thromboembolism (VTE) is a life-threatening complication. Approximately 900,000 people in the United States are affected by VTE with a mortality of 300,000 cases per year. Although potentially preventable, VTE remains the leading cause of hospital deaths in the U.S. The practice problem addressed in the Doctor of Nursing Practice (DNP) project was evidence of an increased incident of VTE events on a trauma surgical unit. The practice-focused question evaluated the extent to which a nurse-driven protocol for VTE prophylaxis could improve adherence to mechanical prophylaxis with sequential compression devices and compliance with nursing documentation. The purpose for the doctoral …

An Educational Activity For Primary Care Providers Treating Older Veterans With Sexually Transmitted Infections, Beatrice Fannie Grant

Walden Dissertations and Doctoral Studies

AbstractComprehensive sex education is an effective method of promoting sexual health. Because primary care providers conduct the initial health need assessment of veterans, it is important that providers understand how to approach the subject of sexual health and the prevention of sexually transmitted infections. The purpose of this evidence-based project was to implement and evaluate an educational activity for primary care providers. The health belief model was used as theoretical framework. This project was introduced to a federal primary care clinic in the Mid-Atlantic United States. Twenty-five participants completed a pretest prior to the start of the educational activity that …

Flipped Classroom Approach To A Critical Care Educational Program For New Graduates, Deborah Ann Smithers

Walden Dissertations and Doctoral Studies

Of the new graduate registered nurses hired to work in critical care areas, a few percent do not receive a formal critical care orientation. Furthermore, there is a high attrition rate of new graduates hired to work in high acuity patient care units. Many resign before their first work anniversary due to a lack of education and training. An initiative was put forth by critical care administration, at the study site, to critical care clinical leadership to significantly revise a critical care educational offering known as critical care core. The revision would allow for the satisfaction of the novice nurses …

Implementing A Diabetes Optimization Protocol For Elective Surgery Patients, Barbie Denise Harbaugh

Walden Dissertations and Doctoral Studies

Diabetes is a recognized risk factor for postoperative infection, acute renal failure, ileus, and lengthy hospital stay. Optimal screening, management, and scheduling of elective surgery for diabetic patients has been shown to improve quality care, decrease complications, and increase the efficiency and lower the costs of preoperative patient care. However, surgery cancellations are common due to inadequate preoperative glycemic control and poor intraoperative glycemic control, which is a recognized risk factor for perioperative or postoperative complications. There were no clinical practice guidelines or optimization protocols for elective surgery patients at a small rural hospital in the Northeast United States. The …

Cannabis As A Safer Alternative To Opioid Management Of Chronic Pain, Loren Nedelman

Walden Dissertations and Doctoral Studies

Chronic pain affects approximately 100 million American adults and costs the United States upwards of $635 billion each year in medical treatments and lost productivity. Opioid prescription for pain has increased exponentially over the past several years, with the CDC estimating 20% of prescriptions lasting longer than 3 months for patients with noncancerous pain. Opioid addiction has become a national public health crisis with mortality surpassing 100,000 deaths annually due to overdose. As States have begun to deregulate the use of cannabis and cannabis derivatives for medical purposes; oversight and regulation by the federal government on its use as a …

Improving The Ethical Use Of E-Health And Emr, Josephine Tafie

Walden Dissertations and Doctoral Studies

Improving the Ethical Use of E-health and EMR

by

Josephine Tafie

MS, Walden University

BS, Washington Adventist University

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

August 2020

Abstract

The healthcare industry is experiencing ethical problems with the integration of new technological applications, such as e-health and electronic medical records (EMRs) in service delivery. Thus, the purpose of this capstone project was to conduct a systematic literature review to determine the best practices that are well suited to a large urban hospital, to ensure patients’ privacy with the continued use …

Nurses’ Aesthetic Responses And Emotional Judgements To Senior Leaders’ Symbolism, Lucinda A. Easler

Walden Dissertations and Doctoral Studies

Stress can be heightened during a merger; understanding how acute care nurses who work in a hospital undergoing a merger, experience senior leaders’ use of symbolism may help to promote hospital and leader sustainability. Executive symbolism unfolds into aesthetic experience, normally considered a response to art, with few studies of its existence and benefit to organizational life. The purpose of this phenomenological-hermeneutic study guided by Parker’s aesthetic theory was to examine acute care nurses’ emotional responses and experiences with senior leaders’ use of executive symbolism in the midst of the organizational change. Interviews with 11 acute care registered nurses were …

Lived Experience Of Parenting Nurses Pursuing A Doctorate: A Phenomenological Inquiry, Jaimee Feldstein

Walden Dissertations and Doctoral Studies

The need for more doctoral prepared nurses is evident; data indicate that less than 1% of nurses hold doctoral degrees, yet, little is known about student persistence in doctoral nursing programs. Even less is known about doctoral nursing students navigating an online learning environment while balancing parenthood. The purpose of this phenomenological study, guided by Rovai’s composite persistence model, was to explore the embedded meanings in the experiences of parenting nurses pursuing their doctoral degrees at an online university. Ten female parenting nurses who completed a doctorate within the last 2 years were interviewed and shared the key factors that …

Evaluating The Impact Of Nurse Leader Professional Development, Celeste Rogers Romp

Walden Dissertations and Doctoral Studies

A health care organization’s success is impacted by its leaders’ knowledge, confidence, and training. A quality improvement (QI) project was undertaken by a 300-bed acute care medical center to determine the impact of providing nurse leaders with education and training in increasing the leader’s knowledge and confidence in their role and in improving nursing satisfaction, catheter-associated urinary tract infection (CAUTI) rates, and fall rates. The FOCUS-PDSA QI model and the nurse manager leadership collaborative learning domain framework were used to guide the QI project and its evaluation. There were four primary sources of evidence. A nurse leader professional development pre- …

Evaluation Of A Shared Governance Model, Gorda Peters-Joseph

Walden Dissertations and Doctoral Studies

AbstractShared governance (SG) has been defined as a style of management in which frontline staff and managers work together to improve clinical practice. Guided by the PLAN-DO-STUDY-ACT cycle, the purpose of this project was to evaluate the implementation of the SG model for pediatric services in a US acute care hospital. The practice question explored whether the implementation of the SG model would demonstrate improvements in nurse satisfaction using the culture of safety survey, a change in nurse staff turnover reported as numbers hired, retired, resigned, or transferred, and changes in patient satisfaction measured by survey scores from the Hospital …