Nursing Commons^™

Impact Of Transitional Care Model On Readmissions Of Adults With Chronic Heart Failure, Sheila Delaine Stuckey

Walden Dissertations and Doctoral Studies

Chronic heart failure (CHF) is often associated with high morbidity, mortality, and increased health expenditures. The readmission rate of patients with CHF is approximately 30% within 30 to 60 days following discharge. This project examined the literature to identify best practices based on the use of the transitional care model (TCM) in the reduction of hospital readmissions among older patients with CHF. The review included articles that were published between 2015 and 2019, used a quantitative study methodology, were peer-reviewed, and written in English. Keywords used in the search were chronic heart failure, the transitional care model, and hospital readmissions. …

A Phenomenological Study Of Lived Experiences Of Transport Nurses Experiencing Patient Death, Joshua B. Wall

Walden Dissertations and Doctoral Studies

Experiencing a patient death can directly affect the well-being of health care professionals; however, this phenomenon and the effects of patients' deaths are not well understood in the transport setting. Transport nurses work in unique settings with complex patients and significant autonomy in determining the plan of care; therefore, the experiences of other health care professionals may not be applicable in this environment. The purpose of this qualitative study was to explore the lived experiences of transport nurses who have experienced patient death using Husserl's life-world and phenomenological philosophies as a theoretical framework. Semistructured interviews were completed with 8 transport …

Effect Of Multiple Entry Levels Into Nursing Practice And Professionalism, Ogechi Abalihi

Walden Dissertations and Doctoral Studies

Entry into professional nursing practice in the United States occurs at varied education levels including a diploma, an associate degree, and a baccalaureate degree. These multiple entry levels into practice create a situation where academic preparedness for nursing practice varies, which may influence the professional behavior of nurses and, consequently, patient care and outcomes. The purpose of this quantitative comparative study, guided by Miller's wheel of professionalism in nursing, was to determine if there is a difference in the professional behaviors of associate degree prepared registered nurses (RNs) compared to the professional behaviors of baccalaureate degree prepared RNs. The Behavior …

Bedside Nurses' Perceptions Of Pursuing An Academic Career As Nursing Faculty, Suzanne Lynne Benfield

Walden Dissertations and Doctoral Studies

There is a nursing faculty shortage at a Mid-Atlantic associate degree nursing program. In response, program administrators have hired adjunct faculty with bachelor of science in nursing degrees (BSNs), hired full-time faculty with master of science in nursing degrees in areas other than education who also are not certified nurse educators, and reduced its minimum requirement for nursing faculty clinical experience. The nursing faculty shortage combined with the resulting gaps in practice are problematic because they may (a) negatively influence the program's ability to produce degreed nurses; (b) increase faculty workload; (c) decrease the quality of student education, which may …

Improving Nurses' Knowledge Of Central Line-Associated Bloodstream Infection, Misty Cooper

Walden Dissertations and Doctoral Studies

Central line-associated bloodstream infections (CLABSI) are usually attributable to suboptimal line insertion, care, or maintenance and are associated with poor patient outcomes. Nursing plays a pivotal role in preventing CLABSI, because nurses are generally responsible for the routine care and maintenance of central lines. The purpose of this project was to determine if CLABSI nursing education and demonstration-based competency could improve nurses' knowledge on a neurology unit as compared to current practice of an annual e-learning module as the sole source of nurse education. This project was informed by Lewin's planned change theory and involved changing behaviors, attitudes, and practices …

Staff Education Intervention To Enhance Care Planning For Older Adults, Mozhgan Peiravi

Walden Dissertations and Doctoral Studies

The increased prevalence of cognitive deterioration has increased the challenges of caring for older adults. This study's project site offers a psychiatric program for older adults with customized care for complex geriatric mental health patients. Clinical assessment and care management are often overlooked in geriatric mental health patients diagnosed with behavioral and psychological symptoms of dementia (BPSD). The purpose of this project was to deliver an education program developed from the Staff Training in Assisted Living Residences-Veterans Administration, P.I.E.C.E.S model and the Castle framework to 42 nursing and allied health staff of the project site. The project question explored whether …

Educating Medical--Surgical Nurses To Improve Nursing Knowledge And Understanding Of Health Literacy, Heather Smith

Walden Dissertations and Doctoral Studies

Low health literacy levels put patients at greater risk for poorer compliance and access to care, which leads to worse patient outcomes. Nurses must understand health literacy to improve health literacy for their medical surgical patient population. It is necessary for a formal education program on this topic. The purpose of this project was to increase medical surgical nurses' awareness and knowledge of the importance of health literacy and to introduce the REALM-SF tool to assess a patient's literacy level, allowing a nurse to better individualize the education provided to the patient. Lewin's change management theory was key in the …

Decreasing Catheter-Associated Urinary Tract Infections In The Acute Care Setting, Marshanell Wright

Walden Dissertations and Doctoral Studies

The most important risk factor for developing a catheter-associated urinary tract infection (CAUTI) is the prolonged use of the urinary catheter. To address the CAUTI rate at the project site, which was higher than the national benchmark, a team of healthcare practice leaders developed an evidence-based algorithm addressing the appropriate indications for inserting or discontinuing a patient's Foley catheter. Using the plan-do-study-act model, the purpose of this quality improvement evaluation project was to evaluate the effectiveness of the evidence-based Foley algorithm for decreasing the use of Foley catheters and reducing the CAUTI rate and to explore whether using the Foley …

Development Of An Online Resource Manual And Online Protocol To Facilitate Care Coordination, Leonore Bingham

Walden Dissertations and Doctoral Studies

Persons with disabilities tend to be in poorer health compared to those without disabilities, and timely coordination of care is essential for maintaining optimal health and wellness. The problem addressed in the Care Coordination Referral Project was the lack of timely access to health care and preventive care services for clients with disabilities in the organization for which this project was developed. Using the appraisal of guidelines research and evaluation II model, the purpose of this DNP project was to analyze and synthesize the evidence-based literature to support the project and develop an online health care resource manual and protocol. …

Patient's Compliance With Diabetes Self-Management In The Primary Care Setting, Chidinma Onyegwu

Walden Dissertations and Doctoral Studies

Diabetes is a chronic disease that can be self-managed to control the disease and its adverse consequence. The purpose of this systematic literature review was to examine the barriers to patients' successful adherence to the self-management plan and to examine strategies used to improve patients' compliance with self-care behaviors. Three practice-focused questions focused on the personal characteristics or factors influencing patients' compliance with self-management, the barriers to patient compliance regarding diabetes self-management, and the effective strategies used to improve patients' compliance with diabetes self-management at primary care clinics. The literature review used the preferred reporting items for systematic reviews and …

Development Of An Interactive Game For Education Regarding Sexually Transmitted Infections, Sherri Arrington

Walden Dissertations and Doctoral Studies

Sexually transmitted infection (STI) prevalence rates are increasing in the United States and globally. Education has been found to be an important strategy for increasing STI testing and treatment rates among sexually active young adults. The goal of this project was to develop an interactive educational game suitable for young adults to decrease the social and economic burden of STIs. The health belief model informed the project. A moderated usability evaluation was conducted using the concurrent think-aloud technique. The participants (N = 5) were a purposive sample of professionals who played the interactive game and then completed Schnall, Cho, and …

Systematic Review Of Alternative Therapies To Treat Cancer Pain, Karla Michelle Bonilla Carmona

Walden Dissertations and Doctoral Studies

Cancer pain is a complex symptom that affects the quality of life of oncology patients, caregivers, and families. The limitations of pain management treatment for cancer patients can be attributed to the lack of knowledge and availability of nonpharmacological treatments. The purpose of this project was to identify and gather evidence on the effectiveness of nonpharmacological interventions in the treatment of cancer pain using the methodology of a systematic review. Watson's theory of human caring supported the project by incorporating the perception of treating the human being holistically during the illness process. The Johns Hopkins nursing evidence-based practice model provided …

Educating Nurses About Nurse Residency Program, Tammy Lea Franklin

Walden Dissertations and Doctoral Studies

Educating Nurses About a Nurse Residency Program

by

Tammy Lea Franklin

MSN, Walden University, 2012

BSN, Oklahoma City University, 2010

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

May 2019

The problem addressed in this project was the challenges related to retention of new graduate nurses. This includes Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Bachelor of Science Nurses (BSNs) on two medical/surgical units in an acute care facility. The purpose was to work with a project team to develop an education module and accompanying resources to present to …

Patient Satisfaction With Nursing Care Related To Hospital Magnet Designation, Sharon Haylett

Walden Dissertations and Doctoral Studies

Many U.S. hospitals have historically failed to recognize nursing as essential to quality of care. Given the relationship between the patients' experiences, measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), and government reimbursement, stakeholders now value the role of nurses in the care experience. Some hospitals have pursued Magnet designation, which is a rigorous and costly process, in order to promote patient satisfaction through nurse autonomy and retention. The purpose of this study was to understand whether non-Magnet hospitals received similar HCAHPS scores. Expectancy disconfirmation theory provides a framework to understand the components of patient satisfaction …

Teach-Back Process As A Best Practice In Patient Education, Laura Hoffman

Walden Dissertations and Doctoral Studies

Limited health literacy is a national problem. Nurses are in a position to address patients' limited health literacy skills using a universal precautions approach through the teach-back process. The purpose of this project was to plan a program to educate nurses on best practices in patient education. The theoretical framework informing this work was Bandura's social cognitive theory, which asserts that increases in knowledge and self-efficacy are precursors to affecting behavior change. The logic model was used to guide the project planning processes. Evidentiary sources included literature obtained online and through database searches, input from a team of experts and …

The Nurse And Certified Nursing Assistant Perception Of Person-Centered Care, Latonya Dickerson Hughes

Walden Dissertations and Doctoral Studies

Over the last decade, long-term care facilities have transitioned from institutional care models that focus on person-centered care, in which the resident is the center of the care. The purpose of this study is to explore the nurse and certified nursing assistant perception of the person-centered care services they deliver. Jean Watson's theory of human caring is the theoretical framework that guided this study. The theory focusing on the human caring experiences and person-centered care is being characterized as a caring feeling. The carative factors of Watson's theory, the fundamental concept of caring, has been associated with improved outcomes for …

Venous Thromboembolism Prevention Education For Practitioners In The Acute Care Setting, Eppie Ann Labiche

Walden Dissertations and Doctoral Studies

During the last several decades, venous thromboembolism (VTE) has been identified as a preventable health condition. The gaps in clinical practice have led to an increased incidence of VTE. The lack of using existing evidence-based VTE prevention guidelines in practice has limited the implementation of VTE risk assessment stratifications and affected the appropriateness and timeliness of addressing pharmacologic and mechanical prophylaxis. The purpose of the scholarly project was to educate practitioners on existing VTE prevention practice guidelines. The practice-focused question explored whether an educational learning activity on evidence-based VTE prevention guidelines improved the awareness, knowledge, and compliance with existing evidence-based …

Cultivating Cultural Competence To Address Childhood Obesity In Ethnic Minority Youth, Tia Knight-Forbes

Walden Dissertations and Doctoral Studies

Obesity is an increasingly prevalent health issue, especially among children who live in high poverty, low income, and low education areas that lack needed resources and health care to promote quality of life. African American youth have a higher rate of obesity than other populations. The purpose of this project was to address an identified gap in practice by improving health care professionals' ability to provide culturally competent care to African American youth. An educational intervention framed by the Purnell model for cultural competence was developed to address the question, Will cultural competency staff education improve knowledge to prevent and …

The Meaning Of Instagram Use For Rheumatoid Arthritis Information, Deborah Lewis

Walden Dissertations and Doctoral Studies

Social media use related to chronic disease has become pervasive, yet few researchers have examined the influence of social media on health care message dissemination and health care outcomes. In this study, the use of Instagram, an image-rich social media platform, for sharing health information was examined. Nurses, as key providers of patient information, need to understand the relative effectiveness of different types of social media for health information, how social media is currently used by health care consumers, and how to best use various social media platforms to improve patient outcomes. The purpose of this study was to gain …

Reducing 30-Day Readmission Rates In Chronic Obstructive Pulmonary Disease Patients, Stacey Jerrick Machado

Walden Dissertations and Doctoral Studies

Early avoidable 30-day post discharge readmission among patients diagnosed with chronic obstructive pulmonary disease (COPD) is associated with poor transition care processes. The purpose of this project was to analyze organizational system processes for admission and discharge transition care of patients diagnosed with COPD to identify key intervention strategies that could decrease the rate of 30-day post-discharge readmission by 1%. The project used the transitional care model as the framework to target specific care transition needs and create patient-centered, supportive, evidence-based relationships among the patient, the providers, the community, and the health care system to identify key intervention strategies for …

Developing A Clinical Practice Guideline For Improving Communication During Transitions Of Care, Darla P. Hardy

Walden Dissertations and Doctoral Studies

Transition of care refers to the movement of patients between health care settings; it occurs each time patients move between providers within the same setting or between settings based on the patient's acute or chronic health care needs. Care transition includes the efficient and accurate exchange of information needed to provide high-quality continuity of care. A rural community hospital in in the northeastern region of the United States has a skilled nursing facility and an acute care hospital on one campus. This project focused on the development of a clinical practice guideline (CPG) for the hospital to improve communication during …

Mentoring Relationship Preferences Of Early, Middle, And Late Career Stage Registered Nurses, Tonya M. Harewood-Lawrence

Walden Dissertations and Doctoral Studies

Registered nurses perceive the healthcare work environment as stressful. Stress can have a negative effect on patient care and nurses' attrition and health. In the literature, mentors have been identified as having a positive influence on nurses. This qualitative study was an examination of nurses in mentoring relationships in the early, middle, and late career stage and working in a hospital setting. Two research questions addressed mentoring relationship preferences and mentors' influence on perceived stress. Fourteen nurses were interviewed in the study. The conceptual framework was based on the career and psychosocial mentoring theory, the mentoring the adult learner theory, …

Transitioning From Student To Nurse Practitioner Using The One-Minute-Preceptor Model, Yetrevias Seymour

Walden Dissertations and Doctoral Studies

Nurse practitioners (NPs) are significant members of the health care team. Variation and lack of standardization in the practicum preparation of the NP has been identified as problematic. There is a need to improve NPs preparation to efficiently and independently impact health care. This project presented the 1-minute-preceptor (OMP) model as a standard tool in the practicum preparation of the NP through a preceptor-focused continuing education session. The aim of the OMP is to help ensure that students are exposed to the level of critical thinking and problem solving needed in the role of an independent, efficient NP. Knowles's adult …

Barriers To Male Faculty In Nursing Education, Troy Jeffrey Palmer

Walden Dissertations and Doctoral Studies

Men are underrepresented among nursing faculty, providing few role models for male students who might benefit from interaction with male faculty. Male nursing faculty may face barriers similar to those faced by women in male-dominated professions. Diehl and Dzubinski's model of gender-based barriers served as the framework for this quantitative study conducted to identify disparities between male and female nursing faculty that may prevent men from entering, continuing, and advancing in nursing education. The association between the percentage of male nursing faculty with geographic region; institution type (i.e., public, private secular, or private religious); and 4 career variables (i.e., education …

Nursing Educators' And Nursing Leaders' Views On Practice Readiness In Novice Nurses, Diane Robinson

Walden Dissertations and Doctoral Studies

A perceived discrepancy exists in understanding between nursing educators' and hospital nurse leaders' views on job performance expectations and the reality of current job performance that may contribute to the difficulty experienced by novice nurses during their transition period. Lack of clarity in expectations may lead novice nurses to change jobs or leave the nursing profession within the first year of practice. The purpose of this descriptive study, guided by Benner's novice to expert theory, was to determine whether a difference exists between hospital nurse leaders' beliefs and nursing educators' beliefs about the frequency and competency levels, including leadership for …

Reducing Errors With Blood Administration Transfusion Systems, Kim D. Stevens

Walden Dissertations and Doctoral Studies

The intention of implementing technology into healthcare practices is to reduce opportunity for errors in the delivery of providing health care. However, errors still occur, and many times are preventable. Configurations of health information technology systems should match clinical workflows to promote usage as intended. The purpose of this quality improvement project was to evaluate the impact of revised system configurations and use of a blood product transfusion system for the administration of blood products after one year of implementation. The method of heuristic evaluation is a usability engineering method for finding problems in a user interface design with the …

Assessment Of Cancer-Related Fatigue In Breast Cancer Survivors, Meagan Walker

Walden Dissertations and Doctoral Studies

Cancer-related fatigue (CRF) is a persistent and debilitating problem for many breast cancer survivors. Although many CRF measurement tools are available, no consensus exists on the most appropriate tool to use for breast cancer survivors. The purpose of this project was to identify the best method of assessing CRF in breast cancer survivors. The practice-focused question inquired about the most appropriate way to assess fatigue in breast cancer survivors. The central concepts of the project were CRF and cancer survivorship. This project was informed by the theory of health as expanding consciousness and Mishel's theory of uncertainty in illness. The …

Male Perspectives Of Lateral Violence In Nursing, Benita Kinard

Walden Dissertations and Doctoral Studies

Lateral violence is an intentional and harmful behavior in the workplace by one employee against another. In nursing lateral violence has impacted the performance of nurses as well as patient care. Research suggests that lateral violence behaviors are still prevalent in the nursing workplace and that there have been few interventions to change these behaviors or address the power dynamics that cause them. Though most of the research on lateral violence has been conducted on female nurses, the population of male nurses is growing. Thus, the purpose of the study was to explore lateral violence in the workplace from the …

Hand Hygiene And Compliance Rates In An Acute Care Setting, Ilona Lungui

Walden Dissertations and Doctoral Studies

Hospital-acquired infections (HAIs) are a significant problem faced by healthcare organizations globally. The Centers for Disease Control reported that in 2014, 722,000 patients acquired an HAI, and of those, 75,000 died as a result. This project focused on reeducating healthcare staff on hand hygiene practices to prevent HAIs. Preintervention hand hygiene compliance rates were compared to postintervention hand hygiene compliance rates on 2 units in an acute care setting to evaluate if reeducation of healthcare staff on hand hygiene protocols and practices would increase hand hygiene compliance rates. The evidence-based practice model used for this project was Nightingale's environmental theory. …

The Role Of Advanced Practice Nurses In Advanced Care Planning For Cancer Patients, Sincere Mcmillan

Walden Dissertations and Doctoral Studies

In the United States, more than 75% of people will spend their last months of life in a health care facility. A key role for clinicians is to discuss care goals with the patients as part of a process called advanced care planning (ACP). As part of the oncology care team, advanced practice nurses (APNs) could help to increase the frequency of ACP discussions. The purpose of this project was to assess the knowledge and practice experiences of APNs regarding ACP at a National Cancer Institute designated cancer care hospital. Carper's patterns of knowing was the theoretical framework of this …