Nursing Commons^™

Impact Of Smoking Cessation Education On Workplace Wellness, Monica Coles

Walden Dissertations and Doctoral Studies

Guidelines and laws prohibit smoking in public places, and evidence supports the safety and effectiveness of workplace wellness programs in promoting healthy environments. A long-term care (LTC) facility selected as the focus for this project does not offer wellness programs and does not restrict on-site smoking by employees. The purpose of this project was to construct an evidence-based smoking cessation education program for delivery to employees at the LTC facility. The practice-focused question addressed whether a workplace wellness smoking cessation education program would increase employees' knowledge of the harmful effects of smoking and promote engagement in smoking cessation strategies. A …

Blood Lead Testing Guideline Development For A Public Health Department, Becky Sue Johnson Himes

Walden Dissertations and Doctoral Studies

A lack of consistent, evidence-based practices for blood lead testing of children existed in a local public health department (LHD). No known blood lead level is safe, and toxicity can result in behavioral and cognitive impairments. The purpose of this project was to develop and analyze a clinical practice guideline to establish blood lead testing procedures in the LHD to improve testing procedures and enhance future testing within the jurisdiction. The RE-AIM framework was used to address the reach, effectiveness, adoption, implementation, and maintenance of the clinical practice guideline. Five experts evaluated the guideline using the Appraisal of Guidelines for …

Compassion Fatigue In Emergency Department Nurses, Michelle Candice Lawrence

Walden Dissertations and Doctoral Studies

Compassion fatigue (CF) is defined as a sudden onset of the inability to experience feelings or compassion for others that is triggered by a nurse's inability to separate his/her feelings of stress and anxiety associated with caring for patients who have suffered from a traumatic event. The practice problem addressed in this doctoral project was the lack of knowledge of emergency department nurses (EDNs) related to CF in the work setting, resulting in a negative impact on a nurse's ability to provide quality care to patients. The purpose of the project was to present an educational program on how to …

Ambidexterity And Innovation In Chief Nursing Officers In The Healthcare Setting, Jennifer Wasilewski

Walden Dissertations and Doctoral Studies

Leaders in the healthcare setting are challenged with competing responsibilities as they seek to provide high-quality services, ensure the implementation of safety measures, and engage in workforce maintenance. Many researchers have described innovation as a strategic approach to organizational concerns and have noted a failure to implement innovative measures in healthcare. This study was an investigation of the impact of ambidexterity in healthcare leaders on innovation. The purpose of this quantitative study, guided by the ambidexterity theory of leadership for innovation, was to analyze the extent to which ambidextrous leadership characteristics of healthcare executives and chief nursing officers (CNOs) influence …

Staff Education For Providers In An Outpatient Hemodialysis Center, Ibijoke Owolabi

Walden Dissertations and Doctoral Studies

The impact of end-stage renal disease (ESRD) on healthcare costs is significant. In 2013, the cost of providing care for the ESRD patient population was 7.1% of total Medicare expenses. ESRD patients' non-adherence with the medical plan is a reason for the high cost of care and poor patient outcomes. Staff education can have a positive impact on patient adherence in terms of the management of chronic illnesses, such as ESRD. This DNP project was an education program for hemodialysis (HD) staff regarding empowering patients to learn about self-care strategies aimed at improving ESRD patients' adherence to fluid restriction and …

Root Cause Of Medication Errors In A Pediatric Intensive Care Unit, Louis Gilbert Tingling

Walden Dissertations and Doctoral Studies

Five to 27% of all pediatric medication orders lead to errors and play a significant role in the morbidity and mortality of the pediatric patients admitted to hospitals. The practice problem explored the high rate of medication errors in the pediatric intensive care unit (PICU) of the project site, where the population is particularly vulnerable due to their acute illnesses. The purpose of this project was to analyze the root causes of all cases of medication error in this hospital's PICU during the last 2 years. The literature review was used to categorize secondary data extracted from the hospital's quality …

Nursing Program Progression Requirements And Student Success At A U.S. Community College, Deborah Joleen Cipale

Walden Dissertations and Doctoral Studies

Although licensed registered nurses (RNs) comprise a significant percentage of the U.S. health care workforce, there is a lack of qualified nurses to meet patient needs. This shortage is expected to intensify as practicing nurses leave the profession. The problem that prompted this study was that an attrition-reduction program implemented in the nursing program at a U.S. midwestern community college did not show a reduction in the average attrition rate. The academic integration construct of Tinto's theory of student departure was used to examine archival academic performance records of 145 students enrolled in the local program from 2010 to 2012. …

Prevention And Management Of Aggression And Violence In Mental Health Settings, Margaret Arotimi

Walden Dissertations and Doctoral Studies

Aggression and violence in healthcare settings can lead to severe psychological, physical, and economic consequences for the victims, institutions, and society in general. Empirical evidence indicated that patient-initiated physical and verbal aggression is a longstanding problem affecting nurses working in psychiatric hospital settings. At the project site, approximately 88% of the staff members reported having been assaulted by mental health patients in the admission units at some point in the provision of care between 2015 and 2017. The purpose of this project was to develop an educational program for nurses at the site to use as preventive strategies in managing …

Targeted Education For The Prevention Of Vaccine Refusal, Catina Lashawn Davis

Walden Dissertations and Doctoral Studies

Vaccinations are important factors in the eradication of most communicable diseases. Tetanus, diphtheria, and pertussis (Tdap) vaccine has been found to decrease the incidence and further spread of pertussis, and even nullify its existence, yet many postpartum mothers opt not to receive the vaccination even if eligible to do so. It was unknown whether clinical nursing staff at the project site had sufficient knowledge about Tdap vaccine to educate postpartum mothers to accept the vaccine. The practice-focused question explored whether an educational program and a toolkit implemented for nursing staff members on the postpartum nursing unit would improve Tdap vaccination …

The Benefit Of Leadership Using First Choice For New Graduate Nurse Retention, Jodie Marie Lyons

Walden Dissertations and Doctoral Studies

The United States has a nursing shortage that is projected to grow to over 500,000 by the year 2030. This is an issue for leaders because the nursing shortage affects health care organizations sustainability. The purpose of this qualitative descriptive phenomenological study was to identify and report the lived experiences of new graduate nurses (NGNs) in oncology and whether unit of first choice (UFC) effected their intention to remain after 2 years of practice. The research question considered the lived experiences of NGNs in oncology units who either had oncology as their UFC or were placed on an oncology unit …

Addresing Challenges In Caring For Morbidly Obese By Learning About Bariatric Care, John Abayomi Makanjuola

Walden Dissertations and Doctoral Studies

Obesity is a public health issue linked to high morbidity and mortality among critically ill patients. There are approximately 15.5 million morbidly obese adults in the United States. The purpose of the project was to develop and implement an educational program using evidence-based protocols for bariatric care to educate nurses and caregivers regarding best practices when attending to obese patients. The practice-focused question examined whether learning about evidence-based bariatric care would improve the knowledge of nurses and caregivers caring for morbidly obese patients in an acute care setting. The theoretical foundation was Bandura'€™s self-efficacy theory. A questionnaire using a Likert …

Advanced-Beginner Registered Nurses' Perceptions On Growth From Entry Level, Brenda Mason

Walden Dissertations and Doctoral Studies

Many entry-level nurses are not prepared to handle medical emergencies. Although responsible for managing the care of individuals with complex medical conditions, many of these nurses compromise the safety of patients due to a lack of experience and an inability to apply clinical judgment. The purpose of this study was to explore the perceptions of registered nurses about their transition from entry-level to advanced beginner. Bandura's social cognitive theory, along with Colaizzi's descriptive method of data analysis, provided a basis for this phenomenological study. Research questions focused on challenges that entry-level nurses have experienced with problem-solving and complex patient care …

A Quality Improvement Evaluation Of Patient Experience Through The Enhanced Recovery Program, Sarah Orozco

Walden Dissertations and Doctoral Studies

The purpose of this project was to evaluate the effectiveness of adopting clinical care bundles for the enhanced recovery program (ERP) at the project site. The practice-focused questions explored whether care bundles from the enhanced recovery program (ERP) would achieve positive postoperative patient care experiences when compared to the traditional surgical care pathways. The concepts, models, method, and theories used for this project include the Iowa model, the plan-do-study-act model, lean methodology, Donabedian's framework, and Watson's theory of caring. The sources of evidence included the facility site analysis report to evaluate surgical inpatient complications, morbidity, and mortality rates. Over 100 …

Evaluating The Discharge Process Improvement Initiative In Reducing The Length Of Stay, Maria Reina Ventura Siazon

Walden Dissertations and Doctoral Studies

Extended hospital length of stay (LOS) causes increased health care costs and incidence of never events, such as hospital-acquired infections, pressure ulcers, and falls, which are not reimbursed by Medicare. This study examined if there would be a statistically significant decrease in the LOS of patients after the implementation of a discharge process improvement initiative (DPII), The model for improvement and small tests of change concept were used to guide the DPII at a hospital in northern California. Sources of data included archival data obtained from the hospital's quality improvement department that showed LOS prior to and after the implementation …

Noncompliance With Follow-Up Visits In Primary Care, Amanda Michelle Northern

Walden Dissertations and Doctoral Studies

No-show appointments, also referred to as missed appointments, occur 23% to 34% annually in general practice care settings. Missed appointments can lead to reduction in appointment availability, decrease in provider/staff productivity, patient/provider discordance, disruption in continuity of care, and reduced quality of care. There is a gap in the nursing literature regarding effective interventions to reduce missed appointments. The purpose of this quality improvement, secondary analysis project was to determine whether implementation of an evidence-based no-show, nurse-led intervention would reduce missed appointment rates in a family medicine practice. The health belief model and the plan, do, study, act model guided …

Development Of A Nurse Residency Program In Perinatal Nursing, Elizabeth W. Roberts

Walden Dissertations and Doctoral Studies

Staffing turnover created a challenge for the women’s services department of a hospital in the southern United States, potentially compromising care for women and infants during childbirth. The gap in practice was the lack of a structured nurse orientation/residency program for nurses new to perinatal nursing, which requires specific competencies not learned at the prelicensure level of education. The guiding practice-focused question was whether a multidisciplinary team could develop a formal evidence-based perinatal nurse residency program that would meet the needs of on-boarding and support for the new nursing hires at this facility. A team of experienced nurses, which included …

Sleep Deprivation In The Intensive Care Unit: Lowering Elective Intervention Times, La Von Michelle Ross Purdie

Walden Dissertations and Doctoral Studies

Sleep deprivation is a multifactorial phenomenon, occurring frequently in the intensive care unit (ICU) and linked to adverse patient healthcare outcomes. The key practice question of this project focused on determining if retiming of routine laboratory and imaging testing outside of the designated “quiet time” can improve sleep quality among adult patients in the ICU. The purpose was to evaluate the effectiveness of implementing an evidence-based intervention to improve sleep quality in the ICU setting. The theoretical framework was the plan-do-study-act model, which offered a process for implementing a practice change and reevaluation of the intervention’s sustainability within the organization. …

Preventing Catheter-Associated Urinary Tract Infections With Education On Using The Catheter Bundle, Diana Elizabeth Carlson

Walden Dissertations and Doctoral Studies

The Centers for Disease Control and Prevention, the Joint Commission, and the Agency for Healthcare Research and Quality recognized the importance of reducing health-care-associated infections (HAIs) and catheter-associated urinary tract infections (CAUTIs) for the safety of all patients. The U.S Department of Health and Human Services has focused on approving a plan to address HAIs in the health care setting with an emphasis on CAUTIs. The purpose of this project was to decrease CAUTI rates on a long-term care and rehab unit by educating staff about using the CAUTI bundle and CAUTI maintenance tool kit. The theoretical framework that guided …

Best Practice Suicide Screening/Assessment Tools For The Emergency Department, Katheryn M. Spirito

Walden Dissertations and Doctoral Studies

Patients presenting to the emergency department (ED) often suffer from more than physical ailments when seeking care and treatment. Some of these patients have emotional ailments and suicidal ideation when they come to the local ED. The lack of recognition of at-risk patients by health care providers can lead to poor patient outcomes and death. The focus of this project was to understand which valid and reliable suicide assessment tools described in the literature were considered the best evidence-based instruments to identify ED patients who were at risk for suicide. Peplau's theory of interpersonal relations guided this project. A systematic …

Implementing A Self-Scheduling Model To Decrease Nurse Turnover In Medical-Surgical Nursing, Rebecca Fuentes

Walden Dissertations and Doctoral Studies

Nurses may experience job stress and burnout due to the amount of hours worked and demanding schedules. At one hospital, nurse turnover rates were high in medical-surgical units. Surveys and interviews conducted by hospital administration found that the bedside nurses were dissatisfied with scheduling practices and that this dissatisfaction could lead to heightened turnover. The purpose of this project was to determine if the implementation of a self-scheduling model would decrease nurse turnover on a medical-surgical nursing unit. This quality improvement project focused on facilitating the empowerment of nurses through a self-scheduling model; it followed the quality improvement steps of …

The Relationship Of Nurse Manager’S Leadership Styles In Maintaining A Just Culture, Aida Solomon

Walden Dissertations and Doctoral Studies

Healthcare leaders must establish a just culture to mitigate preventable medical deaths that occur at 250,000 per year, making medical errors the 3rd leading cause of death in the United States. However, there is a gap in knowledge regarding the attributes of nurse manager leadership styles that contribute to promoting a just culture at the unit level. Guided by the full range leadership theory and the just culture model, the purpose of this descriptive correlational study was to determine the relationship between nurse manager transformational, transactional, and laissez-faire leadership styles and unit level just culture perceptions and the differences between …

Evaluation Of A Postpartum Hemorrhage Protocol, Lori M. Davies

Walden Dissertations and Doctoral Studies

Postpartum hemorrhage is a leading cause of maternal death, yet many deaths related to hemorrhage might be prevented with early recognition and intervention. The birthing unit of a U.S. community hospital formed an interprofessional task force to plan and implement a postpartum hemorrhage protocol that would provide the obstetric team with the knowledge, skills, and tools needed for early identification and quick action when hemorrhage occurred. Lewin's model of change provided a framework for protocol implementation. The purpose of this doctoral project was to evaluate this quality improvement project. Secondary data internal to the organization were collected and analyzed to …

Improving Lesbian, Gay, Bisexual, And Transgender Health Care Outcomes, David Agosto

Walden Dissertations and Doctoral Studies

Many lesbian, gay, bisexual, and transgender (LGBT) individuals report experiencing discrimination in their health care that leads to avoidance of regular appointments with providers. Lack of regular primary care can delay diagnoses of preventable conditions and increase patient risks for chronic disease complications. A systematic review of the literature was conducted to understand LGBT cultural competencies for nursing and other health care providers. The Cochrane Handbook for Systematic Reviews and Melnyk's levels of evidence framed this systematic literature review. Articles for inclusion were limited to those published in English between 2008 and 2018. Keywords used in the literature search included …

An Instructional Module For Nurses To Teach Patients With Gestational Diabetes Mellitus, Josephine Onyekachi Ollawa

Walden Dissertations and Doctoral Studies

Gestational diabetes mellitus (GDM) is a carbohydrate metabolism issue during pregnancy that is dangerous for mother and the baby. GDM occurs in 1 out of 3 diabetic women in 16.2% of live births. GDM knowledge and treatment practices among nurses were found inadequate when nurses’ effectiveness in treating a disease they have a shallow knowledge about (GDM) was investigated in the local medical facility. A GDM instructional module was applied and its effectiveness in promoting nurse’s use of GDM education as a treatment strategy tested. The total concept for knowledge and care, empowerment and the social cognitive theories grounded this …

Development Of Nursing Education For An Observation Unit, Donna Mckinney

Walden Dissertations and Doctoral Studies

As healthcare continues to face scrutiny related to the cost and quality of patient care, organizations are challenged with providing the right care to patients in the right setting. Some healthcare organizations are implementing observation units to provide appropriate care to a specific subset of patients. The purpose of this project was to develop education for nursing staff who will work on the dedicated observation unit and are unfamiliar with the care requirements. Benner's novice-to-expert theory was used as the framework for the project. This theorist posits that nurses transitioning to a new area require new knowledge and skills to …

Nursing Staff Development For Novice Nurse Practitioners In Acute Care, Carolyn Berglund

Walden Dissertations and Doctoral Studies

An acute care practice site reported 75% turnover of novice nurse practitioners (NPs),

which indicated a gap in the transition from student to practitioner within the first year of

clinical practice. This gap can leave novice NPs unprepared to manage patients

effectively and contribute to high turnover. The practice-focused question addressed

whether an evidence-based staff development program for novice NPs at an acute care

site could be developed. The purpose of this project was to create a framework based on

evidence to transition novice NPs successfully into practice. Benner's skill-acquisition

in-nursing theory informed this project. Evidence was obtained by searching …

Compassion Fatigue Among Critical Care Nurses, Debra Callender

Walden Dissertations and Doctoral Studies

Compassion fatigue (CF), also known as secondary traumatic stress (STS), impacts critical care nurses (CCN) through exposure to pain, suffering, and loss of those for whom they provide care and results in a reduction of compassion satisfaction (CS). High incidence of CF and turnover (TO) rates at the project site were identified among CCNs. The institution's CCN TO rate was at 81% in comparison to peers in other areas at 29%–35%. The practice-focused question asked whether leadership education on CF might ameliorate CF at the project site. The purpose of the Doctor of Nursing Practice project was to reduce the …

Emotional Intelligence And Sociodemographic Status In Associate Degree Nursing Students, Melanie Renee Benington

Walden Dissertations and Doctoral Studies

Emotional intelligence (EI) is essential for providing quality and competent care in the nursing profession. Because nurses need to be competent in EI, it is important to determine if inherent factors and academic performance contribute to the development of EI. The purpose of this study, guided by the 4-branch ability model of EI by Mayer and Salovey, was to examine the relationship of EI levels and academic performance, gender, and ethnic background in associate degree nursing (ADN) students who attended a community college. Using convenience sampling, 110 ADN students completed the Schutte Self-Report Emotional Intelligence Test and sociodemographic data. Data …

Increasing Depression Screening And Treatment For Adults Living With Hiv/Aids, Velma Asneth Frasier

Walden Dissertations and Doctoral Studies

The lifetime prevalence of clinical depression in patients living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is approximately 22% compared to 3% to 10% in the primary care population. The nursing practice problem at the project site concerned nurses' lack of knowledge and understanding of procedures to help ensure that all patients living with HIV/AIDS were properly screened for depression and referred for further evaluation and treatment. The purpose of this project was to implement a staff education module to address the use of the PHQ-9 screening tool to identify depression in people diagnosed with HIV/AIDS. The theoretical framework …

Depression Screening For Bariatric Surgical Patients, Cova Teresa Stidham

Walden Dissertations and Doctoral Studies

Obesity in the United States has increased to epidemic numbers over the last decade. Practitioners need to reverse the trend. To address the problem of depression in obesity, a practice guideline from a bariatric clinic for under-served populations was proposed to an expert panel. The Spell Out on First Use (PHQ-9) screening is a valid and reliable self-screening tool to assist the practitioner in determining the level of depression if any. The PHQ-9 has nine questions. No formal screening existed at the bariatric clinic, and the practice guideline (with algorithm and revised workflow) was proposed for use at the clinic. …