Nursing Commons^™

Nonfatal Strangulation Continuing Education Program For Forensic Nurses, Pamela Susan Holtzinger

Walden Dissertations and Doctoral Studies

Patients experiencing nonfatal strangulation during intimate partner violence (IPV) are suffering the consequences of unrecognized injuries and delayed life-threatening medical sequela. Forensic nurses offer expertise in the physical assessment and documentation to a variety of assault victims including those impacted by IPV. This project addressed whether an educational program on nonfatal strangulation increased the knowledge and assessment skills of forensic nurse examiners. The purpose of this doctoral project was to develop a continuing education program on the topic of nonfatal strangulation for forensic nurse examiners. The project design was created using Knowles's adult learning theory principles. The content outline was …

Depression Screening In Poststroke, Shannah Lowe

Walden Dissertations and Doctoral Studies

Depression, a sequela of stroke, is underrecognized and underreported. The American Heart/Stroke Association estimated 1/3 of patients develop depression after a stroke. Depression after a stroke has negative influence on stroke recovery through decreased participation in rehabilitation, and increased morbidity and mortality. The American Heart/Stroke Association recommended that depression screening be conducted on stroke patient; however, there is a lack of guidance regarding the optimal time and tools for depression screening. The practice problem identified was the absence of depression screening in poststroke patients at the project site. The project question focused on identifying evidence-based approaches for depression screening in …

Reducing Fall Recurrence In Institutionalized Elderly Residents On Narcotics, Paul Niyungeko

Walden Dissertations and Doctoral Studies

Falls constitute a health care safety concern, specifically among the geriatric population institutionalized in health care facilities. From the pattern of observed falls at the project site, a discrepancy between fall prevention measures and expected outcomes was noted. Knowledge deficiency, inadequate practice skills, and insufficient organizational support were found to be the major obstacles to improving fall prevention. The purpose of this systematic literature review project was to identify evidence-based actions to reduce falls. The project was guided by Taylor's personality theory and Watson's theory of care. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses method was used to …

Improving Hypertensive Therapy Outcomes Among African Americans, Tanya Sullivan

Walden Dissertations and Doctoral Studies

The effects of nonadherence to prescribed blood pressure medication adversely impacts

African Americans (AA) in comparison to their European American counterparts. The

associated health consequences of uncontrolled hypertension include heart failure, stroke,

and renal dysfunction. And the treatment of the complications negatively impacts quality

of life and contributes to increased health care costs. To address the problem at 1 clinic, a

quality improvement (QI) project was developed by the clinic nursing staff, but the

project had never been evaluated. The project included blood pressure measurements

assessed among AA patients before and after implementation of a 4-item Morisky

Medication-Taking Adherence Scale …

Standardized Clinical Guideline For Assessment, Documentation, And Treatment Of Statins, Esther Onyirimba

Walden Dissertations and Doctoral Studies

The purpose of this project was to develop a practice guideline for screening patients at risk for cardiovascular disease, educate the staff at the site about the guideline, and implement the guideline at a primary care clinic. The intention was to identify and treat patients at risk for cardiovascular disease to prevent occurrence of heart disease. Cardiovascular disease includes hypertension, coronary heart disease, heart failure, and stroke. Coronary heart disease is one of the leading causes of death in the Western world. The local practice problem and focus of this project was underprescribed statin therapy for patients at risk for …

Male Students And Stress During Their Nursing Education, Stephen Joseph Alves

Walden Dissertations and Doctoral Studies

Stress is a common phenomenon experienced by nursing students; however, there is a gap regarding the perception of stress by male nursing students. It is important for nurse educators to be aware of the stressors that are unique to male students to provide appropriate resources and ensure their success in nursing school. The purpose of this qualitative study was to identify the lived experiences male nursing students’ stress. Lazarus and Folkman’s transactional model of stress was the theoretical framework for this study. Semistructured interviews were conducted with 8 participants, who were male students enrolled in associate degree nursing programs, to …

Instrumental Role Modeling And The Sensitive Topic Of Obesity: A Grounded Theory, Tulie Blot Gay

Walden Dissertations and Doctoral Studies

The nurse practitioner (NP) role is more prominent now than ever before in primary healthcare, positioning them as providers who defend initiatives and ongoing health agendas. Obesity is among those agendas. The concept of instrumental role modeling was explained as a combination of understanding and physical presence that gives meaning and quality to inspire change. It implied that health professionals are not merely insightful clinicians but suggested their expertise is complimented by demonstrations of wellness in knowledge and practice. This topic of weight was perceived as sensitive but must be addressed. In this grounded theory study, the perspectives of NPs …

Improving Spiritual Care In Preoperative Nursing, Victoria Ngozi Ogbuji

Walden Dissertations and Doctoral Studies

Spirituality and nursing have been intertwined from the beginning of the profession; however, there is little evidence that clearly defines spiritual nursing care and no standardized practices that can be included in the routine preoperative plan of care for patients undergoing invasive surgical procedures. The purpose of this project was to conduct a systematic review of the literature to define spiritual care and identify specific spiritual nursing care interventions. The biopsychosocial model, Narayanasamy's transcultural care practice model, and Watson's theory of human caring provided the theoretical framework for the project. MEDLINE, PubMed, Wiley online library, SCIENCE, WOS, Cochrane, and SciELO …

Advanced Practice Nursing In Nigerian Healthcare: Prospects And Challenges, Raymond O. Chimezie, Sally N. Ibe

Journal of Sustainable Social Impact

This study explored the prospects and challenges of introducing advanced practice nursing (APN) in the Nigerian health system. It sought to address the following: career pathways for registered nurses and midwives, advanced duties performed by them and the circumstances, their views and willingness for autonomous practice, and doctors’ degree of acceptance. Research population composed of registered nurses, midwives and medical doctors in primary healthcare. The conceptual framework for this study was based on the scope of practice, standards and competencies of the APN established by the International Council of Nurses (2008). A 12-item checklist of typical duties of APN from …

Program Evaluation Of The Rn Clinical Learning And Development Specialist, Brittany Montecuollo

Walden Dissertations and Doctoral Studies

The purpose of this project was to evaluate the impact of a quality improvement strategy to implement an RN clinical learning and development specialist (CLDS) with the intent to reduce high turnover in novice nurses and low nurse engagement. The CLDS served as expert, role-model, coach, and mentor. Benner'€™s model of novice-to-expert was used as the conceptual framework to monitor progression of nurses mentored by the CLDS. The Institute for Healthcare Improvement model for improvement was reviewed to assess the effectiveness of the CLDS on turnover rates and nurse engagement. At the time of program evaluation, the CLDS role had …

Strategies To Improve Customer Care Services In Urgent Care Businesses, Marcus Ellis Caster

Walden Dissertations and Doctoral Studies

Healthcare industry owners who have unsatisfactory customer care services may experience a financial risk and create dissatisfied patients. The purpose of this case study was to explore customer care strategies that managers of urgent care businesses used to improve customer care services and patient satisfaction. The target population consisted of 1 urgent care manager from 3 separate urgent care clinics with the highest customer satisfaction ratings in Alabama. The urgent care managers were knowledgeable about effective customer care strategies that improved customer care services and patient satisfaction. Customer loyalty theory with emphases on customer behavior, customer attitude, repeat patronage, and …

Telehealth Integration Influencing Success And Sustainability, Melissa Jean Miller

Walden Dissertations and Doctoral Studies

Telehealth initiated a transformation in the realm of innovative strategies to meet the demands of an ever-changing health care system. Adapting provisions to new delivery care models such as telehealth is one way to improve access to care. The purpose of this project was to explore evidence of best practices in telehealth through an extensive, systematic literature review. The practice-focused question focused on identifying advantages of and barriers to the use of telehealth for improving patient satisfaction and quality of care. The plan-do-study-act cycle served as a model for accelerating quality improvement through improved systems of practice, and the Critical …

Evidence-Based Care In Urgent Care Centers, Kelly Wagner

Walden Dissertations and Doctoral Studies

Concussions are brain injuries--also called mild traumatic brain injuries--that affect the function of the brain temporarily or permanently. The purpose of this doctoral project was to develop an education module for staff at an urgent care center to address the lack of knowledge and low level of comfort regarding the care for patients with a head trauma. This project introduced and educated the clinical staff on an evidence-based protocol for the treatment and management of a patient with a concussion. The Rosswurm and Larrabee model for evidence-based change was used as a foundation for refining the practice question, gathering evidence, …

A Magnet System Implementation Of The Hester Davis Fall Reduction Program, Debra Ann Bauer

Walden Dissertations and Doctoral Studies

A Magnet-recognized academic hospital system experienced an increase in patient falls and patient falls with injury after transitioning to a new electronic health record. The purpose of the project was to evaluate the effectiveness of a system-wide quality improvement practice change. The practice-focused question addressed a Magnet model implementation of a standardized, system-wide, evidence-based Hester Davis Scale (HDS) fall risk assessment and intervention tool and the impact on the nursing-sensitive indicators of patient fall rates and fall rates with injury. Successful implementation and sustained, correct use of the HDS fall risk assessment and targeted fall-prevention-intervention tools added to the evidence …

Strategies For Reducing Nurses' Turnover In Specialty Care Clinics, Lawrence Benjamin

Walden Dissertations and Doctoral Studies

The nursing shortage and high turnover rates are a problem in Canada and the world over. The purpose of this single case study was to explore leadership strategies that nurse leaders in specialty care clinics in Canada use to reduce nurse turnover. The participants were 7 nurse leaders from a single organization with specialty care clinics across Canada who all had above average nurse retention rates when compared to the case organization's average nurse retention rate. The authentic leadership theory was the conceptual framework. Data sources for this study were company documents, participants' semistructured interview responses, member checking of the …

Educating Staff On The Family Caregiver Needs Of Brain Injury Patients, Carrie Maloney Robertshaw

Walden Dissertations and Doctoral Studies

Acute rehabilitation hospitals assist brain injury patients and families who face a life- changing event to achieve greater independence and quality of life. During the acute rehabilitation phase of recovery, care is focused on the patient; however, there is a nationwide movement to implement patient- and family-centered care because caregivers experience grief and uncertainty about how to care for their loved one during hospitalization and upon discharge. The purpose of this staff education project was to educate rehabilitation staff on how to identify and to meet the needs of family members of brain injury patients in an acute rehabilitation center …

Educational Plan For Correctional Officers To Increase Awareness Of Diabetes Mellitus Among Inmates, Zaheerah Yasmeen Shareef

Walden Dissertations and Doctoral Studies

In the United States, approximately 30.3 million or 9.4% of the population have been diagnosed with diabetes mellitus. Of these, 8.3 million remain undiagnosed. There are approximately 2 million people incarcerated in detention centers, jails, and prisons across the United States with approximately 80,000 inmates living with diabetes. Correctional officers are not educated to identify and respond to inmates with evolving medical complications, such as low or high blood glucose, which can lead to preventable adverse events, including permanent injury or death. The purpose of this project was to develop an evidence-based education module to teach correctional officers how to …

Clinical Practice Guidelines For Home Management Of Intravenous Immunoglobulin Therapy, Rosemary Taylor

Walden Dissertations and Doctoral Studies

The infusion of intravenous immunoglobulin therapy in the home setting requires a critical nursing assessment and interventions aimed at managing and preventing the escalation of adverse events. Some patients experience side effects that necessitate a rapid response by field nurses, requiring standing orders for nursing administration and the availability of essential medications to alleviate symptoms in the patient's home. The clinical practice issue was that the home health agency did not have a uniform clinical practice nursing guideline to assist field nurses in providing rapid responses for managing infusion-related reactions. The purpose of this project was to develop an evidence-based …

Educational Intervention On Metabolic Syndrome For Psychiatric Providers, Chika Emelda Okafor

Walden Dissertations and Doctoral Studies

Statistics show a high prevalence of metabolic syndrome (MetS) in patients with mental illness receiving second-generation antipsychotic medications. MetS is associated with elevation of obesity, truncal obesity, blood pressure, cholesterol, and fasting glucose. The purpose of this project was to educate psychiatric providers about the importance of MetS screening, early detection, management, and referral for better treatment and management. The project was guided by Lewin's theory of change model. The project inquired if educational intervention on MetS improved providers' knowledge and intent to adopt MetS guidelines. A literature review and established guidelines of the American Psychiatric Association and American Diabetic …

A Clinical Practice Guideline To Improve Education In The Heart Failure Population, Mailey L. Wilks

Walden Dissertations and Doctoral Studies

Managing heart failure patients in the outpatient setting can pose a challenge for nurses and health care staff due to the need to educate patients on self-care skills and management of disease. Several factors, including health literacy and numeracy, need to be considered when developing an education program for heart failure patients to promote self-care management. The purpose of this project was to provide nursing staff with a clinical practice guideline (CPG) that incorporated health and numeracy literacy assessment into an individualized education program. The Johns Hopkins nursing evidence-based practice (EBP) model, the situation-specific theory of heart failure (HF) self-care, …

Nursing Education To Prevent Resident Falls In Long-Term Care, Henrietta Aguwa

Walden Dissertations and Doctoral Studies

Residents in nursing facilities are more prone to falls than those living in the community. Injuries resulting from falls impact residents, their families, and healthcare costs. The gap in nursing practice was the lack of a comprehensive fall-prevention program in a long-term care facility that had experienced high fall rates among residents. This project addressed whether an educational program using the American Medical Directors Association's clinical practice guideline and the Centers for Disease Control and Prevention's STEADI (Stopping Elderly Accidents, Deaths, & Injuries) toolkit for fall- prevention improved the self-efficacy of direct-care staff in preventing falls among residents in a …

Educating Staff Nurses For Successful Patient Discharge, Julie First-Williams

Walden Dissertations and Doctoral Studies

The definition of a successful discharge is a discharge that results in patients successfully managing a chronic disease for at least 30 days without requiring an acute inpatient hospitalization. Many chronic disease readmissions are preventable. Successful discharge planning takes a multidisciplinary team that includes nurses who assess the discharge plan and provide additional education where needed. The purpose of this project was to determine staff nurses' understanding of their role in discharge education. Dorothea Orem's self-care deficit theory guided the project and root cause analysis was used in the development of the problem statements. Staff nurses (n=12) from evening and …

Prescreening Recommendations For Patients On Medical Cannabis, Wen Chieh Hu

Walden Dissertations and Doctoral Studies

Marijuana is the most frequently used illegal substance in the United States and is most widely used among young people aged 12 to 21 years. Accurate screening and monitored issuance of medical cannabis recommendations have been shown to decrease abuse rates of the substance, create fewer deaths from opiates, reduce crime rates, reduce marijuana use in youths, decrease car crash deaths, and lessen prevalence of suicide in young men. The purpose of this project was to explore whether multiple screening methods for depression and anxiety in patients who seek medical cannabis referrals for anxiety and depression would improve screening and …

Simulation As A Remediation Tool For Clinically At-Risk Associate Degree Nursing Students, Janna G. Lock

Walden Dissertations and Doctoral Studies

Evidence-based remediation options are limited for nursing students who fail their clinical competency evaluations. Scholarly literature provides a paucity of studies related to the use of simulation-based technology to remediate nursing students. The research question focused on the difference in the initial competency demonstration evaluation scores of associate degree nursing students compared to the reevaluation scores after remediation with simulation-based technology. Benner's novice to expert and Kolb's experiential learning theories were used to explain how nurses acquire and develop skills. The researcher used a quantitative one-group pretest posttest design to examine archival data from 149 nursing students from a South-Central …

Pediatric Behavioral Health Best Practices In The Children's Emergency Department, Kristina Marie Pickering

Walden Dissertations and Doctoral Studies

Emergency department (ED) use for behavioral-health-associated diagnoses has steadily increased in adult and pediatric populations, accounting for 1 out of every 8 ED visits. The increase in pediatric behavioral health ED visits, combined with limited resources for treatment, has created a challenge for EDs faced with extended boarding and constant observation of this population. The generalized behavioral health guidelines used at the practice site have not been adapted for the pediatric population. This project focused on providing age- and developmentally appropriate best practice guidelines for children under constant observation in the children's emergency department (CED) using Havelock's theory of planned …

Discharge Phone Call On Unplanned Readmission Due To Chemotherapy Among Cancer Patients, Denise Angelo Moreno Prudencio

Walden Dissertations and Doctoral Studies

The transition after hospitalization is a vulnerable period when adverse events like unplanned readmissions may occur. Unplanned readmissions with patients undergoing chemotherapy that are the result of gaps in communicating the discharge plan may be preventable. Several transitional care interventions have been explored, and one of these is the nurse discharge phone call. This project explored the effect of a nurse-led transitional discharge phone call within 30-days after hospital discharge on unplanned readmission due to chemotherapy among patients in the medical-oncology compared to patients without a nurse-led transitional discharge phone call. A nurse-led transitional discharge phone call was implemented within …

Staff Development Introducing Self-Care Within The Nurse Residency Curriculum, Lauren Elizabeth Rogers

Walden Dissertations and Doctoral Studies

Caregiver burnout is an issue for health care organizations, negatively influencing cost, engagement, and workforce stability. Nurse residency programs are intended to address the gap in practice between academia and clinical practice and provide social support during this transitional time. Self-care education can positively affect novice acute care nurses' transition into their new professional role while building connections with the health care organization during the first year of employment. The purpose of this project was to develop a staff educational module to address the nursing practice problem of evidence-based self-care education within a nurse residency curriculum at the doctoral site. …

Improving Provider A1c Testing Frequency Adherence To Recommended Diabetes Guidelines, Susan Ann Simmons

Walden Dissertations and Doctoral Studies

The Appalachian region of the United States has a high prevalence of diabetes, placing residents with diabetes at risk for physical, psychological, social, and financial burdens. To compound the issue, primary care providers often do not adhere to the guidelines established by the American Diabetes Association (ADA) regarding the recommended frequency of testing hemoglobin A1C in patients with diabetes. Lewin's planned change theory guided the project. The purpose of this project was to measure the knowledge of the primary care providers before and after an educational intervention covering the ADA guidelines for A1C monitoring and testing and to assess compliance …

Validation Of Communication Simulation Scenarios For Nurse Preceptors, Karie Thurston

Walden Dissertations and Doctoral Studies

An expectation of the nurse preceptor role includes the ability to evaluate, deliver feedback, and coach new graduate nurses. A gap in nurse preceptors' communication skills can affect the safety-related behaviors and quality of care provided by new graduate nurses, thus affecting patient outcomes. To bridge this gap, robust training on delivering feedback and coaching is needed for preceptors. The purpose of this staff education project was to develop and validate 5 communication simulation scenarios for preceptor training. Mezirow's transformative learning theory and the National League for Nurses-Jeffries simulation theory were used to guide the project. A panel of nurse …

Promoting Nurses Management Of Night Shift Sleepiness, Sunday Iken Okundolor

Walden Dissertations and Doctoral Studies

Nurses are largely unaware of the problems of night-shift-nurse sleepiness and available strategies to manage night-shift sleepiness. The purpose of this project was to examine nurses' self-perception, awareness of sleepiness, and current strategies to manage this problem in the emergency medicine department of a major academic hospital in the western United States. The validated de-identified Karolinska Sleepiness Scale (KSS) was used to measure the prevalence and intensity of night shift nurses' sleepiness prior to the development of an educational program on strategies to manage sleepiness. Of the 164 registered nurses surveyed, 72 (43.9%) reported sleepiness greater than 7 on the …