Nursing Commons^™

Patient Navigation Program In Oncolgy Clinical Practice, Mercy George

Walden Dissertations and Doctoral Studies

Cancer diagnoses affect millions of people in the United States each year. Today, cancer patients face many challenges when trying to navigate the complex healthcare system. Patient navigation programs were developed to address and overcome barriers patients may face as they make their way through the healthcare system. The purpose of this project was to provide an analysis and discussion of the current published literature to provide evidence for improving care coordination and patient satisfaction in the oncology clinical setting with a patient navigator program. The practice-focused question for this project asked if a patient navigator program for adult cancer …

Implementation Of The Crafft Cannabis Screening Tool, Barbara Loeprich

Walden Dissertations and Doctoral Studies

Cannabis use among teenagers in Canada is a concern because of the long-term and irreversible effects cannabis has on the developing body and mind. Nurses can be instrumental in screening for cannabis abuse by implementing a tool to assess for substance use disorder (SUD) and triage drug users to appropriate treatment. This project focused on how to implement the CRAFFT screening tool while gaining insight of the practitioner's knowledge base about the tool and how SUD is being screened for, currently. The CRAFFT screening tool aligns with the DSM-IV's SUD diagnosis criteria, allowing for efficient identification of those at risk …

Incorporating Technology To Decrease Heart Failure Readmission Rates, Vernell Thames

Walden Dissertations and Doctoral Studies

The rate of hospital readmissions within 30 days of discharge of heart failure (HF) patients affects patient outcomes, the financial stability of the health care facility, and the economy. Hospitals focus on strategies that will decrease the HF readmission rates by cultivating evidence-based interventions that improve patients' transition from the hospital to the community, including promoting self-management of their condition. The purpose of this quality improvement project was to develop, implement, and evaluate the use of health information technology along with written forms of plans of care to assist HF patients in managing their care, divert the HF patients to …

Child Sexual Abuse And Prenatal Care: Understanding Screening, Modifications, And Proper Care, Wendy Abbott-Egnor

Walden Dissertations and Doctoral Studies

Research has shown that 1 in 9 women in prenatal care have a history of childhood sexual abuse. Pregnant women with a history of childhood sexual abuse are at increased risk of depression, somatization, preterm contractions, posttraumatic stress symptomology, and re-traumatization. The purpose of this study was to bridge the gap in literature between research and practice. Data was collected from practitioners regarding the care and treatment of pregnant women with a childhood sexual abuse history. It was hypothesized that screening practices and modification to care and treatment based on practitioner knowledge of prior sex abuse history will vary by …

Transition Of Care Guideline For Reducing Heart Failure Hospital Readmission, Geeti Farrahi

Walden Dissertations and Doctoral Studies

Heart failure (HF) patients are among the populations with the highest rates of hospital readmission within 30 days of discharge. Because of the 2010 Health Care Reform legislation, healthcare organizations are subject to financial penalty when a patient population exhibits excess readmissions. A significant reason for readmission of HF patients is a gap in the transition of care from hospital to home. The purpose of this doctoral project was to develop a practice guideline of best practices for transitioning HF patients from hospital to home. The transitional care model and care transitions intervention provided the theoretical underpinnings for developing this …

Predicting Certification Success For The Family Nurse Practitioner, Tammy Lee Gravel

Walden Dissertations and Doctoral Studies

High-stakes licensure or certification examinations are required for many health professions disciplines to ensure safe entry-level practice. Accrediting agencies set a benchmark for graduates' first-time licensure or certification success as a measure of program effectiveness. Failures of graduates on licensure or certification examinations may directly affect the school's recruitment and retention of qualified students and faculty, as well as institutional financial viability. A health science university has added Health Education System, Inc. (HESI) standardized examinations using computer adaptive testing into the family nurse practitioner (FNP) master's program to support certification success, although research on these advanced practice examinations as related …

Assessing Nurses' Safety Attitudes In Preventing Clabsi, Seraphine Ikwueme

Walden Dissertations and Doctoral Studies

Central line-associated bloodstream infection (CLABSI) has been widely studied because of its impact on patient morbidity, mortality, and overall health care costs. Research has shown that nurses' attitudes and perceptions regarding safety are critical to developing and maintaining clinical environments that are safe, prevent CLABSI, and assure better health outcomes. The practice-focused question for this project sought to determine the safety attitudes exhibited by registered nurses on a medical-surgical unit at the practice site. The Stetler model was used as a framework to guide the study. The Safety Attitude Questionnaire (SAQ) measured attitudes and perceptions regarding teamwork, safety, job satisfaction, …

Increasing Patients' Understanding Of Prescribed Medication Adherence, Valarie Finley Thomas

Walden Dissertations and Doctoral Studies

The cost of healthcare in the United States has increased due to growing numbers of patients who live with chronic health problems, such as heart disease. The cost of healthcare is compounded by the cost in terms of complications of cardiovascular disease secondary to medication non-adherence. Education about medication use and adherence, safety, and side effects was needed for patients in a cardiovascular unit to improve adherence to medications as prescribed. Results of a health care provider (HCP) and nursing staff needs assessment provided by the site showed the need for improved cardiovascular medication education. The project focused question asked …

Progression Of Clinical Self-Efficacy Among Baccalaureate Nursing Students, Christine Lee Hamilton

Walden Dissertations and Doctoral Studies

Clinical self-efficacy, or the confidence that nursing students have in their ability to successfully perform nursing clinical skills, is imperative for the safe and effective practice of nursing. A gap in knowledge exists about the change in clinical self-efficacy as baccalaureate nursing (BSN) students move through a nursing program, in which they learn and practice clinical skills in laboratory and clinical settings. Guided by Bandura's social cognitive theory, the purpose of this quantitative study was to determine the relationship between clinical experience within a nursing program and the reported clinical self-efficacy of BSN students in the sophomore, junior, and senior …

Perceptions Of Collaboration And Mutual Respect Among Members Of Interprofessional Teams, Brenda Lankhof

Walden Dissertations and Doctoral Studies

Government agencies are encouraging healthcare practitioners to work in interprofessional teams to address the complex needs of an aging population, to improve client outcomes, and to increase the cost-effectiveness of health care. However, a clearer understanding of the elements required for an effective interprofessional collaborative practice is needed. The purpose of this online, descriptive study was to focus on one component, mutual respect, and determine its relationship to collaboration among members of interprofessional teams working in family health teams (FHTs) and community health centers (CHCs) across Ontario. D'Amour's four-dimensional model of collaboration was used as the theoretical basis. This model …

Evaluation Of The Bedside Swallow Screen, Ruby Ben

Walden Dissertations and Doctoral Studies

Dysphagia is a leading complication of a stroke. A nurse-driven bedside swallow screen can identify dysphagia and decrease the risk for complications such as aspiration pneumonia. At the project site, the use of the bedside swallow screen was at 33%; there was noncompliance with the use of the bedside swallow screen by the emergency department nurses. The purpose of the doctoral project was to increase the use of the bedside swallow screen. Published outcomes, research, and reports generated from archived data were the sources of evidence. The six sigma methodology was used to inform the quality improvement doctoral project. At …

Fall Reduction Among The Geriatric Population In Assisted Living Facilities, Marylyn A. Hagerty

Walden Dissertations and Doctoral Studies

Incidents of falls among the elderly increase with age. About $31 million is spent annually in the United States on medical costs related to fall injuries in the elderly. This project evaluated the outcomes of a fall reduction program implemented in an assisted living facility (ALF). The Stop Elderly Accidents, Death & Injury program developed by the Centers for Disease Control and Prevention was implemented by the ALF for 60 days prior to the outcome evaluation project. The program included a convenience sample of 62 residents and involved medication evaluation, exercises, assistive devices, environmental risk reduction, and evaluation of blood …

Staff Education And Training For The Maternal Cardiac Arrest, Kimberly Sue Gililland

Walden Dissertations and Doctoral Studies

Maternal cardiac arrest is among the most frightening events that can happen on the labor and delivery unit. A maternal arrest can have catastrophic results. Staff must be vigilant, competent, and ready to handle the maternal arrest emergency at all times. A maternal cardiac arrest requires coordination among multiple disciplines and precise performance is paramount in saving not one life, but two. The purpose of the project was to establish a clinical training course for maternal arrest intended for education to improve staff knowledge during a maternal cardiac arrest. Evaluation of the knowledge and skills were through an exam, participation …

Early Recognition And Treatment Of Acquired Pneumonia, Michael Lamorgese

Walden Dissertations and Doctoral Studies

Sepsis is a life-threatening organ dysfunction disease process that costs the healthcare system millions of dollars each year. By using existing assets, the number of patients admitted to the hospital suffering from sepsis secondary to community-acquired pneumonia can be reduced. The purpose of this project was to improve and expand the scope of practice of the registered nurse working in a private medical office to initiate treatment for suspected CAP using evidence-based practice. Data from the last quarter of 2017 and the first quarter of 2018 were compared. The purpose of comparing these data sets was to examine outcomes of …

Department Structure And Leadership Functions For Advanced Practice Providers, Deondela Love

Walden Dissertations and Doctoral Studies

Department structure and leadership functions can influence work climate. In one healthcare system, advanced practice providers (APPs) worked in a decentralized structure with multiple leaders. This project explored the impact of the change to centralized leadership for APPs working in an academic healthcare system in which employee turnover was high and satisfaction was low. An ad hoc committee led by the chief medical officer created a centralized department with a designated leader. Surveys and interviews were used to identify the benefits of the strategies implemented and understand whether the change in organizational structure resulted in an improved work climate for …

A Transition Quick-Guide For Educating Youth With Hemophilia, Joetta Smith

Walden Dissertations and Doctoral Studies

A 2009-2010 National Assessment Survey of youth with special needs such as hemophilia showed that 40% of youth between the ages of 12 and 17 had a transition plan before transitioning to adult care services. The lack of a transition plan caused youth to fall into a fragmented care gap when transition services are inadequate. During the gap, youth with hemophilia increased use of the emergency room and were hospitalized for complications such as frequent joint or muscle bleeding and joint disability. As a result, the health status of affected youth becomes fragile and health care costs escalate. The practice …

Educating Staff Members In An Outpatient Clinic On Hypertension Management, Helen Anyiam

Walden Dissertations and Doctoral Studies

An educational module on hypertension was created in response to the recurring pattern of patient visits with hypertension and an observed knowledge gap among nursing staff in an outpatient clinic located in the southern United States. The educational module was patterned after Joint National Committee-8 and American College of Cardiology guidelines involving patient lifestyle modification and provided clinic staff with information on hypertension diagnosis and self-management for use in patient education. The module was reviewed by a panel of 3 experts who approved it for appropriateness and clarity of content and made one minor recommendation for revision. The education materials …

Exploring The Cultural Intelligence Of Nurse Leaders, Valerie D. Campbell

Walden Dissertations and Doctoral Studies

Today, nurses represent many cultures and ethnic backgrounds. In their leadership style, nurse leaders must learn to embrace cultural intelligence or cultural quotient (CQ), that is, an extension of emotional intelligence that affords them the ability to manage a culturally diverse workforce. Historically, CQ has been relevant to business, locally and globally. But it is also important to explore the CQ of nurse leaders. Scholarly studies show that leaders with CQ are responsible for developing innovative employee behaviors, forward-thinking ideas, and creativeness in the workplace. CQ has a theoretical foundation in the 2003 research of Early and Ang who focused …

Stress, Anxiety, And Depression: Role Of Campus Connectedness, Social Support, And Coping Among Nepalese Nursing Students, Priscilla Samson

Walden Dissertations and Doctoral Studies

High levels of stress, anxiety, and depression (SAD) can adversely influence physical health, psychological well-being, and academic and clinical performance of nursing students. Numerous studies have identified the factors associated with SAD; however, a paucity of empirical research addresses the relationship of SAD with campus connectedness (CC), perceived social support (PSS), and coping. The purpose of this quantitative cross-sectional study, guided by Lazarus and Folkman's theory of stress, coping, and adaptation, was to determine the prevalence of SAD and examine its relationship with CC, PSS, and coping among undergraduate nursing students of Nepal. Survey research was conducted using depression anxiety …

Nursing Candidates' Perceptions Of The Greatest Challenges To Becoming A Professional Nurse, Lee Ann Williams

Walden Dissertations and Doctoral Studies

Nursing candidates' overall goal is to become a professional nurse. To reach this goal, the student must graduate from an associate or baccalaureate nursing program and pass the state board, National Council Licensure Examination (NCLEX). Student retention in nursing programs and passing the NCLEX continue to be a problem for educational institutions throughout the United States. The purpose of this study was to examine nursing candidates' perceptions of their greatest challenges in becoming a professional nurse. Wenger's social learning systems and the community of practice comprised the conceptual framework that guided this study. The research questions pertained to nursing students' …

Strategies To Reduce Hospital Readmission Rates After Bariatric Surgery, Catherine Scarlett

Walden Dissertations and Doctoral Studies

Bariatric surgery is a major surgery that has become a frequent procedure in North America; growth in the number of bariatric surgery procedures has resulted in an increase in readmissions after the procedure. A systematic review of the literature using the shifting processes model as a guide was used to answer the practice-focused questions regarding reasons for hospital readmissions for postoperative bariatric surgery patients and strategies that reduce complications of the procedure. Providing Innovative Service Models and Assessment chart (PRISMA) was used to quantify 17 studies that met the inclusion criteria. Results demonstrated that the reasons for readmissions after bariatric …

Reducing Clabsi Rate Among Icu Patients, Rita L. Walker

Walden Dissertations and Doctoral Studies

Approximately 55% of intensive care unit (ICU) patients require the use of a central venous catheter (CVC). CVCs are often an essential component of care; however, CVCs can create avenues for pathogens to enter the bloodstream and cause a central line-associated bloodstream infections (CLABSI), which can lead to increased mortality and morbidity, prolonged length of stay, increased cost of care, decreased patient satisfaction, and increased workload. In 2017, the CLABSI rate at the project site was 4.3 per 1,000 catheter days as compared to the national rate of 0.8 per 1,000 catheter days. Based on Piaget's theory of constructivism, a …

Patient Self-Assessment For Older Adult Fall Prevention, Deborah Brennan

Walden Dissertations and Doctoral Studies

Falls and falls with injury are a leading contributor to decreased quality of life for adults aged 65 and older. Complications associated with fall occurrences include death, long term disability, decreased mobility, decreased quality of life, and psychological effects.

The practice focused question addressed in the project asked if the use of a standardized publicly available assessment for falls risk will assist registered nurses in learning more about the patient's fall risk. To address the question, the Stay Independent Check Your Risk for Falling Questionnaire (SICRFQ), obtained from the CDC website, was used as the basis for an education program …

Evaluation Of An Opioid Risk-Assessment Screening Tool, Jacquelyne Guerra

Walden Dissertations and Doctoral Studies

According to the Centers for Disease Control and Prevention, prescribers should evaluate risk factors related to opioid use prior to initiation of opioid medication. The practice problem in this DNP project was that providers failed to consistently assess patients with complaints of pain for risk of opioid misuse and/or abuse prior to initiating opioid medication. An opioid risk-assessment screening tool (ORAST) has the potential to identify patients at high risk for opioid misuse and/or abuse. The purpose of this Doctor of Nursing Practice project was to identify and introduce an ORAST and then develop a policy to guide providers in …

Reducing Lateral Violence Among Nurses Through Staff Education, Alexandra Lindsay Tripp

Walden Dissertations and Doctoral Studies

Most nurses experience lateral violence (LV) during their careers. LV can be detrimental to nurses' livelihoods and careers, to facilities due to nurse replacement costs, to the nursing profession due to attrition, and to patient safety. The purpose of this staff education project was to educate registered nurses on the issue of LV and to equip nurses to respond to their aggressors. The project question addressed whether education would increase awareness of LV and empower nurses to stand up to their aggressors. The theory of the nurse as the wounded healer, social learning theory, and the theory of reciprocal determinism …

Hardiness, Adult Attachment Style, And Burnout In Nurses, Kristy A. Negri

Walden Dissertations and Doctoral Studies

The current nursing shortage is a pressing crisis that is expected to worsen over time. A key reason nurses leave nursing is burnout. The purpose of this study was to investigate personality hardiness and adult attachment style in relation to the development of burnout in licensed professional nurses. Hardiness theory and attachment theory indicated that each provided protection against burnout, but no research has been conducted to examine both factors in relation to burnout in nurses. Research Question 1 asked if there was a relationship between attachment style and total hardiness score; Research Question 2 asked if there was a …

Adherence To The Icu Liberation Abcdef Bundle Improves Patient Outcomes In The Icu, Jennifer Sweeney

Walden Dissertations and Doctoral Studies

Delirium is a frequent complication of intensive care unit (ICU) admissions manifesting as acute confusion with inattention and disordered thinking. Patients in the ICU who develop acute delirium are more likely to experience long term disability and mortality. The purpose of this doctoral project was to evaluate an existing organizational quality improvement project to guide recommendations on improving care in the ICU. The practice-focused research question was: Does improving adherence to the ICU Liberation ABCDEF bundle for patients admitted to the ICU decrease incidence of delirium compared to outcomes prior to implementation? The Program Logic Model served as a framework …

Transitional Care For The Cardiac Surgery Population: Development Of A Clinical Practice Guideline, Sheila Davies

Walden Dissertations and Doctoral Studies

Recovering from a cardiac surgery procedure and the transition to home can be an overwhelming experience for patients and caregivers. A tertiary care hospital's cardiothoracic surgery department suspended a nurse-practitioner-coordinated transitional care program in the 1st quarter of 2016. Following this decision, the readmission rate increased from its previous rate of 15.6% in quarter 1 to 20% in quarter 3. The purpose of this scholarly project was to develop a clinical practice guideline (CPG) that can bridge the gap in the transitional care process. The transitional care model informed the design of the project. A draft guideline was distributed to …

Development Of A Scholarly Educational Intervention To Improve Inpatient Diabetes Care, Sharon.Hasfal Hasfal

Walden Dissertations and Doctoral Studies

Advanced practice providers (APPs), consisting of nurse practitioners and physician assistants, face many challenges in the provision of evidence-based practice in their management of hospitalized adult patients with diabetes. Some of the barriers faced by APPs at a Northeast acute care facility are poor communication between disciplines, lack of confidence in initiating insulin, limited understanding of the management of insulin and the insulin pump, and insufficient treatment of the hospitalized patient with diabetes that aligns with current clinical guidelines for the management of inpatient hyperglycemia. This quality improvement project focused on the development of an evidence-based theory supported educational intervention …

Evaluation Of A Difficult Urinary Catheter Team In An Academic Medical Center, David Price

Walden Dissertations and Doctoral Studies

The placement of an indwelling urinary catheter (IUC) is a commonly performed clinical procedure which may become challenging for the clinician and painful for the patient. In response to urologic complications attributed to repeated failed IUC insertion attempts by nurses, a difficult urinary catheter (DUC) team program was launched in October 2012. The purpose of the doctoral project was to conduct a quality improvement evaluation of the effectiveness of the DUC team program using retrospective data from May 1, 2013 through May 31, 2017. Benner's novice to expert model was chosen as the theoretical framework to guide the additional training, …