Nursing Commons^™

Stroke Risk Factor Knowledge, Attitude, Prevention Practices, And Stroke, Adaku Ngozika Madubuko

Walden Dissertations and Doctoral Studies

Regardless of the advances that have been made in stroke research and treatment and the overall decrease in stroke mortality, the stroke mortality rate for African Americans is still high at 45.2/100,000 and is still the leading cause of adult disability. Knowledge of the risk factors of stroke is paramount to reducing the morbidity and mortality of stroke, but knowledge of stroke risk factors has been found to be suboptimal in the African American population. The purpose of this study was to examine if there is a relationship between the knowledge, perception, and sources of stroke information of risk factors …

The Relationship Between Pre-Licensure Employment And Student Nurse Self-Efficacy, Khristina Lee Grimm

2017 Program & Posters

Lack of self-efficacy in nursing practice contributes to high levels of stress as new nurses enter the workforce, which causes turnover during their first year of practice. Little is known about how the type and amount of pre-licensure employment affects the selfefficacy in nursing practice of the student nurse.

Evaluating The Impact Of An Evidence- Based Weight Reduction Program Among The Obese At A Medical Facility In North Central United States, Petronilla Eke

Walden Dissertations and Doctoral Studies

In September 2016, the Centers for Disease Control and Prevention (CDC) determined that more than one-third (36.5%) of U.S. adults have an obesity problem. According to the CDC, this issue results in other medical conditions such as type 11 diabetes, hypertension, cancer, heart disease, and stroke. This project was designed to evaluate the effectiveness of an evidence-based weight reduction program for obese individuals at a medical facility in the North Central United States. The methodology used consisted of a retrospective chart review of pre- and post-data for 45 people who participated in the medical facility's weight-reduction program over a 6 …

The Impact Of Engagement Strategies On The Reduction Of Patient Falls, Rosemary Martin

Walden Dissertations and Doctoral Studies

Despite the availability of many fall prevention measures, many patients fall in U.S. hospitals each year. Experts view patient fall rates as the measure that can be most affected by a nurse-led, evidence-based intervention. The purpose of this quality improvement project was to implement and evaluate the impact of patient engagement strategies on patient compliance to fall prevention education and the reduction of falls. The quality improvement framework used for this project was the Iowa Model. Interventions for this project included patient engagement strategies including the teach-back (TB) method and video-based fall prevention education paired with the project site's existing …

Prevention And Management Of Postpartum Hemorrhage, Lisa N. Medoh

Walden Dissertations and Doctoral Studies

Postpartum hemorrhage (PPH) remains a major traumatic event that can occur after delivery. All expectant women are considered to be at risk of PPH and its effects. PPH is a preventable condition and primary interventions including active management of the 3rd stage of labor, use of uterotonics, and uterine massage. Analysis of the project site showed that PPH affected approximately 15% of all deliveries that occurred between 2014 and 2015. The overarching aim of the project was to determine how a nursing-focused educational intervention would affect staff nurse knowledge regarding PPH to decrease the incidence rate. The goal of the …

An Rn Sepsis Training Program That Supports Registered Nurses In The Emergency Room Setting, Daphne Marjorie Davis-Patrick

Walden Dissertations and Doctoral Studies

Sepsis is a severe blood stream infection that claim the lives of almost 220,000 Americans annually. Delayed patient treatment results in multi-organ failure, morbidity, mortality, and increased hospital length of stay. Timely sepsis management enables hospitals to have decreased expenses, increased patient survival, and judicious interventions. The problem addressed in this project was the lack of sepsis- training for registered nurses (RNs) working in the emergency department (ED) of a 628-bed hospital in the southeastern United States. Under the direction of the director of the ED, 269 patient charts were reviewed during 2014 to February 2015 for data related to …

Faculty Perspectives On Effective Integration Of Simulation Into A Baccalaureate Nursing Curriculum, Linda Jane Howell

Walden Dissertations and Doctoral Studies

Research shows that use of high fidelity simulation (HFS) as a teaching strategy requires extensive amounts of faculty time and financial resources for faculty development and equipment. This project study addressed the challenges encountered in the integration of HFS into a Midwestern metropolitan baccalaureate nursing program. The purpose of this qualitative case study was to explore perceptions of nursing faculty about best practice elements for successful integration of HFS into undergraduate nursing programs. Guiding questions were developed using Donabedian's structure-process-outcome model and focused on faculty perceptions related to successful implementation of simulation in their programs. Purposeful sampling was used to …

The Effects Of Structured Health Policy Education On Connecticut Registered Nurses' Clinical Documentation, Rosale Lobo

Walden Dissertations and Doctoral Studies

Registered Nurses use clinical documentation to describe care planning processes, measure quality outcomes, support reimbursement, and defend litigation. The Connecticut Department of Health, guided by federal Conditions of Participation, defines state-level healthcare policy to include required care planning processes. Nurses are educated in care planning process standards, however no policy-required competency verification processes in academia or employers exists. Guided by the advocacy coalition framework, the purpose of this quasi-experimental study was to determine if the quality of nurse coalition actors’ clinical documentation, a relatively stable parameter, would increase after attending policy-centered structured education. Data were extracted from 272 electronic medical …

Design And Development Of An Educational Intervention On Nurse Perceptions Of Caring, John S. Norris Iii

Walden Dissertations and Doctoral Studies

Caring is central to the nursing profession and important to patients and family members who expect nurses to display caring attributes. The acute care hospital in this study did not have an education program on caring practices for nursing staff although the organization acknowledged the importance of and need for a culture of caring practices in the organization. The purpose of this project was to design an educational program based on Watsons' theory of caring for registered nurses at the acute care hospital where the project took place. Rosswurm and Larrabee's model for change and Watson's theory of caring were …

Development Of An Educational Program To Obtain And Maintain Healthy Weights Among 4th And 5th Grade Students, Stephanie Dean Black

Walden Dissertations and Doctoral Studies

Development of an Educational Program to Obtain and Maintain Healthy Weights Among 4th and 5th Grade Students

By

Stephanie D. Black

MSN, University of Phoenix, 2008

BSN, Southwest Baptist University, 2006

ASN, Southwest Baptist University, 2003

Capstone Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

October 2017

Obesity is prevalent in schoolchildren and increases risk of chronic diseases throughout the lifespan. Strategies are needed to address this growing health problem. Education in elementary schools targeting the topics of nutritional choices and prevention of obesity, particularly in 4th-5th grade population, is …

New Graduate Nurses' Perceptions Of Their Delay To Professional Practice, Ruth Ann Obregon

Walden Dissertations and Doctoral Studies

This project study addressed the problem of knowledge and skills lost by new graduate RNs while delayed in transitioning to professional nursing practice. There is a paucity of knowledge about how new RNs experience their delay and how a delay may affect their future clinical performance. Mezirow's transformation learning theory was the conceptual framework for this qualitative case study. Research questions addressed new RNs' understanding of their experiences during a delay to professional practice. A purposeful sample included 8 new RNs who had completed a New Graduate Residency Transition Program (NGRTP) after a delay to practice of 6 months to …

Impact Of Osteoarthritis Self-Efficacy Toolkit On Adults With Osteoarthritis, Connie Hutley Kiser

Walden Dissertations and Doctoral Studies

Over 26 million U.S. citizens have a form of arthritis; osteoarthritis (OA) is the most common form. Self-efficacy (SE) is defined as a psychological construct which identifies an individual's confidence when performing a behavior. SE is deemed a vital judge of self-management (SM) in those with OA. The purpose of this evidence-based practice, quality improvement project was to improve SE in OA patients. The identified gap in nursing practice was the lack of SE in OA patients. The project question asked whether a toolkit with information regarding SE in OA can improve SE of management of disease-associated symptoms in adults …

Advanced Triage Protocols In The Emergency Department, Lijuan Zhao

Walden Dissertations and Doctoral Studies

Overcrowded emergency departments (EDs) are a major problem in the United States resulting in inefficiency in operation and performance. A Southern California hospital ED was the site for this project because it had operated over its maximum capacity during the last decade. Advanced triage protocols integrating standard order sets were implemented to improve quality of care; however, no evaluation of the protocols had been done. The purpose of this project was to evaluate the effect of the advanced triage protocols. Two project questions determined whether advanced triage protocols reduced ED length of stay (LOS), number of patients who left without …

Health Promotion Behavior Among Hypertensive And Normotensive Armenian Americans, Zoya Minasyan

Walden Dissertations and Doctoral Studies

Hypertension presents a significant health risk to both developed and developing countries, affecting approximately 78 million Americans of various ethnic backgrounds. Though a great deal of research about hypertension and minority groups has been published, few studies have examined hypertension in the Armenian American population in the Los Angeles area, one of the most concentrated Armenian American communities in the United States. The purpose of this study was to examine the differences in health promotion behavior between hypertensive and normotensive Armenian Americans. The theoretical basis for this study was Pender's health promotion model and the health promoting lifestyle profile (HPLP-II), …

Losing New Graduate Bedside Nurses, A Practice Improvement Initiative, Beverly Elaine Miller

Walden Dissertations and Doctoral Studies

New graduate nurses (NGNs) at bedside are faced with numerous challenges, which prompt them to leave jobs in their first year. The transition from being a student to competent nurse requires a NGN to have the necessary skills and experience. Subsequently, hospitals continue to face shortages of staff because of high turnover and low retention levels. Nonetheless, evidence from reviewed literature has indicated that the use of residency programs can increase NGNs' stay at bedside, improve retention, reduce costs of operations, and return employees' turnover. The purpose of this quality improvement project was to identify the likelihood of NGNs remaining …

Standardized Communication At The Bedside: A Review For Reimplementation, Eunice Rosas

Walden Dissertations and Doctoral Studies

This paper discusses a developmental, interdisciplinary quality improvement project that seeks to improve healthcare communication by standardizing clinician communication across all levels of care. The purpose of this project was to develop an organizational policy and interdisciplinary practice guidelines to standardize the patient handoff at the bedside. The initiative intended to use processes already in place in the organization and to integrate the knowledge from a literature review to plan the implementation of bedside handoff procedures. The quality improvement project process included assembling an interdisciplinary committee; reviewing relevant peer-reviewed literature; and developing policy, relevant guidelines, as well as long-term plans …

Development Of A Transformational, Relationship-Based Charge Nurse Program, Kimetha D. Broussard

Walden Dissertations and Doctoral Studies

Leaders of a rural Southwest Oklahoma hospital requested the development of an evidence-based program that could transform unit charge nurses into effective leaders in order to improve the leadership of direct care nurses. Nursing executive leadership discovered staff members were demonstrating high levels of stress, dissatisfaction, and burnout. Press-Ganey survey results revealed that staff felt they were not supported and did not believe nurses cared for patients' or other co-workers' well-being or safety. The Hospital Consumer Assessment of Healthcare Providers and Systems outcome scores, which were below hospital and national desired benchmarks, revealed that patients were not satisfied with the …

A Nursing-Driven Pathway To Lung Cancer Screening; A Push For Prevention, Teresa Elizabeth Giamboy

Walden Dissertations and Doctoral Studies

Lung cancer affects many individuals each year and accounts for many deaths around the globe. Lung cancer screening is a preventative health measure that has the ability to detect lung cancer earlier. The purpose of this project was to focus on the education of nursing staff within a community health system, with subsequent implementation of an electronic health record clinical decision support system, to create a direct referral pathway to lung cancer screening, delivered through patient education. The concept of prevention was the framework for this project design, which was further organized around the plan-do-study -act model, while taking into …

Evaluation Of The Safety Of Mri Scanning Of Patients With Mr Conditional Pacemakers, Shelly Lynn Mcgurk

Walden Dissertations and Doctoral Studies

Magnetic resonance imaging (MRI) of patients with cardiac implantable electronic devices (CIED) has been associated with risks such as device/lead movement, device dysfunction, and lead heating. New technological advancements have made it possible for MRI to be safely performed when adhering to an evidence-based protocol; however, this practice has not yet been widely adopted. The purpose of this practice-focused question project was to examine the safety of MRI as a diagnostic modality for the aggregate population of adult patients with MR conditional pacemakers when a nurse-practitioner-led, evidence-based protocol was used. The Iowa model served as the guide for implementation of …

Nursing Staff Responsiveness To Patients And Hourly Rounding, Lucretia Wilson Wilson

Walden Dissertations and Doctoral Studies

The Center for Medicare/Medicaid Services reduced the hospital's reimbursement by $500,000 due to patient care linked to the poor outcomes of marginal fall rates and low patient satisfaction survey scores as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The scores for fiscal years 2013 and 2014 for the medical-surgical unit fluctuated between 40-42.9%, without significant improvement, while the house-wide scores were 63.17%. To address the problem, a quality improvement project (QIP) was implemented. An evidence-based (EB) hourly rounding intervention was initiated following an education program for nursing staff (n=47) tailored to enrich patient communication. The …

Care Coordination For Better Outcomes, Chad Dunavan

Walden Dissertations and Doctoral Studies

A deficiency of care coordination and delayed discharge planning has contributed to increased lengths of stay for telemetry patients and has pressed staff to discharge patients expeditiously, potentially leading to increased 30-day readmissions. Rushing the discharge process on the day of discharge has resulted in breakdowns in communication and lack of collaboration amongst the health care team of this study, contributing to extended lengths of stay, increased readmissions, and low Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) scores. This project highlighted a patient-centered care coordination team approach with 2 clinical registered nurses and a social worker who coordinated …

Using Music Intervention To Reduce Anxiety And Agitation For Dementia Residents In Long Term Setting, Sonia Brown

Walden Dissertations and Doctoral Studies

Abstract

Dementia is one of the degenerative conditions that present in old age with a decline in cognitive function resulting in changes in personality and the ability to carry out activities of daily living and social functions. Dementia is usually associated with behavioral disturbances that include anxiety and agitation that pose a challenge for family members or caregivers in an alternate home or care-related facility. The purpose of this project was to design and implement a quality improvement program to evaluate music therapy intervention for residents in a long-term care who have dementia. The aim was to evaluate if music …

Introducing The Health Coach Method Of Motivational Interviewing To Medical Assistants To Improve The Patient Care Approach, Allison Marlene Souza

Walden Dissertations and Doctoral Studies

The emerging health care culture of accountability for patient outcomes compounds problems for already overwhelmed clinicians struggling to fit everything entailed in complicated office visits into 15-minute appointments. Unprocessed frustrations tempt clinicians to use ineffective and outdated methods for trying to get their patients to comply or adhere to their care plans, undermining effective health care management. The intention of this project was to evaluate whether educating medical assistants in the health coaching method of motivational interviewing can improve the patient care approach while simultaneously assisting clinicians struggling with insufficient time. Several individual scheduling conflicts limited the target population into …

Implementation Of An Early Progressive Mobility Program In The Intensive Care Units, Rene Merced Rodriguez

Walden Dissertations and Doctoral Studies

In the United States, adult ICU patient care consumes $90 billion annually, or 1% of the gross national product. In the ICU, about 40% of the patients are mechanically ventilated resulting in an 11% greater length of stay (LOS) that requires 35% more resources. And, an estimated 60% of these patients are adversely impacted for as long as five years following discharge. Patient immobility while ventilated contributes to poor quality and financial outcomes. The Institute of Healthcare Improvement (IHI) reports on average early patient mobility (EPM) reduces a 4.5-day LOS by as much as 1.3 days; and reduces the risk …

Perceptions Of Childhood Obesity Among African Americans In A Low-Income Community, Cotella Wilkes Wilkes

Walden Dissertations and Doctoral Studies

Childhood obesity is a prevalent chronic condition affecting millions of children and adolescents in the United States and is rising in record-breaking numbers among African Americans in low-income communities. Guided by the social cognitive theory, the purpose of this evidence-based project was to understand the impact of an educational intervention on parents' perceptions of childhood obesity risk factors, weight status, and prevention strategies in a rural South Carolina community. A convenience sample of parents who attended a church-based community health promotion service in a low-income area (n = 10), aged 28 to 54, completed The Childhood Obesity Perceptions survey before …

Low Health Literacy And Preoperative Instruction Compliance Among Patients Undergoing Surgical Procedures, Mariefel Casino Paqueo

Walden Dissertations and Doctoral Studies

In addition to cancelations and delays of needed surgical procedures, serious or fatal complications can occur when patients with low health literacy do not comply with preoperative instructions. The purpose of this quality improvement project was to provide more insight about ways to decrease on cancelled and delayed surgical procedures in low health literacy patients' due to noncompliance with preoperative fasting instructions. The project was informed by the reach, effectiveness, adoption, implementation, and maintenance model (King, D. K., Glasgow, R. E., and Leeman-Castillo, B. (2010). The project question centered on whether health literate preoperative fasting instructions could decrease cancellations and …

Using Nursing Simulation To Improve Early Recognition Of Emergent Situations, Carlene Blais

Walden Dissertations and Doctoral Studies

Nurses' ability to recognize and respond to postoperative patients who require emergent medical care and need immediate assistance during a code blue in the first 10 minutes is essential to improve patient outcomes. This is particularly important for the project site, a 44-bed inpatient surgical specialty hospital located in the Northeast, providing care for patients with head and neck cancer, as the hospital does not have an internal code blue response team. An adjacent facility responds to all code blue emergencies and takes approximately 10 minutes for the team to respond. The purpose of this DNP project was to develop …

Barriers To Membership In A Professional Organization For Advanced Practice Nurses, Kesha Renee Walton

Walden Dissertations and Doctoral Studies

Professional organizations offer nurses services and resources for professional growth throughout their careers; yet, membership has declined over the past 10 years. Accordingly, this study was to understand the barriers in membership and identify positive changes that will increase membership and retain members. A quantitative descriptive design was employed within a convenience sample of 150 advanced practice registered nurses (APRNs) who were past or nonmembers of a professional organization. Exchange theory was applied and the Professional Association Membership Questionnaire (PAMQ) was administered to assess the barriers to APRNs participating in a specific professional organization. Statistical analysis included mean scores for …

Effective Communication And Teamwork Improve Patient Safety, Helene M. Anderson

Walden Dissertations and Doctoral Studies

Work environment influences the effectiveness of care for patients in any healthcare setting. It is even more important in settings such as the neonatal ICU (NICU) where this project took place. When the environment is not healthy, communication may suffer and result in poor patient outcomes and, family, patient, and staff dissatisfaction. The purpose of this quality improvement project was to understand how the implementation of the TeamSTEPPS program, for nurses in the NICU, could impact the safety culture as measured by the AACN Healthy Work Environment (HWE) tool. Lewin's professional practice change theory and the AHRQ change model were …

Impact Of Nursing Certification On Patient Perception, Satisfaction, And Outcomes, Rodney Baccus

Walden Dissertations and Doctoral Studies

Increased responsibilities for patient care within the nursing profession leads one to examine the correlation between nursing care and patient satisfaction. Current evidence indicates that higher levels of nursing education are associated with better patient outcomes. The literature further demonstrates that increased expertise and certification within a nursing specialty leads to increased nursing empowerment, improved intrinsic value and better collaborative relationships. However, the relationship between certification status and patient satisfaction remain unclear. This systematic review sought to understand the relationship between nursing certification and patient satisfaction. Guided by Rogers' diffusion of innovation theory this project examined the peer-reviewed literature using …