Nursing Commons^™

Caring For Patients With Delirium In The Intensive Care Unit, Susan Archer

Walden Dissertations and Doctoral Studies

Patients in hospital intensive care units are at increased risk to develop delirium, a condition which is characterized by a disturbance of consciousness and a change in cognition. Critical care nurses must have the knowledge to assess, recognize, and manage delirium. The purpose of this project was to develop an evidence-based policy for the assessment of delirium and a comprehensive nursing education plan which included an analysis and synthesis of the literature, a curriculum plan, and a pretest/posttest. The Johns Hopkins Evidence-Based Practice Model framed the project, which used a multidisciplinary team approach. Two nursing leaders, each with a doctor …

Decreasing Thirty Days Hospital Readmission Rates Of Adult Heart Failure Patients, Katherine Eyegue-Sandy

Walden Dissertations and Doctoral Studies

Heart failure is a complex heart disease that incapacitates more than 5 million people, is associated with increasing healthcare cost, and remains the leading cause of admission in the United States. As the United States faces increasing financial burden related to readmission of heart failure patients within 30 days of discharge, many healthcare institutions are evaluating interventions to determine the most effective opportunities to improve systems, including nursing practice. The purpose of this doctoral project was to improve readmission rates within 30 days of discharge from an acute care facility through the development and implementation of a standardized, evidence-based, patient-centered …

Relationship Between Student Characteristics And Attrition Among Associate Degree Nursing Students, Wendy Elizabeth Watson

Walden Dissertations and Doctoral Studies

High nursing student attrition has been a pervasive problem in the nursing program at the research site of this study. The purpose of this project study was to investigate the relationship between attrition and nursing student characteristics, including age, gender, ethnicity, English as Second Language (ESL) background, licensed practical nurse (LPN) licensure, grade point average (GPA), the number of preadmission college credits, and the Test of Essential Academic Skills (TEAS) scores. This correlational study of archival data was guided by Jeffreys's nursing undergraduate retention and success model and included a convenience sample of 240 students admitted to the program between …

Improving Nurse Mentor Retention Through The Use Of Nurse Residency Programs, Morgan Newman

Walden Dissertations and Doctoral Studies

Graduate nurses beginning their nursing career require a collaborative relationship with an expert nurse mentor to make this transition successful. However, high turnover among these experienced nurse mentors is causing a problematic gap in knowledge transfer, experience, and expertise in the nursing workforce. This project investigated whether nurse mentors who mentored in a Nurse Residency Program (NRP) remained with the organization longer and were more satisfied with their mentoring experience than nurse mentors who mentored outside of a NRP. The diffusion of innovations theory was used to support the project and process of dispersing information on the outcome of the …

Reducing Delirium In The Hospitalized Elderly With A Nursing Prevention Protocol, Mari L. Fraire

Walden Dissertations and Doctoral Studies

The aim of this project was to implement and evaluate the effectiveness of the Clear Minds protocol for early detection and prevention of delirium in hospitalized, elderly patients. The protocol was used to monitor for delirium and improve sleep quality by reducing sleep disturbances caused by environmental factors in hospital settings. Due to the risk of delirium for patients in late adulthood, implementation of a delirium-prevention protocol was needed. Upon admission, patients 60 years and older or patients that screened positive for the Brief Confusion Assessment Method (bCAM) were placed on the Clear Minds protocol. The protocol consisted of establishing …

Barriers To Transition Of Care For Heart Failure Patients, Catherine Mary Murray

Walden Dissertations and Doctoral Studies

Heart failure (HF) is an escalating chronic disorder that impacts patients, families, and society. HF necessitates efficient transition of care and complex self-care knowledge in a population often burdened with low health literacy and high readmission rates. The purpose of this project was to improve transition of discharged HF patients from a Level 1 trauma system in a mostly rural area of South Carolina to its affiliated nurse-led HF clinic. The no-show rate for initial visits to the health care system's outpatient HF clinic by postdischarge patients was 59%. Using Henderson's need theory and Stevens's knowledge transformation model for theoretical …

Needs Assessment For A Lifestyle Intervention Weight Loss Program For Hospital Employees, Karen Baumann

Walden Dissertations and Doctoral Studies

The rate of obesity is increasing in the United States. In Florida, almost 60% of the population will be obese by 2030. This increase is expected to contribute to millions of cases of preventable chronic diseases costing the state an estimated $34 billion dollars. Employer-sponsored health programs can positively influence employees' lifestyle choices and support weight loss programs to reduce health-related costs to the employee and the employer. Guided by the transtheoretical model, the purpose of the project was to conduct an employee assessment to determine the need for, interest in, and readiness for a lifestyle intervention weight loss program. …

Barriers Cardiac Nurses Face In Addressing Psychosocial Issues Of Heart Failure Patients, Debra Kay Disbrow

Walden Dissertations and Doctoral Studies

Heart failure is a chronic disease and a common cause of hospitalizations and readmissions within 30-days of discharge. To decrease the cost of care for patients with heart failure, the Centers for Medicare and Medicaid Services initiated the Readmissions Reduction Program that reduces payment to hospitals with preventable readmissions. Among the causes for readmissions of patients with heart failure are concurrent behavioral health issues that can lead to decreased medication compliance and increased risk for disease progression. The prevalence of comorbid depression is as high as 77% among patients with heart failure and may be an important factor in readmissions. …

Applying Clinical Guidelines To Curtail Opioid Overprescribing In Primary Care, Glenda Leflore

Walden Dissertations and Doctoral Studies

The purpose of this scholarly project was to evaluate an evidence-based quality improvement program implemented in 2016 in a clinical practice setting to curtail overprescribing of opioids for noncancer pain management. In 2001, the National Pharmaceutical Council and The Joint Commission on Accreditation and Hospital Accreditation initiated a standard of practice for opioid use in noncancer pain management that resulted in opioid overprescribing and a 200% increase in opioid-related deaths and incalculable societal costs. Primary care providers including nurse practitioners issue the greatest number of opioid prescriptions; therefore, to address the problem of opioid overprescribing, the 2016 Centers for Disease …

Introduction Of Evidence-Based Practice To Acute Stroke Center Nursing In Jakarta, Indonesia, Tonya Sue Stagner

Walden Dissertations and Doctoral Studies

Evidence-based practice (EBP) is a relatively new concept for nurses in Indonesia; it has not

been integrated into nursing care. This project sought to introduce EBP to nurses at an acute stroke center (ASC). The knowledge transfer team approach guided the project. The goal was to identify and analyze current data and to develop an EBP guideline for clinical nursing practice in the ASC. Sources of evidence that was used to address the practice-focused question included project team members, organizational documents, and a database search to identify EBP guidelines for the nursing care of acute stroke patients. A database search …

Nursing Student's Breast Cancer Knowledge And Breast- Self Examination Technique Confidence, Lydia E. Gaud

Walden Dissertations and Doctoral Studies

Breast cancer is the second leading cause of cancer death in women in the United States. Several factors have been identified that interfere with women's breast cancer screening practices, including lack of knowledge and confidence in the breast self-examination (BSE) technique, and lack of information provided by health care provider. One of the reasons nurses do not teach breast cancer detection could be the little emphasis given to breast cancer examination in nursing schools. The BSE is a measure of significant value in detecting cancer of the breast. However, less than half of the women in the United States are …

Nursing Education On Caring For The Dying, Holley Tyler

Walden Dissertations and Doctoral Studies

Healthcare teams can implement care initiatives to promote a positive dying experience. However, there is a lack of knowledge related to how best to care for dying patients. Nurses do not receive extensive training in nursing school to care for patients at the end of life, yet most, at some point in their careers, experience the provision of this type of care. It is important to ensure that nurses caring for dying patients have been educated about end-of-life care. The purpose of the quality improvement project was to address the lack of end-of-life care education among critical care nurses in …

Evaluating Behavioral Health Homes To Decrease Emergency Department Use, Resa Jane Noe-Norman

Walden Dissertations and Doctoral Studies

The Affordable Care Act of 2010 proposed a new integrated care model for individuals with chronic mental illness and multiple medical comorbidities by using Behavioral Health Homes (BHH). The purpose of this doctoral project was to evaluate the effectiveness of the BHH in reducing emergency department (ED) use in the community mental health outpatient setting. Guided by the American Association for Critical Care Nurses synergy model for patient care a cross-sectional, post-test only with comparison group quasi-experimental research design was used. A de-identified data set of 68 patient records in the BHH group and 73 patient records in non-BHH as …

College Health Clinic Population Health Improvement Plan Project, Kathryn M. Flynn

Walden Dissertations and Doctoral Studies

A college community health improvement plan (CHIP) focusing on the indicators of nutrition and weight status, and physical activity and fitness is designed with the goal of reducing obesity risk, improving health, and preventing chronic disease. The precede proceed model, logic model, innovative care for chronic conditions model, self-care theory, and Bandura's social cognitive learning theory were used as a research design framework for assessing, planning, and managing sustainability through a two-year college health clinic. The research questions were: what are the current health promotion inputs and activities in terms of environment, ecology, education, and policy and what could be …

Patients, Preferences, And Portals: Barriers Identified To Accessing Personal Health Information Through A Secure Online Website, Helen Patricia Fox-Mccloy

Walden Dissertations and Doctoral Studies

Patient engagement is one of the 6 quality directives issued by the Institute of Medicine for patient-centered care. Federal meaningful use regulations require health care organizations to offer patients a secure online website, or patient portal, to access their health information. Although the patient portal offers patients the opportunity to be more involved in their care, the portal has not been widely used. However, barriers to utilization are best understood from the perspective of the patient. Any barriers to patients accessing the portal are also barriers to patient engagement. The purpose of this project was to understand from the patient …

Body Piercing And Health Complications Among College Students In Puerto Rico, Elsie Goicochea

Walden Dissertations and Doctoral Studies

The incidence and prevalence of body piercing health complications among students is a public health matter that has not been researched in Puerto Rico. College students are the most consistent participants in body piercing activities and have reported health complications resulting in visits to medical offices and emergency rooms. Based on the health belief model, which is used to explain and predict health attitudes, the purpose of this quantitative nonexperimental study was to analyze the health risks and possible complications occurring after body piercing and to investigate the association between sex and age and medical complications. Data were collected from …

The Effect Of Health Literacy In Low Estimated Glomerular Filtration And Diabetes, Nicklett Johnston Johnston

Walden Dissertations and Doctoral Studies

Health literacy is widespread, but its potential is not recognized. By not recognizing health literacy, patients have the burden of coping with diabetes with renal complications without full knowledge of their responsibility to their health. The focus of the project was to assess participants with diabetes with low health literacy and low mean glomerular filtration rate (eGFR). The project goal was achieved by the assessment of the participants' health literacy and eGFR before and after education for their diabetes, then assessed to determine if teaching the participants would improve their health literacy, lab values, and overall health. Participants were recruited …

Improving New Nurses' Transition To Practice, Merri Morgan

Walden Dissertations and Doctoral Studies

Almost 30% of new nurse graduates leave the position within the first year of practice, and almost 60% leave within 2 years. When new nurse graduates do not effectively transition into practice, nursing satisfaction is affected, and additional costs are incurred by their organizations through continual hiring of nurses. The purpose of this project was to develop a comprehensive, evidence-based nurse residency program (NRP) for new nurse graduates working in a 16-bed intensive care unit (ICU) of a 160-bed community hospital in the mid-Atlantic region of the United States. Using a team approach, Rosswurm and Larrabee's model of evidence-based practice …

Pediatric Emergence Delirium In The Postoperative Setting, Jennifer Miranda Snell

Walden Dissertations and Doctoral Studies

Emergence delirium (ED), also known as emergence agitation, is a postoperative condition characterized by aberrant cognitive and psychomotor behaviors following general anesthesia. The incidence of ED is 3 to 8 times higher in children 5 years of age or less. There is no standard of nursing practice for managing ED symptoms in the pediatric surgical population. The purpose of this quality improvement project was to address a gap in knowledge needed to inform clinical decision-making when managing ED in the postoperative setting. Using an educational presentation for post anesthesia care unit (PACU) nurses, this project introduced the use of non-pharmacological …

Consensus In Anesthesia Handoff Reporting, Robin Lee Anselm

Walden Dissertations and Doctoral Studies

Despite some improvement, no consensus exists to perfect quality in anesthesia handoff practice and policy. This quality improvement project was designed to assist a local anesthesia and perioperative workforce questioning the quality of its current handoff. Theories and models used to inform the project included the Inter-Professional Team Collaborative, Lewin's change theory, the continuous quality improvement theory, and the knowledge to action model. The communication assessment tool (CAT) functioned as a needs assessment yielding a gap in handoff practice of 25 participants. The CAT also served as the post project evaluation survey. The situation, background, assessment, and recommendation (SBAR) tool …

Structured Physical Activity And Dietary Education Program For Obese Adolescents: An Evaluation Of A Quality Improvement Project At A Rural Primary Care Clinic, Andrietta Wright Barnett

Walden Dissertations and Doctoral Studies

Childhood obesity is a worldwide epidemic. In the United States, approximately 17% of adolescents are obese; and 13% of the general population is overweight. Obese adolescents are at threefold risk for developing chronic health conditions in adulthood, including type II diabetes, hypertension, and heart disease. The purpose of this project was to evaluate the results of a quality improvement program to reduce adolescent obesity as measured by BMI 5% over 18 months in a rural health primary care clinic. The health belief model and theory of planned behavior guided the project as adolescents need to first understand the risks associated …

Self-Efficacy And Cultural Competency Assessment Of The Associate Degree Nursing Student, Deborah Smith Hartman

Walden Dissertations and Doctoral Studies

Effective nursing care can be threatened when nurses are not culturally attuned with their patients. Associate degree nursing (ADN) students receive information about diverse ethnicities in the nursing curriculum, but it may not be sufficient to provide the expertise necessary to care for patients of various cultural backgrounds. The purpose of this quantitative study was to explore the 2nd year ADN students' levels of cultural competence and their perceptions of self-efficacy in working with Caucasian, African American, Native American, Hispanic, and Asian ethnicities. The study used a cross-sectional survey design to determine if a relationship existed between the students' reported …

Development And Evaluation Of An Evidence-Based Educational Process To Reduce Post-Transplant Infections, Erica Vanessa Henderson

Walden Dissertations and Doctoral Studies

The targeted transplant center's abdominal organ transplant unit had difficulty providing

adequate education to patients prior to discharge, which had resulted in a 24% readmission rate within 30 days due to infections. Patients and caregivers were unavailable to receive education despite multiple attempts, which made it challenging for health care providers to complete this aspect of their job, resulting in a negative impact on patients' long-term outcomes. A more structured educational environment was needed to provide appropriate and effective patient and caregiver education to increase adherence and positive outcomes. The health promotion model served as a foundation for the development …

Perfecting Patient Bed Flow In The Emergency Department, Kim-Sun Moreira

Walden Dissertations and Doctoral Studies

Emergency department (ED) crowding is a serious problem in the United States. Crowding in the ED can result in delays that may negatively affect patient outcomes and increase the cost of care. The purpose of this project was to understand strategies that can help to improve patient flow in the ED. The plan-to-do-study act model for process improvement influenced this project. Secondary data were collected for a 2-month period to determine the impact of workflow processes (patient boarding time in ED, surge capacity and workflow processes including the impact of ancillary departments) on the movement of admitted patients from the …

Leadership Development For The Formal Nurse Leader, Lori Neu

Walden Dissertations and Doctoral Studies

Nurse leaders are essential to the advancement of healthcare because of their ability to bridge the gap of knowledge between clinical practice and the business of healthcare. Developing nurse managers is imperative to the future of nursing given their influential role in healthcare. The central topic of exploration in the project was how nurse managers use the American Organization of Nurse Executives (AONE) Nurse Manger Inventory Tool to assess their management skills after exposure to the leadership development program currently available to them. In this project, the novice to expert theory was used to evaluate the existing leadership development program …

Translating Evidence Of Skin-To-Skin And Rooming-In To Practice, Francisca Njoku

Walden Dissertations and Doctoral Studies

The old practice of separating the mother-baby-dyad was without measurable benefits to mothers or their infants. Evidence has shown that skin-to-skin care (SSC) prevents hypothermia and hypoglycemia, decreases crying during painful procedures in newborns, and reduces maternal anxiety, stress, and postpartum depression. Rooming-in care (RIC) has been linked to an increase in the rate of breastfeeding and mother-infant interaction, as well as a decrease in the infant morbidity rate. This project assessed the effect of an educational intervention to increase rates of SSC and RIC in an obstetric unit, in addition to measuring nurses' attitudes and barriers in relation to …

Understanding Self-Management Decision Making In Heart Failure, Constance Louise Schumacher

Walden Dissertations and Doctoral Studies

Heart failure patients are responsible for managing fluctuations in symptoms between exacerbations by employing treatment adherence, active monitoring, and management strategies based on expert guidelines. Despite education, delayed help seeking persists among those in the need of acute medical intervention, as evidenced by high hospital admission and readmission rates. The purpose of this qualitative grounded theory study was to explore the decision making processes undertaken by heart failure, community-dwelling individuals as they experience symptom changes. Eighteen face-to-face interviews were conducted with participants who had heart failure and received self-management education from a home care agency in Southern Ontario, Canada. Data …

Quality Improvement Initiative About Patient Engagement With Clinicians In A Community Hospital, Cheryl Simpson

Walden Dissertations and Doctoral Studies

Chronic kidney disease (CKD) is a global health problem and efforts are needed to improve the care of individuals affected by the disease. A recent strategy for improving care within the healthcare system is patient engagement. Nurses and other health care clinicians can apply patient engagement into their clinical practice to improve the care they provide to their patients. Therefore, the purpose of this project was to increase the knowledge and awareness of patient engagement among clinicians who work with CKD patients. This quality improvement project used Lewin's force field analysis to analyze driving and restraining forces to help develop …

Development Of A Program Evaluation For A Preceptor Preparation Program, Olivia Hagos

Walden Dissertations and Doctoral Studies

A significant nursing shortage exists in the United States, which is compounded by high turnover rates. Skilled nurse preceptors are needed to train and assimilate nurses, which would improve retention of nurse preceptors, facilitate transition of nurses to the practice environment, and increase the number of preceptors within the organization. A preceptor preparation program in a 300-bed hospital was developed to promote nurse preceptor success while enhancing learning outcomes and creating a supportive work environment. The organization's leaders are interested in the successes of the program and its long-term role in retaining nurse preceptors who completed the preceptor preparation program. …

Impact Of Telephone Call On Patient Satisfaction In Adult Oncology Patients, Victoria Maria Frazier-Warmack

Walden Dissertations and Doctoral Studies

Patient satisfaction is an ongoing action in which hospitals and health care providers are constantly seeking strategies to improve their satisfaction ratings. In the ambulatory oncology infusion setting, patient satisfaction is also a key metric that is being monitored, but actual patient satisfaction is unknown. Guided by Lewin's change theory and King's theory of goal attainment, the aim of this project was to use a strategy of conducting follow-up telephones calls to determine if patient satisfaction improved in an ambulatory oncology setting. A descriptive comparative approach was used to evaluate patient satisfaction before and after a telephone follow-up intervention. Participants …