Nursing Commons^™

An Assessment Of Heart Failure Screening Tools For An Outpatient Arrhythmia Devices Clinic, Lucy Joanne Paul

Walden Dissertations and Doctoral Studies

People living with heart failure (PLHF) should be screened for symptoms at every

healthcare visit since they are 3 times more likely to experience ventricular arrhythmias. This quality improvement project (QIP) compared 3 self-administered HF symptoms questionnaires to determine the best screening tool for a tertiary hospital arrhythmia devices clinic. The instruments included the Minnesota Living with Heart Failure Questionnaire (MLHFQ), the Kansas City Cardiomyopathy Questionnaire (KCCQ), and the Self-Reported Heart Failure Symptoms (SHEFS) questionnaire. For a 30-day period, 76 people were eligible to participate in the QIP, with 55 participants included in the final analysis (72.5% participation). The questionnaires …

Hospital Administrators' Strategies For Reducing Delayed Hospital Discharges And Improving Profitability, Sheree Boyd

Walden Dissertations and Doctoral Studies

Inefficiencies in leadership and limited leadership strategies in hospitals contribute to delayed hospital discharges and an increased financial burden on a hospital. Three administrators from 2 hospitals who are part of a hospital conglomerate in Chicago, Illinois were selected for interview in this qualitative multiple case study to explore how hospital discharge strategies reduce delayed hospital discharges and improve profitability. Contingency was the primary theoretical theory for this study. The purposive sampling consisted of the selections of individual who were knowledgeable and had experience to organize, manage, and implement processes in an organization. Data collection occurred using face-to-face semistructured interviews, …

Developing An Educational Module On Compassion Fatigue, Francisca Chinyere Hennes

Walden Dissertations and Doctoral Studies

Compassion fatigue is viewed as a disconcerting issue facing healthcare professionals in the clinical care milieu, and nurses are identified as the most susceptible population among healthcare professionals. The purpose of this project was to create positive social change by helping oncology nurses find ways to enhance self-care and self-awareness, thereby reducing the risk of compassion fatigue and burnout among healthcare professionals. This project investigated an educational module on compassion fatigue that focused on (a) identifying the occurrence rates of compassion fatigue among oncology nurses, (b) evaluating the demographic features that were associated with the most frequent rates of compassion …

Effectiveness Of A Medication Administration Protocol On Medication Errors And Inpatient Falls, Avril Dolly

Walden Dissertations and Doctoral Studies

Effectiveness of a Medication Administration Protocol on Medication Errors and Inpatient Falls

By

Avril Dolly

MS, University of the West Indies, 2010

BS, University of the West Indies, 2009

Project Submitted in Partial Fulfillment of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

November 2017

Adverse events such as medication errors and inpatient falls have been reported as the leading cause of safety incidences at the acute care facility in Trinidad and Tobago where this project was conducted. These mishaps aroused concerns about patient safety and led to a quality improvement (QI) initiative at the hospital. …

Evidence-Based Practice Project Proposal: Reducing Chfrr Through The Get Well Networks Chf Prevention Education Materials, Susan Kay Richmond

Walden Dissertations and Doctoral Studies

In the United States, congestive heart failure (CHF) impacts 6.5 million adults and costs about $39 billion year with a projected incidence increasing by 25% by 2030. CHF can be addressed by advancing patient self-care knowledge through interactive patient education. For this project, the Health Beliefs Model guided a strategy to stimulate behavior modification based on perceived benefits of self-care. The purpose of this quality improvement project was to implement an interactive patient education video system, called the Get Well Network, to encourage patient self-care to reduce CHF readmission rates at a veteran's administration hospital. Four evidence-based CHF video order …

Enhancing Nurses' Assessment Of Pain Management In Dementia Patients, Norma Jean Boone

Walden Dissertations and Doctoral Studies

Chronic pain contributes to morbidity, mortality, and disability in millions of people. Prevalence rates for pain are as high as 83% among the 5.2 million older adults living with a diagnosis of dementia. The purpose of the quality improvement project was to assess nurses' knowledge of pain assessment and management in a 45-bed Veterans Health Administration long-term care facility serving older adults with dementia. Knowles' adult learning theory served as the theoretical framework and the knowledge to action model supported the translation of evidence into practice. A convenience sample of 27 licensed and unlicensed nursing staff answered the 16-question, 5-point …

Effect Of Home Telemonitoring On Heart Failure Hospital Readmissions Among Adult Hispanics, Priscilla Liza Caban

Walden Dissertations and Doctoral Studies

Heart failure is ranked as one of the leading causes of hospitalizations and mortality among adults of all racial/ethnic groups in the United States. Telemonitoring, as a homecare intervention for heart failure management, has been used across all groups although the benefit for Hispanics not established. The purpose of this retrospective, quantitative study was to determine the differences in hospital readmission between Hispanic, non-Hispanic Black, and non-Hispanic White patients with heart failure disease who either received or did not receive home telemonitoring services from a homecare agency in Connecticut. The research questions for this study examined the effect of home …

Alcohol Use Disorder And Withdrawal Syndrome In Correctional Facilities: An Evidence-Based Clinical Practice Guideline To Prevent Alcohol-Related Adverse Events, Wanda Wilma González-Méndez

Walden Dissertations and Doctoral Studies

In the United States, one in every 100 adults is confined to a correctional facility. Approximately 60% of inmates have an alcohol use disorder (AUD). When compared to the general population, inmates are twice as likely to have AUD. As they are unable to readily access alcohol, inmates entering a correctional facility with AUD are at high risk for the lethal alcohol withdrawal syndrome (AWS). AWS is preventable and yet correctional nurses process new inmates without an evidence-based clinical practice guideline (CPG) to assess for AUD, the prerequisite for AWS. The purpose of this project was to develop an evidence-based …

Development Of A Guideline For Hospice Staff, Patients, And Families On Appropriate Opioid Use, Trenika Alexander-Goreá

Walden Dissertations and Doctoral Studies

There is an identified problem with patients receiving suboptimal pain management at a hospice agency in the northwestern United States. At this agency, undertreatment of pain is prevalent. Evidence indicates that this may be a result of a lack of guidelines, education, and knowledge of appropriate prescribing. Known barriers to the correct prescription and administration of potent opioids in the hospice setting include prevailing beliefs, knowledge, skills, and attitudes, all of which can impact care negatively. Contextually, hospice principles mandate patient comfort and caregiver involvement in continuous quality improvement, which includes adequate and informed pain management. Moreover, hospice metrics demand …

Educational Interventions To Improve Aggressive Behavior Recognition For An Acute Psychiatric Setting, Marie Elois Ortiz

Walden Dissertations and Doctoral Studies

Nurses working in an acute psychiatric setting within a veterans' administration hospital must maintain a therapeutic milieu by recognizing and managing aggressive behaviors before violence ensues to reduce injuries to staff nurses and patients. The purpose of this project was to develop an evidence-based and theoretically grounded educational program that will help staff nurses manage escalating aggression, violence, and acting out behaviors to provide a safe environment for patients and staff through high risk identifier recognition and intervention training. During the data and information gathering stage, 23 articles were reviewed, rated, and graded to provide the most significant information used …

Decreasing Primary-Care-Related Emergency Department Visits In The Hispanic Population Using Patient Navigators, Arthur Dominguez Jr.

Walden Dissertations and Doctoral Studies

Primary-care-related emergency department (PCR-ED) visits by Hispanic patients enrolled in a not-for-profit Medi-Cal and Medicare health plan resulted in longer wait times in the emergency department (ED) at a regional medical center in Southern California. This congestion decreased access for those with true emergencies, created capacity issues, increased ED length of stay, and resulted in potential safety risks. This project focused on decreasing PCR-ED visits in the Hispanic population using patient navigators in Southern California. Applying the health belief model and Lippitt's theory of change, this doctoral project involved the creation and implementation of a culturally appropriate, population-specific patient navigator …

Postpartum Mothers' Attitudes Toward Breastfeeding, Jackie Denise Jones

Walden Dissertations and Doctoral Studies

Breast milk is the optimal source of nourishment for babies, providing positive nutritional and psychosocial benefits for infants' growth and development. Rates for initiation of breastfeeding and exclusive breastfeeding at 6 months in the United States are well below the target rates for the Healthy People 2020 Maternal, Infant, and Children's Health objectives. Using Ajzen's theory of planned behavior, the purpose of this project was to ascertain how knowledge and attitudes influenced a mother's intent to breastfeed during her hospital stay and the likelihood of exclusive breastfeeding continuing after discharge. A convenience sample of 68 postpartum mothers was recruited from …

Faculty Competence In Facilitating Clinical Simulation, Rose Kronziah-Seme

Walden Dissertations and Doctoral Studies

Clinical simulation is a teaching strategy to assist nursing students to connect classroom knowledge to the clinical setting. Teaching clinical simulation requires special training, but many nursing faculty who teach clinical simulation do not receive clinical simulation training. The purpose of this study was to determine if the effects of formal versus informal simulation training impacted nursing faculty's self-ratings of their competency in facilitating simulation and identify areas for needed educational support. A quantitative descriptive approach was used and grounded in the National League for Nursing and Jefferies (NLN/JSF) theoretical framework. This framework focuses on the relationship between teacher, student, …

The Meaning Of Feeling Fearful For New Community/Public Health Nurses, Demetrius Ann Jones

Walden Dissertations and Doctoral Studies

This study examined the meaning of feeling fearful for nurses entering community/public health (C/PH) nursing. Nurses are entering the C/PH workforce with less experience and education than ever before, and may feel afraid or fearful in their jobs. Additionally, the autonomous nature of C/PH nursing poses significant challenges for this population such as fear of isolation and/ or abandonment. Therefore, the purpose of this qualitative descriptive study was to explicate the meaning of feeling fearful for new C/PH health nurses. Ten nurses with up to 2 years of C/PH experience volunteered for this study. The research questions were guided by …

Improving The Nursing Practice Environment With Point Of Care Specimen Collection, April Marie Saathoff

Walden Dissertations and Doctoral Studies

Specimen collection and identification errors are a significant problem in healthcare, contributing to incorrect diagnoses, delayed care, lack of essential treatments, patient injury or death, increased length of stay and increased healthcare costs, and decreased patient satisfaction. The purpose of the project was to evaluate the implementation of specimen collection technology with barcode scanning and bedside label printing in the maternal child health division of a community teaching hospital. The project was driven from Donabedian's quality framework for healthcare implementations, indicating that evaluating the quality of health care can be drawn from the categories of structure, process, and outcomes. The …

Heart Failure Readmission Strategy Via Heart Failure Script, Michael Todd Williams

Walden Dissertations and Doctoral Studies

Hospital administrators strive to reduce readmission and over use of the acute care setting for chronic health conditions. Historically hospitals have focused on readmission prevention strategies to improve the transition of patients from the hospital to the community and although the causes of a hospital readmission may span multiple providers along the continuum of care, the hospital is currently the only provider being penalized. The project facility implemented a readmission reduction strategy, Re-Engineered Discharge (Project RED), as a means to reduce readmissions and yet continued to have high readmission rates for heart failure (HF) patients. The continued high rate of …

Evaluating The Impact Of A Smoking Cessation Program., Gideon Eke

Walden Dissertations and Doctoral Studies

Forty-six million individuals in the United States used tobacco products. People who use

tobacco products attempt numerous strategies before giving up smoking habit altogether. The goal of this project was to evaluate the impact of a tobacco cessation program by evaluating pre-and post-cessation program data, and hospital records of participants attending the hospital smoking cessation program over a 6-month period to ascertain the degree of reduction in tobacco use and hospitalization from smoking-related diseases. The population sample comprised of both men and women between the ages of 18 years and above. The project question addressed whether the smoking cessation program …

Use Of Tai Chi To Treat Mental Health Disorders In Veterans, Mekeesha Mcclure

Walden Dissertations and Doctoral Studies

Clinicians have a challenge of discovering and implementing new ways to address their patients' health concerns. Some healthcare needs are not completely managed with pharmacotherapy and invasive procedures alone. Military veterans compose a special group due to multiple needs related to physical and emotional symptoms resulting from exposure to trauma. This project explored the benefits of a Tai Chi recreational therapy program. The goal of this trial was to examine gentle movement routines of Tai Chi for emotional benefits for veterans. The literature review provided insight from current evidence into the probable outcome of including alternative medicine options into regular …

Best Practices For Glucose Management Using A Computer-Based Glucose Management, Oteka Jackson-Cenales

Walden Dissertations and Doctoral Studies

The prevalence of diabetes mellitus (DM) continues to be a global concern among health care practitioners. Without collaboration and interventions, this chronic disease, which poses a significant financial burden for health care institutions, will continue to be problematic. Promoting the use of glycemic control measures among diabetic patients is an intervention, which has the potential to reduce diabetic complications and improve outcomes. The purpose of this doctoral project was to explore available evidence through a systematic review of the best practices for glucose management. The chronic care model served as the theoretical framework. The evidence based practice question was, What …

Nursing Approaches For Use And Sustainability Of Barcode Medication Administration Technology, Jackson Ngigi Njeru

Walden Dissertations and Doctoral Studies

Approximately 43.4% of medication errors occur at the time of administration despite the use of bar code medication administration (BCMA) System. This trend has prompted a national effort to mitigate this problem in the United States. Implementing BCMA in health care settings is one of those efforts. Studies focusing on the approaches employed by nurses when using this system are scant. The purpose of this qualitative case study was to investigate strategies nurses and their leaders use to ensure BCMA is implemented, maximized, and sustained. The technology acceptance model was used to guide the study. The 2 research questions addressed …

Lived Experiences Of Individuals Quality Of Life On Prolonged Home Mechanical Ventilation, Munyaradzi Ephie Rwakonda

Walden Dissertations and Doctoral Studies

Improvements in technology have allowed people with tracheostomies to live at home on mechanical ventilation (HMV). Quality of life (QOL) for HMV users has been studied quantitatively, but few qualitative studies have been published. The purpose of this phenomenological study was to explore QOL for individuals with tracheostomies on prolonged HMV focusing on activities of daily living (ADLs) and the role of decision- making. The Roper, Logan, and Tierney activities of living theory were used to categorize activities. Ten participants, 18 years and older, with a tracheostomy and on HMV for at least 6 months were enrolled using purposive sampling. …

Empowering Nurses Through Knowledge And Technology To Decrease Fall Rates, Ngozi Doreen Nwaise

Walden Dissertations and Doctoral Studies

Falls are nurse-sensitive outcome which reflect the quality of nursing care. Nurses, therefore, have a major role to play in efforts to decrease fall rates. The objective of this project is to increase nurses' knowledge on the proper use of the CVVM as an attempt to effectively decrease fall rates. Pretest, post test, and course evaluation data were collected from 30 nurses. A descriptive analysis of the data was performed. Overall, the pretest evaluation showed that nurses had an average score of 43% in the combined assessment of their knowledge on fall prevention strategies, their use of the CVVM, and …

Development And Testing Of An Instrument To Measure Informatics Knowledge, Skills, And Attitudes Among Entry-Level Nursing Students, Diane K. Whitehead, Lynne E. Bryant, Jo Ann Kleier

Walden Faculty and Staff Publications

Informatics competencies in nursing education have long been and continue to be a concern. This article reports on the development and psychometric testing of the Knowledge, Skills, and Attitudes towards Nursing Informatics (KSANI) Scale to measure these constructs among entry-level nursing students. A measurement instrument was developed based on the Quality and Safety Education for Nurses (QSEN) Institute informatics competencies for pre-licensure students (Cronenwett et al., 2007). Survey data were collected from a convenience sample of 300 undergraduate nursing students attending the 2014 Florida Student Nurses Association’s annual convention. The data were subjected to Cronbach’s test to estimate the level …

Physical Activity Improves Depressive Symptoms In Older Adults, Karen Lee Fahey

Walden Dissertations and Doctoral Studies

Engaging in physical activity can help older adults to take part in community activities, maintain relationships, and initiate new friendships, thus preventing loneliness and depression. The purpose of this quality improvement (QI) project was to evaluate whether participation in physical activity improved depressive symptoms in 15 older adults at a local senior center. Pender’s health promotion model was used to determine nursing and behavioral science views on components that affect health behavior. The Exercise Benefit/Barrier Scale (EBBS) survey was evaluated before implementation of the walking program to measure the benefits of and barriers to exercise. The EBBS results showed that …

Health Care Clinicians' Compliance With Conducting Spiritual Assessments And Providing Spiritual Care To Infertile Women, Lesa Miller

Walden Dissertations and Doctoral Studies

Infertility is a disease that can cause psychological impairments in women, and the inability to achieve motherhood brings about cultural and social stigma. Spirituality is a protective element that may provide consolation to women experiencing infertility, yet the literature has shown that few clinicians conduct spirituality assessments or provide spiritual care to patients. The objectives of this scholarly project were to conduct an assessment to determine the needs of health care clinicians in regard to spirituality and spiritual patient care and to develop an educational module based on identified knowledge deficits. Guided by the knowledge-to-action cycle, a needs assessment was …

Pregnancy With Psoriasis: What New Parents Need To Know, Debra Henline Sullivan, Deborah Weatherspoon, Christopher Weatherspoon

Walden Faculty and Staff Publications

Psoriasis is a common, chronic, autoimmune inflammatory disease that affects a substantial number of women annually during pregnancy and childbirth. Some of these women will need and seek guidance before or during their pregnancies and during lactation. The childbirth educator needs a basic knowledge base and ability to answer questions that may arise regarding psoriasis during the childbirth experience. This article will define psoriasis and its effects on pregnancy and childbirth, consider genetic concerns, and explore treatment options.

Evidence-Based Alternative Therapy To Reduce Anxiety In Ambulatory Mental Health Patients, Renee Ann Denobrega

Walden Dissertations and Doctoral Studies

Evidence-Based Alternative Therapy to Reduce Anxiety in Ambulatory Mental Health Patients

by

Renee Denobrega

MS, Widener University, 2013

BS, Alvernia University, 2007

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

January 2016

Employee Engagement In A Cardiac Catherization Lab, Rhonda J. Smith

Walden Dissertations and Doctoral Studies

Employee Engagement in a Cardiac Catheterization Lab

by

Rhonda J. Smith

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

February 2016

This study adds to the existing body of knowledge on employee engagement and workplace climate in the catheter laboratory setting. The study goals were to discover the current state of workplace satisfaction and then to share the results with the staff to determine what to improve and how to guide them through the Lean process. This study was guided by Kanter's structural empowerment theory, which holds that structural factors …

Transforming Care Of The Behavioral Health Patient In An Emergency Department Setting, Theresa J. Kubiel

Walden Dissertations and Doctoral Studies

Behavioral and mental health issues contribute to the needs of many patients presenting to emergency departments, and yet these needs often go unrecognized. Patient processing procedures in emergency departments may not include mechanisms to consistently identify and triage patients whose care is complicated by behavioral illness. The purpose of this project was to plan a program to improve early identification and management of behavioral health patients presenting to the emergency department. The objective of this project was to develop a rapid mental health screening tool and policies guiding use of the tool in the emergency department. A multi-disciplinary team of …

The Relationships Among Job Satisfaction, Length Of Employment, And Mentoring Of Nursing Faculty, Zelda Suzan

Walden Dissertations and Doctoral Studies

The shortage of faculty in nursing education programs has been well documented by the National League for Nursing. Job satisfaction is important in retaining nurse educators, and one New York nursing program was interested in examining the potential impact of mentoring on satisfaction. The purpose of this quantitative study was to examine job satisfaction, measured by the Job Descriptive Index/Job in General scale (JDI/JIG), between nurse faculty participants in formal mentoring programs compared to participants receiving an informal type of mentoring. In addition, the length of employment was examined as a possible factor in predicting job satisfaction. The theoretical framework …