Nursing Commons^™

Making A Difference: Evidence Based Palliative Care Education For Neonatal Nurses, Sherry Elaine Pye

Walden Dissertations and Doctoral Studies

The death of a neonate is a life-changing and tragic experience for the individuals involved in the final moments of the infant's life. As the frontline provider in this clinical scenario, the bedside nurse supports the patient and family through their individual journey of loss. If the nurse does not possess the palliative care educational background and communication skills to support this unique care delivery process, the journey of death can evolve into a particularly negative experience for the parents and the nurse. This specific delivery of care concern was identified and gleaned from a parental bereavement exit interview after …

Characteristics Of The Informal Caregiver: An Integrative Literature Review, Jonanna R. Bryant

Walden Dissertations and Doctoral Studies

The needs of the informal caregiver can be difficult to determine apart from those related to caring for the terminally ill loved one. Often, informal caregivers' individual needs are lost because of their day-to-day responsibility and care of their terminally ill loved one. The purpose of this project was to discover the characteristics of informal caregivers of the terminally ill. An integrated literature review was conducted using the Fineout-Overhalt, Melnyk, Stillwell, and Williamson's (2010) analytical approach to reviewing the evidence. The approach consisted of 7 levels for evaluating the hierachy of evidence. Inclusion criteria were studies limited from January 2004 …

Development And Evaluation Of A Heart Failure Tool For Homebound Patients, Matthew Kaspar

Walden Dissertations and Doctoral Studies

With more than 700,000 new diagnoses annually, congestive heart failure (CHF) is a chronic condition that affects the chambers of the heart. When not managed correctly, the disease rapidly progresses to substantial fluid volume overload that impacts activities of daily living and the overall quality of life. The financial implications for poor CHF management cost a mean annual medical expenditure of $33,427 per patient per year. The need for a diagnostic and prognostic at-home protocol is needed in the medical community, as there is currently no such tool on the market. Donabedian's framework was used to guide the formulation and …

Development Of A Program Proposal For A Nitrous Oxide Program In Pediatrics, Sarah Oleson

Walden Dissertations and Doctoral Studies

When pediatric patients are admitted to the inpatient or outpatient hospital setting they potentially have to endure procedures that cause pain, fear, and anxiety which can have a lifelong impact on the child's response to future healthcare needs. The purpose of this project was to create a comprehensive program proposal for a nitrous oxide sedation program to minimize those perceptions towards medical procedures. The project utilized a systematic review of literature and secondary data to address the most important indicators for developing a comprehensive program proposal to present to the pediatric leadership team. Multiple studies have shown nitrous oxide having …

Fostering An Environment Of Magnet Recognition By Using Internet Technology, Shyneka Montgomery

Walden Dissertations and Doctoral Studies

Magnet Recognition, a nurse-driven certification, is an acknowledgement of nursing excellence within a hospital. Magnetic Recognition supports the highest quality of patient outcomes and is the standard for nursing care and professionalism in nursing practice. The site for this project has engaged in the process of seeking Magnet Recognition but lacked a method of communicating their progress to staff, prompting the need for the institutional intranet Magnet webpage. Guided by Roger's diffusion of innovation theory and Lewin's change management model, the purpose of this quality improvement project was to develop an evaluation plan for this webpage on the institutional intranet. …

Return To Full Duty Work: Determining The Ideal Time To Refer Occupationally Isolated Acute Low Back Pain Patients To Physical Therapy, Aletha Mae Stephenson

Walden Dissertations and Doctoral Studies

Employees who develop and report nontraumatic acute low back pain that occurs while performing work duties, or shortly thereafter, are classified as having occupational isolated acute low back pain (OIALBP). The purpose of this project was to identify and implement an evidence- based time frame to refer occupational isolated acute low back pain patients (OIALBPPs) to physical therapy (PT) that returns them to full duty work (FDW) more quickly. The diffusion of innovation theory aided the project leader and health care providers to develop strategies to overcome barriers in implementing the project's results into the practice. A total of 932 …

Using Sbar To Decrease Transfers From The Long-Term Care To The Emergency Room, Phyllis Marie Bowers Garrett

Walden Dissertations and Doctoral Studies

Care of the elderly, long-term care resident in the emergency department is an issue of importance because of the overall impact on healthcare costs, potential for negative outcomes for the resident, and the loss of revenue. The purpose of this project was to decrease avoidable transfer of residents to the Emergency Department. Using the Antecedent, Target, Measurement logic model, poor quality assessment data was deemed the antecedent of the avoidable transfer. The goal of the project was the implementation of a standardized process of assessment that would have decreased avoidable transfer of the resident. The project would have involved training …

Orientation Of Nurses Transitioning Into Hospital Specialty Units, Mary Laly Chacko

Walden Dissertations and Doctoral Studies

Competency-based nurse orientation programs focus on the new nursing graduate and experienced nurse employees' ability to perform skills necessary in a new work setting. The purpose of this project was to develop a learner-focused and competency-based orientation program for new nursing employees at a large urban hospital to enhance patient safety and nurse retention. The Johns Hopkins nursing evidence-based practice model and guideline were used in the selection of articles with higher levels of evidence and research quality for the critical appraisal of literature in support of the program development. The best practices for nursing orientation content and delivery for …

The Aftermath Of Violence: The Lived Experience Phenomena Of Assault In Nursing, Kathleen Clark

Walden Dissertations and Doctoral Studies

Despite the high incidence of violence directed at registered nurses while on duty, there is limited qualitative data that explores the lived experience of returning to the workplace after an assaultive incident. This phenomenological study sought to explore and analyze the phenomena of registered nurses who are employed in high-risk settings. The research questions considered the detailed descriptions of the experiences of nurses returning to the workplace. The conceptual framework was resiliency, as these participants continued to survive and thrive after the adverse assaultive events. Data were collected using in-depth interviews from purposeful sampling. Registered nurses working in the high …

Improving Self-Management In Patients With Chronic Conditions, Jeryl Yvette Horton

Walden Dissertations and Doctoral Studies

Care Coordination Home Telehealth (CCHT) maintains a positive impact on the delivery of patient care in the primary care clinic at the Department of Veterans Administration Medical Center (VAMC). This quality improvement initiative targets patients with chronic conditions such as diabetes, hypertension, heart failure, and chronic obstructive pulmonary disease. These patient are frequently seen in the emergency room, and are often admitted to the hospital, where they saturate the outpatient clinics' waiting room with multiple walk-ins. CCHT has, to some extent, reduced walk-ins, emergency room visits, and hospitalization while minimizing the strain on access to care at the VAMC. Sustaining …

Tools That Measure Caring: A Systematic Literature Review Of The Impact Of Caring, Jennifer Drake

Walden Dissertations and Doctoral Studies

Technology and the complexity of the patient care can take the nurse's attention away from caring for the patient to caring for the technology. The purpose of this systematic review was to gather evidence from the literature on tools for measuring caring and the outcomes in order to make that body of knowledge easily accessible to the direct care nurse for implementation. Jean Watson's theory of human caring 'the theoretical framework that guided and informed this DNP project' focuses on human caring processes and experiences. It assumes that effective caring promotes health and outcomes of the nurse and patient. By …

Development Of A Teach-Back Educational Module For Heart Failure Discharge Teaching, Marissa Blair Jamarik

Walden Dissertations and Doctoral Studies

Heart failure (HF) readmissions create a financial burden for healthcare nationwide and speak to the lack of effective discharge preparation for patients to be successful with self-care at home. The 183-bed hospital where this DNP quality initiative will take place currently reports an observed-over-expected (O/E) readmission rate for HF patients (Centers for Medicare and Medicaid [CMS]). Core measures on HF developed by the Joint Commission and the Centers for Medicare and Medicaid Services do not appear to be enough to ensure successful transitions of care from hospital to home. Guided by the LOGIC model, the purpose of this quality improvement …

An Evidence-Based Strategy To Improve Influenza Vaccination Rates Among Registered Nurses In Hospitals, Terri Lynn Spoltore

Walden Dissertations and Doctoral Studies

Seasonal influenza, or the flu, impacts over 3 million people each year. Within the health sector, nosocomial infection and absenteeism are frequently associated with the flu. The Centers for Disease Control and Prevention (CDC) recommend flu vaccination for all eligible individuals, especially health care workers (HCWs). Interventions associated with increased HCW vaccination include educational programs and occupational health campaigns to address misconceptions regarding vaccine safety and efficacy. This project evaluated the impact of a voluntary, web-based education module to encourage registered nurse (RN) vaccination. The logic and health belief models served as the theoretical frameworks. In a nonequivalent group design, …

Nurse Practitioner Residency Programs: An Educational Journey, Gregory Paul Rys

Walden Dissertations and Doctoral Studies

Primary care is in a state of crisis due to the lack of clinicians and increasing numbers of insured patients. Encouraging more students to go directly through school for their doctor of nursing practice degree and nurse practitioner (NP) certifications is one proposal to alleviate this crisis. However, this approach would deliver graduates with minimal leadership and clinical experiences directly into practice. One resolution to mitigate this concern would be an NP residency program. Evaluating the knowledge and attitudes of stakeholders prior to the implementation of a NP residency program is an important first step to this implementation plan. The …

Diagnosing Fibromyalgia: Using A Diagnostic Screening Tool In Primary Care, Lilo Fink

Walden Dissertations and Doctoral Studies

Fibromyalgia (FMS) goes undiagnosed in as many as 3 out of 4 people who have the disease. Primary care providers (PCPs) are the first to evaluate patients; therefore, PCPs need to be able to recognize FMS, implement initial treatment, and refer for further consultation. The Fibromyalgia Diagnostic Screening Tool (FDST), a validated instrument to identify FMS, can improve the speed and accuracy of FMS diagnosis. The purpose of this project was to familiarize PCPS with the FDST, evaluate their receptiveness to the tool, and train them in its use. The Leventhal, Diefenbach, and Levanthal, common sense model of illness provided …

Assessing Knowledge Of Evidence-Basedpractice Among Nurses, Suja Merin John

Walden Dissertations and Doctoral Studies

Evidence-based practice (EBP) is used worldwide to improve the quality of patient care to provide cost-effective care. EBP is a mandate for nursing practice combining individual clinical judgment with available expertise to generate a positive outcome for the patient. Investigators have documented that nurses have varying degrees of confidence and knowledge about EBP. The purpose of this project was to improve knowledge of EBP among registered nurses (RNs). The ACE Star Model of Knowledge transformation was used as the conceptual model. The key project question was to assess the level of knowledge and confidence about EBP among RNs in a …

New Graduate Nurses: Evaluating An Innovative Mixed Method Orientation Program, Mary Josette Armendariz-Batiste

Walden Dissertations and Doctoral Studies

Institutions are recruiting new graduate nurses to fill their vacancies. The aim of this project was to create a new graduate nurse orientation program that consists of the Essentials of Critical Care Orientation (ECCO) program created by the American Association of Critical Care Nurses (2014), scenarios, and simulation that will result in an increase in nurses' sense of their ability to provide safe patient care, communicate effectively, perform skills, and increase their sense of institutional support. The theoretical framework for this mixed methods project was Benner's "From Novice to Expert." The convenience sample participants consisted of 17 baccalaureate-prepared new graduate …

Education And Mentoring Of Staff Nurses In Evidence Based Practice, Sherri L. Smith-Keys

Walden Dissertations and Doctoral Studies

Current gaps in nursing practice can decrease by the translation, implementation, and dissemination of evidence-based practice (EBP). The purpose of this project was to provide staff nurses with EBP education and mentoring in identifying and addressing nursing practice issues using EBP to manage patient care. The Advancing Research & Clinical Practice through Close Collaboration (ARCC) and the social cognitive theory were used as a framework to guide this project development, which addressed if medical surgical nurses receiving education in EBP practice led to improved use, implementation, and improved best practice outcomes. Seven randomly selected medical surgical nurses from a local …

Impact Of Simulation Training On Novice Nurses, Sheila Marjean Moore

Walden Dissertations and Doctoral Studies

In 1999, the Institute of Medicine released its report on building a safer health system. Since then, safety in patient care has become a paramount interest. Given the growing support for increasing patient safety, simulation training has become a common part of novice nurses' orientation program. This simulation training is designed to mimic situations in the acute care setting where novice nurses can practice in a patient safe environment. In this DNP project, a stroke simulation scenario and supporting patient chart was developed as an addition to a novice nurses' orientation program. The National League for Nursing simulation template was …

The Development And Content Validation Of An Adult Obesity Educational Program, Abel Okuma

Walden Dissertations and Doctoral Studies

Overweight and obesity in patients with intellectual and developmental disabilities (IDD) are at epidemic levels in the United States. The problem identified for this DNP project is the incidence of overweight and obesity in IDD. The framework used involved the quality model for improvement. For this DNP project a new program called the Daily-Enhanced Physical Activities Program (DEPA) was developed to promote weight loss, reduce sedentary activities, and optimal body mass index (BMI) for IDD patients. Local experts consisting of two registered nurses, two physical therapists, and one direct support personnel working with IDD patients were recruited. Each expert reviewed …

Effect Of Home Telehealth On Vterans With Chronic Heart Failure, Yolanda Major

Walden Dissertations and Doctoral Studies

More than 5 million Americans have heart failure, with approximately 5% of those affected being veterans. As the number of patients with CHF continues to rise, new treatment options are needed to improve the quality of care. Current studies show Telehealth is one treatment option. The purpose of this scholarly project was to determine if veterans diagnosed with CHF were able to maintain optimal weight and blood pressure following participation in Care Coordination Home Telehealth (CCHT) program. The CCHT program provides care to veterans, through the use of monitoring devices placed in their home. Bandura's self-efficacy theory was used as …

Promoting Shared Decision Making Through Patient Education Of Labor Inductions, Lenora W.Y. Low

Walden Dissertations and Doctoral Studies

The induction of labor is medically indicated for many conditions in which delivering the baby outweighs the risk of continuing the pregnancy. Patients admitted for the induction of labor require adequate information to actively participate in decision making that affects their plan of care. The purpose of this quality improvement project was to improve the quality of healthcare delivery and promote patient engagement by providing consistent education using a teaching tool. The project question addressed the impact of a labor-induction teaching tool on improving patient education, participation, and overall satisfaction. The Plan-Do-Study-Act (PDSA) model was used to plan, implement, and …

Knowledge, Attitudes, And Beliefs About Preconception Care Among American Adolescent Females, Lynette Collins Collins

Walden Dissertations and Doctoral Studies

Despite an initiative to provide preconception care (PCC) and reproductive life planning (RLP) for all women of childbearing age, many women, especially those with low incomes, are not receiving it. As a result, there continues to be a high rate of infant morbidity and mortality in this population. Furthermore, low income adolescent females have not been adequately studied regarding this phenomenon. The purpose of this phenomenological study was to explore low income adolescent females' knowledge, attitudes, and beliefs about PCC and RLP in order to serve them more effectively. Five low income adolescent females, aged 18 to 21, were recruited …

Nurses' Experiences Transitioning From Staff Nurse To Management In A Community Hospital, Jennifer Sylvia Buffenbarger

Walden Dissertations and Doctoral Studies

This project study addressed the problem of frequent turnover of nurse managers at a Northeastern community hospital. The lack of retention of nurse managers has led to attenuated support for the nursing staff who continued to hold the front line in patient care. The purpose of this qualitative bounded case study was to explore nurse managers' experiences with turnover in order to identify strategies for enhancing retention. Work empowerment and servant leadership theories served as the frameworks for the study. Research questions focused on nurse managers' perceptions of empowerment and servant leadership characteristics that were important in decisions to assume …

The Use Of The Illness Perception Questionnaire: Enhancing Clinical Staff Understanding, Typhanie Beasley

Walden Dissertations and Doctoral Studies

Women with Type II diabetes face unique challenges coping with the physiologic complications of the disease, which can be enhanced or hindered by their perception of their ability to effectively manage their diabetes. The Illness Perception Questionnaire (IPQ-R) is a tool that evaluates factors influencing patient-provider communication and assesses patient's perception of their health. Guided by the common sense model of self-regulation, this quality improvement project focused on familiarizing health care providers with the IPQ-R and evaluating their receptiveness to implement it with women with Type II diabetes. Seven Primary Care providers participated in an educational in-service that included information …

Improving The Completion Rate Of Advance Directives In Home Health Agencies, Ndidiamaka Ezinne Mbakpuo

Walden Dissertations and Doctoral Studies

The number of individuals aged more than 65 years in the United States and their life expectancy has been increasing in the past decades. In spite of the presence of federal and accreditation policies recommending completion of advance directive documents by patients admitted to health care settings, advance directive completion rates are low in most health care organizations. The purpose of this study was to determine the level of advance directive completion among home health patients. The health belief model provided the theoretical framework that guided this study. A retrospective chart review was carried out in a home health agency …

Managing Acute Pain In Postoperative Surgical Patients, Sabrina Gregory

Walden Dissertations and Doctoral Studies

Every year, millions of Americans suffer from either chronic or acute pain that results in tremendous healthcare cost, rehabilitation, and loss of work productivity. Pain is an unpleasant sensation associated with sensory and emotional experiences that can cause potential or actual tissue damage. One plausible solution to managing pain is the use of nonpharmacological modalities such as guided imagery. The purpose of this project was to determine if there was a difference in pain scores following pharmacological interventions and the use of guided imagery among postoperative same day surgical patients. Guided imagery is a nonpharmacological modality that uses pictures, music, …

Healthy Work Environment: Essentials For Outcome Improvement, Lisa Cuff

Walden Dissertations and Doctoral Studies

The purpose of this project was to identify the standards for the American Association of Critical Care Nurses (AACN). The employees of a 39-bed medical surgical unit within a 697-bed metropolitan medical center were selected through collaboration with the practicum site. Out of 68 allocated positions for this unit, only permanent employees were selected to participate. An employee presented the purpose of the project, the survey process, and inferred consent represented by online login to complete the survey. Following the online assessment, the employee explained the AACN healthy work environment standards in a subsequent presentation. The online healthy work environment …

Development Of A Mentorship Program To Help Support And Retain New Nurses, Sherrie Marie Jones

Walden Dissertations and Doctoral Studies

Many newly graduated registered nurses (NGRNs) leave the nursing profession within the first 2 years of employment in a rural hospital located in the Southwestern region of Oklahoma. A strategy to address this problem was to introduce a mentorship process that would help support the NGRNs as they transition into independent practice in the clinical setting. The goal of this project was to develop a mentorship program for future implementation. The Partners In Nursing (PIN) program sponsored by the Robert Wood Johnson Foundation, and developed by the American Association of Colleges of Nursing and the American Nurses Association, was selected …

A Nurse's Perception Of Hand-Off Communication Before And After Utilization Of The I-5 Verification Of Information Tool, Maryann Bowersox

Walden Dissertations and Doctoral Studies

Abstract

Miscommunication or omission of critical patient information contributes to preventable

medical errors that result in 98,000 patient deaths each year. The hand-off

communication process creates a critical time for the patient as necessary information for

the continuity of care must be communicated. The purpose of this practice project was to

evaluate the nurses' perception of the current hand-off communication process before and

after an educational intervention and implementation of the I-5 Verification of

Information Tool. Registered nurses were asked to complete a pre survey of their

perception of the current hand-off communication process, followed by an educational

power point …