Nursing Commons^™

Cultural Competence In Certified Registered Nurse Anesthetists, Martina Renee Steed

Walden Dissertations and Doctoral Studies

For several decades, the field of nursing has focused on the integration of cultural competence content into its prelicensure educational programs. Despite this focus, little is known about the cultural competence of nurses extending their education past initial licensure into an advanced practice nursing specialty, such as nurse anesthesia. Researchers in other fields have found that provider race and previous cultural competence training are associated with higher levels of cultural competence. This research, guided by the culture care diversity and universality theory, sought to determine the relationship between the two subscales, Cultural Awareness and Sensitivity (CAS) and the Cultural Competence …

Nursing Faculty Perceptions Of And Responses To Student Incivility, Lori Linn Theodore

Walden Dissertations and Doctoral Studies

Student incivility has become a problem in nursing schools around the country. Researchers have noted that uncivil behavior that goes unaddressed may compromise the educational environment. Nursing faculty have differing standards about uncivil behavior; thus, students experience inconsistencies in approaches to incivility. The purpose of this mixed-methods explanatory study was to explore nursing faculty experiences with, understandings of, and responses to student incivility. The conceptual framework was Clark's continuum of incivility and the conceptual model for fostering civility in nursing education. Descriptive analysis of the level and frequency of uncivil behaviors of nursing faculty members (17 full-time and 15 part-time), …

Decreasing Attrition Of Novice And Newly Hired Professional Nurses Through Preceptorship, Brenda Gould-Johnson

Walden Dissertations and Doctoral Studies

Approval

Walden University

College of Health Sciences

This is to certify that the doctoral study by

Brenda Gould-Johnson

has been found to be complete and satisfactory in all respects,

and that any and all revisions required by

the review committee have been made.

Review Committee

Dr. Eric Anderson, Committee Chairperson, Health Services Faculty

Dr. Patti Urso, Committee Member, Health Services Faculty

Dr. Jonas Nguh, University Reviewer, Health Services Faculty

Chief Academic Officer

Eric Riedel, Ph.D.

Walden University

2015

Walden University

College of Health Sciences

This is to certify that the doctoral study by

Brenda Gould-Johnson

has been found to be …

Perceptions Of The Community Of Inquiry In An Online Rn To Bsn Program, Beth Ann Townsend

Walden Dissertations and Doctoral Studies

Basic nursing education is no longer sufficient to meet the escalating demands of today's complex healthcare environment. Recognizing the need for the advanced cognitive skills incurred by these demands, increasing numbers of registered nurses (RNs) have been enrolling in online Bachelor of Science in Nursing (BSN) programs. The problem identified in the RN to BSN degree completion program at a large Midwestern university was the lack of information as to how online teaching and learning strategies were experienced by students. Research has demonstrated that the online community of inquiry (CoI) model facilitates higher order thinking through collaborative learning strategies and …

Effect Of A Cardiology Nurse Practitioner Service On The Reduction In Length Of Stay For Low Risk Chest Pain Patients, Marcia Andrea Reid

Walden Dissertations and Doctoral Studies

Healthcare organizations are responding to changes in reimbursements by redesigning and re-evaluating existing programs to improve patient outcomes. .One such intervention at the project setting was the re-evaluation of the treatment of patients with low risk for chest pain and implementing a cardiology nurse practitioner (NP) service focusing on the reduction of length of stay (LOS) with the goal of improving patient outcomes. The purpose of this doctor of nursing practice project was to evaluate the effectiveness of a nurse practitioner-led service on the reduction of LOS of patients with low risk for chest pain. An established evidenced-based guideline developed …

Educating Medical-Surgical/Staff Nurses To Improve Nursing Knowledge Of Patient Education, Focusing On Health Literacy, Justin Thomas Loew

Walden Dissertations and Doctoral Studies

A primary problem faced by a majority of medical-surgical nurses is a lack of knowledge and skills necessary to improve health literacy among patients. This inadequacy among medical-surgical nurses is often linked to insufficient training on how to identify and interact with patients with lower health literacy. Improvement of patient health literacy can be realized through proper training, education, and a better application of communication strategies. The aim of this project was to improve current medical-surgical nurses' practice guidelines via the use of educational programs. The project developed pilot protocols and policies in order to improve its practical applications. The …

Barriers To The Influenza Vaccination In Veterans, Zina Floyd

Walden Dissertations and Doctoral Studies

Influenza is the eighth leading cause of death in the United States, accounting for 56,000 deaths annually and leading to an average of more than 200,000 hospitalizations every year. Adults 65 years of age and older account for 50% to 60% of influenza-related hospital admissions and an estimated 90% of influenza-associated deaths occur in people age 65 and older. During the 2011 to 2012 influenza season, approximately 50 % of veterans between 45 and 70 years of age refused the influenza vaccine within the metro-area outpatient Veteran Administration (VA) facility in Atlanta, Georgia. The aim of this project was to …

Success Experiences Of Hispanic Nursing Students Who Persisted And Graduated After Academic Failure, Barbara Ninan

Walden Dissertations and Doctoral Studies

Twenty percent of Hispanic nursing students at a west coast university are being dismissed from the nursing program due to repeated failures in nursing courses. The purpose of this study was to gain a better understanding of Hispanic nursing students' experiences of successfully completing a nursing program, earning a baccalaureate of science degree, and passing the state licensing examination for registered nurses despite having failed a nursing course and having been placed on academic probation. Guided by Tinto's theory of academic integration, a descriptive phenomenological design was used to explore Hispanic nursing graduates' success experiences. Purposive sampling was used to …

Bedside Nurses' Influence On Patients' Continuum Of Care Through Effective Discharge Teaching, Mary Ann Whicker

Walden Dissertations and Doctoral Studies

The evolution of person-centered healthcare reinforces the need for nursing to provide effective patient education. Literature suggests nurses desire to provide strong discharge education to patients, but are challenged by knowledge gaps and other barriers. This DNP project developed a plan for integrating teach-back on a 30-bed cardiac unit, focusing on heart failure patients. Following a logic model, the process improvement plan to implement teach-back includes education on teach-back, empowerment of unit champions to support the project and evaluation of effectiveness of the education plan and impact on heart failure patients. The sample size of 15 cardiac nurses provides a …

Employee Wellness Model For Obesity, Barbara Siebold

Walden Dissertations and Doctoral Studies

Obesity, a condition of having a body mass index (BMI) greater than 30, is a universal epidemic with the greatest prevalence in the United States. The greatest concern with this epidemic health problem is that it presents with many comorbidities and is a risk factor for other chronic diseases. Employee wellness programs (EWP) have been in place for years and incorporate programs on weight management, nutritional education, and smoking cessation to reduce risk factors associated with chronic diseases. These programs utilize the concept of empowerment, often guided by Pender's self-management theory, to encourage employees to take onus for their health …

Interrupting The Sepsis Process With An Evidence-Based Education Intervention, Martha Olson

Walden Dissertations and Doctoral Studies

Interrupting the Sepsis Process with an Evidence-Based Education Intervention

by

Martha Olson

MSN, Walden University, 2013

MS, Southwest Minnesota State University, 2003

BSN, The University of Iowa, 1998

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

May 2015

Abstract

Sepsis is a concern, especially for the vulnerable populations. The early signs of sepsis are vague and often difficult to detect, but when detected early, are treatable with antibiotics and fluid resuscitation. When a nurse is unaware of the early signs, treatment is delayed and multiorgan failure may progress quickly. To …

The Impact Of Implementing Bedside Report To Transition Patients Across Units, Tonya Johnson

Walden Dissertations and Doctoral Studies

Evidence supports bedside report as a mechanism to improve communication, patient safety, quality of report, and nurse and patient satisfaction when implemented in a closed unit. The purpose of this project was to examine the impact of implementing a bedside report process to transition patients from the emergency department to a medical-surgical unit. Specifically, the goal was to analyze the impact of a bedside- reporting process on patient progression and on nurse and patient satisfaction. Lewin's change model provided the theoretical framework for this quasi-experimental study. Patient progression data consisted of 706 patient transitions from the emergency department to the …

Patient Safety Culture And High Reliability Organizations, Jared D. Padgett

Walden Dissertations and Doctoral Studies

A 1999 evaluation of case studies performed by staff from the Institute of Medicine found that between 40,000 and 98,000 patients died from preventable errors, while 43,598 individuals died in car accidents that year. A 2011 report increased that estimate nearly 10 times. Widespread preventable patient harm still occurs despite an increase in healthcare regulations. High-reliability organization theory has contributed to improved safety and may potentially reverse this trend. This explorative single case study explored how the perceptions and experiences of nursing and respiratory staff affected the successful transition of a healthcare organization into a reliability-seeking organization. Fourteen participants from …

The Effects Of Holistic Coping Strategies On Perceived Stress And Absenteeism In Hospital Nurses, Mary Alice Ayon

Walden Dissertations and Doctoral Studies

The demanding work environments of professional nurses often contribute to high levels of stress that impact their professional practice and well-being. Although there is a significant amount of research regarding stress and absenteeism, a gap in the literature exists about the effects of holistic coping strategies on nurses' perceived stress and absenteeism. Based on the biopsychosocial model, the purpose of this quantitative study was to investigate effects of holistic coping strategies on perceived stress and absenteeism in 128 hospital nurses. An online cross-sectional survey design used the Perceived Stress Scale-10 to measure nurses' perceptions of stress. The independent grouping variable …

The Innovation Of Simulation Laboratories And The Novice Nurses In The Clinical Setting, Brenda Washington Moore

Walden Dissertations and Doctoral Studies

The push to generate professional nurses has raised questions about the competency level of the novice nurses that are entering the workforce. Utilization of simulation laboratories is being viewed as an option for bridging the gap for the shortage of nurses, nurse educators, and clinical sites. The theory of goal attainment was used to guide this project, which aimed to develop and validate an ER simulation scenario that mimics a clinical setting as a tool for measuring nursing skills. An additional purpose, to be accomplished after graduation, will be to implement a pilot project to determine the impact of the …

Decreasing Central Line Complications With A Dedicated Team Approach, Donna Degennaro

Walden Dissertations and Doctoral Studies

Central-line catheters save lives, but they can also bring about complications, such as hospital-acquired infections. The Institute of Healthcare Improvement has collected data indicating that using proper insertion techniques and maintenance care, known as "the bundle," can prevent bloodstream infections associated with central lines. Progress has been made toward that end: The bundle has been used in intensive care units in a variety of hospitals and reportable central-line infections have decreased by 38%. However, because infections continue to occur inside and outside intensive care units, more needs to be done to protect all patients from these deadly infections. The purpose …

Healthy Work Environment Orientation Training And Psychiatric Nurse Retention, Lawanda Rollins

Walden Dissertations and Doctoral Studies

According to recent research, more than 75% of newly employed nurses leave employment within 6 months. Changes in organizational training programs are needed in order to improve psychiatric nurse retention, nationally and globally. A healthy work environment (HWE) has been described as an environment that includes mentoring for good communication skills; it is also one that explores collaborative strategies for safe practice; professional advancement; and empowerment through research, education, and skill development. Examination of the impact of this HWE psychiatric nurse orientation training program on nurse retention was done using Rogers' theory of diffusion. Study variables included the length of …

Understanding Causes Of Attrition Of 1st- And 2nd-Year Nursing Students, Catherine Mary Griswold

Walden Dissertations and Doctoral Studies

Attrition of nursing students has a negative impact on students, university nursing programs, and the heath care community. At a local university, the nursing program and its stakeholders aspire to increase retention of nursing students in order to mitigate the nursing shortage projected over the next decade. The purpose of this study was to examine issues related to high attrition of 1st- and 2nd-year nursing students at a university located in the mid-Atlantic area of the United States. Tinto's model of retention was used as the foundation to explore variables affecting 1st- and 2nd-year nursing students who remained in (n …

Advanced Nurses' Perspectives On The Drug Addiction Treatment Act, 13 Years Later, Dorothy L. Were

Walden Dissertations and Doctoral Studies

The United States experiences opioid addiction at epidemic levels. In 2012, the National Institute of Drug Abuse reported that 23.1 million Americans were in need of addiction treatment services, although only 2.5 million were enrolled in treatment. Following an amendment to the Drug Addiction Treatment Act of 2000 (Public Law 106-310), advanced practice nurses were qualified as providers who could bridge the healthcare gap in treatment access. The purpose of this project was to determine the interest of advanced practice nurses in (a) prescribing buprenorphine and (b) establishing guidelines that would allow them to do so. This quantitative project used …

Developing A Lifestyle Modification Toolkit To Prevent And Manage Hypertension Among African American Women, Julia Ugochi Ugorji

Walden Dissertations and Doctoral Studies

Hypertension is a global public health issue affecting many people in the United States. African American women remain the highest in percentage by race and ethnicity for developing hypertension with poor risk awareness. Hypertension has costly implications for the health care system. Through lifestyle modifications in the form of a nutrition plan called Dietary Approach to Stop Hypertension and increased physical activity, hypertension could be prevented. Among African Americans, the incidence of hypertension increases in their late thirties. The purpose of the project was to develop a toolkit of resources for African American women between the ages of 20 to …

Diminishing Incontinence In Long-Term Care Using Electronic Health Records, Catherine Rodgers

Walden Dissertations and Doctoral Studies

Urinary incontinence affects up to 70% of residents living in a long-term care facility and can affect their quality of life. Specifically, urinary incontinence has a direct impact on older adults in regards to self-esteem, pressure ulcer development, falls, urinary tract infections, and psychosocial wellbeing. The goal of this quality improvement pilot project was to determine if an electronic health record (EHR) assessment tool could help older adults remain continent longer and assist in maintaining an independent lifestyle. Orem's self-care deficit theory and social cognitive theory were used to determine how the electronic health record incontinence template could be used …

African American Race And Culture And Patients' Perceptions Of Diabetes Health Education, Linda Marie Keenan

Walden Dissertations and Doctoral Studies

African Americans diagnosed with diabetes are less likely to self-manage diabetes-specific modifiable risk factors. As a result, utilization of healthcare services occurs at a greater rate than other racial groups, and thereby incurs higher than expected healthcare costs. This ethnographic study explored the elements of diabetes educational material African Americans in a large city in the southern part of the United States found most useful to facilitate self-management of their disease. Bandura's self-efficacy theory provided the theoretical framework. Research questions addressed the preferred educational content, layout of material, and methods for educational delivery and caregiver support. A purposive sample of …

A Developmental Disabilities Program: A Proposed Education Program For Direct Support Professionals, Yurlene Sales Dela Cruz

Walden Dissertations and Doctoral Studies

Nurses can play integral role in collaborating with community leaders and identifying health promotion strategies, such as physical activity and nutrition classes, for people with developmental disabilities (DD). This study identified a role that nurses can establish among Direct Support Professionals (DSPs) who serve important functions in the daily supervision and care of clients with DD. The data reviews from the archival results from Association of Individual Development Health Matters Assessment Reports in August 2012 and September 2013 indicated DSPs' need for further training in their roles as health instructors. The Health Matters Assessment Report in 2012 indicated low scores …

Preoperative Education Needs In Ear, Nose, & Throat Clinic: A Patient Perspective, Jonathan Edmun Ramos

Walden Dissertations and Doctoral Studies

A medical center specializing in ear, nose, and throat (ENT) services noted an increase in the number of postoperative ENT complications compared to the national average. The purpose of this mixed-methods project study was to examine ENT patients' preoperative patient education (PPE) needs regarding postoperative care. Grounded in Knowles's model of learning, core adult learning principles were applied as guidelines in facilitating patients' PPE learning. Data were collected from 58 ENT patients who were selected using a convenience sampling method and who responded to a PPE survey using a 5-point Likert scale and open-ended questions. Quantitative data were analyzed using …

Increasing Hpv Vaccination Rates Among Adolescent Males: A Toolkit For Parents, Lance Everette Hadley

Walden Dissertations and Doctoral Studies

According to the Centers for Disease Control and Prevention (CDC), there are approximately 14 million new cases of HPV diagnosed each year (men and women combined). The rate of vaccine administration among adolescent males is much less than it is among females. As a result, the CDC has urged health care providers to work with state and local health care providers to improve the utilization of the HPV vaccine. The purpose of this scholarly project was to develop an educational toolkit, one guided by Ajzen and Fishbein's theory of reasoned action, regarding the value of the HPV vaccine. The toolkit …

Employing Provider Mentoring/Coaching To Improve Preventive Quality Ordering, Julie Knox-Woodward

Walden Dissertations and Doctoral Studies

Preventive quality ordering is a provider intervention aimed at disease prevention through the ordering of industry-recommended health maintenance tests. This pilot study evaluated the effectiveness of provider mentoring/coaching to improve preventive quality ordering using the 2014 Agency for Healthcare Research and Quality best practice preventive clinical services guidelines. Literature indicates provider inconsistency in preventive and quality ordering as the primary cause of disparate health outcomes. Guided by theories of modeling and role-modeling, as well as the theory of cognitive continuum, this pilot study offered provider mentoring/coaching to encourage timely preventative quality ordering. Routinely monitored historic provider practice patterns in a …

Enhancing Nurses' Perceptions Of Patient Safety Culture Through The Just Culture Model, Aida Solomon

Walden Dissertations and Doctoral Studies

An organizational culture of safety affects employees' attitudes, beliefs, perceptions, and values related to safe practice as well as their behaviors and level of engagement. The purpose of this project was to determine the influence of introducing the just culture model through staff engagement in an interactive workshop. A convenience sample of acute care staff were recruited for this 1-sample pretest and posttest project design. The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture instrument was used to measure safety culture perceptions on 7 dimensions pre and post intervention. For the theoretical framework, Ajzen's theory of …

Consequences For Nursing Graduates Of Failing The National Council Licensure Examination (Nclex), Julius Atemafac

Walden Dissertations and Doctoral Studies

Little information is available regarding the consequences of new nursing graduates who fail the National Council Licensure Examination for Registered Nurses (NCLEX-RN). The purpose of this study was to understand how these graduates could successfully pass this examination in subsequent attempts. Guided by Fisher's personal change model, the key research questions addressed the consequences of failing the NCLEX-RN exam and the actions the new graduate took after failing it. A phenomenological design was employed with a purposive sample of 17 new nursing graduates in the metropolitan area who had failed the NCLEX-RN. An inductive approach using a constant comparison, content …

Integration Of Technology Into A Nursing Curriculum Using A Mixed Method Approach, Susan Ramnarine-Singh

Walden Dissertations and Doctoral Studies

In 2011, the Institute of Medicine and 2010 Affordable Care Act addressed the need to use technology in nursing programs. The purpose of this study was to understand faculty perceptions of technology use and integration into the nursing curriculum at a college located in Texas. Lewin’s change theory acted as the theoretical framework to explore organizational dynamics involved in effective strategies. The guiding research questions explored faculty perceptions of technology use, types of technology used, and correlation to teaching experience using a convergent mixed-method approach. Thirty faculty members completed the Teacher’s Intention to Use Technology survey and 15 faculty members …

Hiv/Aids Care, Coping Strategies And Work Environmental Stress Among Nurses In Botswana, Thabo T. Fako, Debra Rose Wilson, James G. Linn, Ntonghanwah Forcheh

Walden Faculty and Staff Publications

Since 2006 there has been universal acceptance in both developing and industrialized societies that HIV treatment and related services, including more effective programs, be available to all citizens. However, as a result of the worldwide recession and shifting health priorities, progress toward these goals has stalled. While the epidemic continues to grow (approximately 34 million globally, with 2.7 million new cases in 2010), fewer resources are dedicated to treatment and prevention than previously, and clinical staffs, especially nurses are challenged by more patient care responsibilities. This paper focuses on the relationships of HIV/AIDS care, coping strategies and work environmental stress …