Nursing Commons^™

The Effects Of In-Service Education On Workplace Incivility For Crnas, Tran King

Doctoral Projects

Workplace incivility (WPI) affects many healthcare providers, including Certified Registered Nurse Anesthetists. This project was an exploration of the prevalence, nature, and sources of WPI affecting CRNAs. The project’s intervention was an in-service education on WPI for CRNAs. The purposes of the project were to measure the effectiveness of the in-service education in increasing awareness of CRNAs about WPI; and to offer a practice change proposal in terms of a policy against WPI in the anesthesia department.

A Needs Assessment Survey and Demographic Data Information form were distributed from Survey Monkey to participants’ email by way of blind copy. Data …

Student Registered Nurse Anesthetist Simulation Training With The Use Of Cognitive Aids In Malignant Hyperthermia Recognition And Treatment, Daniel Martin

Doctoral Projects

One of the most stressful times in the life of a student registered nurse anesthetist (SRNA) is during the integration of didactic work with that of clinical anesthesia practice (Chipas et al., 2012). One method that has been proven effective in other avenues of student nursing education is the use of procedural simulation labs. These simulation labs allow SRNAs to experience what it is like to be in the operating room setting, while also showing distinct differences within each case, treatment, and the importance to be familiar with all aspects of anesthesia. The purpose of this project was to examine …

Implementing The Use Of Intracuff Alkalinized Lidocaine Among Certified Registered Nurse Anesthetists: A Practice Change Proposal, Shawn Taylor

Doctoral Projects

Patients today are experiencing comorbidities predisposing them to increased risk under general anesthesia. Emergence cough reflex is a response that can lead to hemodynamic alterations occurring during emergence and the postoperative period for many patients requiring general endotracheal tube anesthesia (GETA). It is proposed that 38% to 96% of patients receiving GETA will experience coughing during emergence (As, Iqbal, & Ali, 2009; Watkins, Lee, White Jr, & Mundy, 2012).

The use of intracuff alkalinized lidocaine is an intervention shown to be effective in previous studies at blunting this response during anesthesia emergence. Through verbal communication with CRNAs, it was discovered …

Implementation Of The Sleep Treatment And Education Program For Students (Steps) In Student Registered Nurse Anesthetists, Nicolina Marie Vaught

Doctoral Projects

In the pursuit of graduate level education, student registered nurse anesthetists (SRNAs) undertake curricula requiring an immense investment of time attending didactic classes and clinical training, studying, and completing assignments. The required time commitment combined with the stress accompanying these responsibilities have the potential to leave the SRNA with inadequate time for an optimal amount of sleep, contribute to sleep disturbances, and ultimately result in sleep-related fatigue (SRF). SRF in the SRNA population is a problem because it is imperative for both patient and student safety that SRNAs attain adequate sleep to allow for optimal cognitive function.

This DNP project …

Implementation And Evaluation Of A Preceptor/Mentorship Program During Orientation In A Long Term Care Facility: A Strategy To Increase Nursing Employee Satisfaction, Maria A. Painter

Doctoral Projects

High nursing turnover in long-term care (LTC) facilities is a significant problem that results in additional expenses, lower quality of patient care, increased adverse patient events, and decreased patient and nursing satisfaction. A structured orientation and supportive preceptors are protective factors in retaining nurses as well as increasing nursing job satisfaction and improving patient outcomes. The goal of this pilot project was to implement an evidence-based preceptor program for staff registered nurses (RNs), licensed practical nurses (LPNs) and certified nursing assistants (CNAs) in an LTC facility to develop preceptors’ skills and preceptees’ orientation satisfaction. The preceptor development project facilitated by …

Evaluation Of A Pilot Multidisciplinary Debriefing Program: Promoting Pediatric Provider Emotional, Social, And Spiritual Wellbeing, Allison E. Reynolds

Doctoral Projects

Regular exposure to trauma, such as the act of bearing witness to intense suffering and pain of pediatric patients and families, has a significant effect on healthcare professionals. Despite the fact that traumatic situations in pediatrics are a reality, there is little education and few interventions focused on how to prepare and support healthcare providers to care for dying children and families or for other clinically challenging situations. Pediatric residency program directors within a large, freestanding children’s hospital identified a subjective need for support for their pediatric residents in dealing with clinically challenging situations faced during residency, motivating residency program …

Development Of A Patient-Centered Medical Home Toolkit At An Integrated Primary Care Clinic, Lyndsay A. Randall

Doctoral Projects

Health care spending in the United States far exceeds that of other high-income countries (Squires & Anderson, 2015). In 2013, the U.S. spent 17.1 percent of its gross domestic product (GDP) on healthcare, which was almost 50 percent more than the next highest spender noted as France (Squires & Anderson, 2015). While the U.S. spends more on healthcare than other countries, multiple other health outcome measures are worse including life expectancy, heart disease, diabetes, and chronic respiratory illnesses (Squires & Anderson, 2015). Today’s healthcare system is highly fragmented, lacking the necessary coordination within the primary care setting. Better care coordination …

Improving Care Of Behavioral Health Patients In A Rural Emergency Department: A Needs Assessment, Margaret Perec

Doctoral Projects

Leadership and staff at a rural Critical Access Hospital (CAH)have identified the need for interventions to address the specific care issue of behavioral health patients presenting to the emergency department (ED). The ED has experienced a higher than expected number of visits, which has presented the department with challenges, especially in finding placements for patients who need inpatient treatment. ED management and staff have reported many patients have experienced long lengths of stay in the ED while waiting for beds.

A needs assessment attempts to identify characteristics of patients who remain in the ED for extended lengths of time, and …

Implementing Clinical Practice Guideline Recommendations To Address Prenatal Smoking: A Practice Change In A Community Health Department, Rachel L. Danks

Doctoral Projects

According to the authors of current literature, pregnant women who smoke may be more resistant to change, and may not fully understand the harmful effects of smoking. Therefore, there is agreement among researchers that the use of psychosocial interventions for smoking cessation can be effective. At the time of this project many settings, including clinics, health departments, and providers, were implementing the 5As which guide healthcare and community workers to ask, advise, and assess the smoking status of pregnant women at every health visit, and then assist and arrange smoking cessation interventions if applicable. Despite these efforts, pregnant women are …

Implementation Of The Reengineered Discharge Process And Transitional Care Management At A Rural Critical Access Hospital, Chad L. Wilfong

Doctoral Projects

Healthcare in the United States is changing from a fee-for-service to a value based healthcare delivery system. One area of national focus is reducing 30-day hospital readmissions by providing high-quality transitions-of-care. Patients leaving the hospital without proper assessment of home care needs, patient education, and coordination of care run into barriers managing health conditions, which contributes to hospital readmissions. Poor transitions-of-care contribute to deterioration of health leading to acute care utilization and hospital readmissions, which is costly for healthcare organizations, insurance payers, and individuals. In 2017, the value based healthcare structure will be decreasing reimbursement to hospitals that have 30-day …

Implementation Of An Evidence-Based Process For The Management Of Concussions In Adolescent Patients For A Primary Care Office, Ashley D. Karczewski

Doctoral Projects

The number of recreation and sports-related concussions (SRC) are estimated at 3.8 million every year in the United States. Recently, widespread media attention has been paid to concussion, and with this there has been a rise in adolescents with SRC seeking health care. Primary care providers are often the first to evaluate and provide treatment for adolescents with concussion. Despite the abundance of literature on concussions, there has been little empirical data to support management practices for this patient population. The purpose of the project was to provide an evidence-based process along with a clinical decision support tool to the …

Return On Investment Comparison Of Three Payment Models For Chronic Care Management Under Medicare In A Northwestern Physician Hospital Organization, Megan J. Madole

Doctoral Projects

Chronic disease is the most prevalent and costly health condition. The coordination of care provided to those with multiple chronic conditions (MCCs) is suboptimal and fragmented. This population is among the highest utilizers of healthcare, and accounts for the majority of Medicare expenditures annually. Chronic care management (CCM) programs represent evidence-based initiatives shown to improve outcomes, reduce hospital and emergency department utilization, and reduce healthcare costs. Centers for Medicare and Medicaid Services (CMS) have provided various payment models for reimbursement of CCM services. Primary care practices have stated that inadequate reimbursement and confusing payment models are barriers to CCM implementation. …

Preparing For The Merit-Based Incentive Payment Structure: A Value-Based Business Plan, Ali R. Saheb

Doctoral Projects

The notion of delivering value-based care while maintaining corporate vitality in health care is a multifaceted process. Shaping a business model to reflect this process requires the alignment of quality implications, reimbursement initiatives, a framework that takes into account stipulations on reimbursement for different types of clinicians, and an understanding and preparedness for emerging guidelines and nationally recognized structures for quality indicators. When organizations recognize the need for change, but are not yet prepared to implement it, a comprehensive business plan can help the organization visualize a path to success. In this project, the foundation of requirements for a value-based …

Development Of A Protocol For Implementing A Registered Nurse-Led Annual Wellness Visit In A Primary Care Setting, Jennifer R. Campbell

Doctoral Projects

This project was a quality improvement initiative utilizing a new format to deliver the Medicare Annual Wellness Visit (AWV) to Medicare recipients. The purpose of the project was the development of a protocol for implementing a registered nurse (RN)-led AWV in a primary care setting. The pilot project focused on changing the clinic’s current AWV structure from a provider-led format to a RN-led format. The pilot was geared towards improving care coordination, while enhancing preventive services and early intervention for chronic disease management. The 6-week pilot was used to help identify areas of weaknesses in the registered nurse-led AWV. During …

A Crosswalk Protocol For Implementation Of The Patient-Centered Medical Home And Meaningful Use At A Midwest Nurse Managed Center, Kaitlyn Rath

Doctoral Projects

Healthcare expenditures in the United States far exceed the spending that occurs in other high-income countries (Squires & Anderson, 2015). However, the healthcare outcomes are poorer in the U.S. on multiple key health care measures including life expectancy and the prevalence of chronic illnesses and comorbid conditions (Squires & Anderson, 2015). New care models not only focus on improvement of key health outcomes, but also on healthcare providers to reduce fragmented care with care coordination. This DNP scholarly project addresses the need for financial stability within a Midwest nurse managed center. This center would benefit from utilization of a new …

A Clinical Practice Change Initiative To Incorporate Animal Assisted Therapy In Advanced Practice Registered Nurses' Clinical Practice For Children And Adolescents, Donna Rae Cowell

Doctoral Projects

Background: Children and adolescents mental healthcare needs is vital for the future of our nation’s welfare (American Psychology Association, 2014). Research has indicated AAT may be a considerable choice to help with pediatrics mental healthcare and may be utilized as an adjunct to enhance the care within the psychiatric healthcare field (Chandler, 2012). AAT has become popular within the healthcare realm (Friesen, 2009; Uyemura, 2016) and is a unique method for providing “patients” health care, which may improve patient outcomes (Chandler, 2012; Cowell, 2013; McCullough, 2016; McQuarrie & Urichuk, 2008). Research supports that “providers” in the health care field may …

Decreasing Cost In The Gi Endoscopy Suite By Utilizing Best Sedation Practices, Casey Brianne Mancini

Doctoral Projects

Colorectal cancer is a leading cause of cancer death in the United States (Mandel, Tanner, Lichtenstein, Metz, Katzka, Ginsberg, & Kochman, 2008; Siegel, DeSantis, & Jemal, 2014). Because this lethal disease claims lives of many people every year, more patients are undergoing screening colonoscopies, which have greatly aided in decreasing the number of colorectal cancer deaths (Siegel et al., 2014). The most common form of sedation for colonoscopies is moderate sedation with a benzodiazepine and an opioid (Cohen, Hightower, Wood, Miller, & Aisenberg, 2004; Lera dos Santos, et. al., 2013). However, sedation by anesthesia providers using propofol is becoming more …

Provider Based Interventions To Mitigate Risk For Opioid Pain Medication Abuse Among Adult Patients In A Primary Care Setting, Sheree Lamara Conley-Donaldson

Doctoral Projects

Mental and substance use disorders are predicted to exceed all physical disease processes causing major disability by 2020. Misuse and overdose of opioid pain medications is a significant public health concern in the United States. Approximately 1 in 4 patients receiving prescription opioids in primary care settings struggle with misuse. Half of all opioid prescriptions are written by primary care providers, including nurse practitioners. The purpose of this DNP project was to determine if nurse practitioner providers are implementing evidence-based practice guidelines including screening, brief intervention, and referral to treatment (SBIRT) to mitigate risk of prescription opioid pain medication misuse …

Sexually Transmitted Infection Prevention In 18 To 24-Year-Old Heterosexual Men: Pilot Study, Susan P. Mckeefrey

Doctoral Projects

The CDC reported that there were over 20 million cases in the United States and half affected young adults, 15 to 25-year olds. Strategies STD prevention have been developed by the CDC but does not include avoiding alcohol or other similar agents in the context of a sexual encounter. The purpose of this study was to assess the effectiveness of STD prevention education intervention by improving Condom Use Self-Efficacy in heterosexually 18 to 24-year old men. It was hypothesized self-efficacy would improve with a face-to-face brief educational intervention. A quasi-experimental, pre-/post-test design with simple randomization of subjects into control and …

Curriculum Development Of California Correctional Institution (Cci) Nursing Staff Performance During Simulation Training Related To Cardiac Emergency Response, Dina Wang

Doctoral Projects

The Cycle 4 OIG medical reports published in January 2016 for California Correctional Institution (CCI) noted emergency medical response (EMR) inadequacies. Nursing was specifically called out for EMR care deficits. Chest pain and respiratory distress were amongst the top signs and symptoms identified as having substandard nursing care issues within the report. The cycle 4 OIG medical inspection report gives specific incidences of patient care inadequacies.

As a result of the EMR portion results of the cycle 4 OIG reports, there was a need for improvement planned interventions. The Doctor in Nurse Practice (DNP) project is a quantitative quasi-experimental study …

End Of Life Care Practices For Patients Who Die In Intensive Care Units (Icu), Jila Ghabeljoo

Doctoral Projects

Today, one in five hospital deaths happens in the intensive care unit with the expectation of twice as many by 2030. Increasing, mortality has triggered a growing attention to end-of-life (EOL) care in the ICU. However, the lack of coveted EOL and palliative care skills creates a challenge for ICU nurses. The aim of this study was to assess the current practices of EOL care in the ICU. In this quantitative research, a retrospective chart review method was employed to analyze the collected data from a population 60 EOL patients who died in the ICU of a Southern California hospital. …

Factors That Affect Turnover Intention Of Registered Nurses In The Acute Hospital: A Meta-Analysis From 2006-2016, Helen Pagilagan

Doctoral Projects

Multiple complex variables influence nurse turnover. This meta-analysis examines the strength of the relationships between factors that affect turnover intent among staff registered nurses employed in the acute hospital setting in the United States. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) was used to guide the reporting of essential components of this study. Included studies were published in English between 2006-2016, reported study sample sizes, a Cronbach coefficient for the study instruments, conducted quantitative analysis and reported Pearson correlation r values. Two factors affecting turnover intention were found in the four included studies. Statistical analyses show that …

Implementing Evidence Based Practices For Preventing Cardiac Implantable Electronic Device (Cied) Infection And The Role Of Post-Operative Oral Antibiotics, Ingrid Mitchell

Doctoral Projects

Cardiac pacemakers and implantable cardioverter defibrillators (ICD) are standard therapy for patients with a bradyarrhythmia, tachyarrhythmia or heart failure (HF) with a left bundle branch block (LBBB) (Wilkoff, et al., 2008). Millions of cardiac implantable electronic devices (CIED) have been implanted worldwide and this clinical practice has improved the quality of life for millions (Epstein, DiMarco, & Ellenbogen, 2008). With the increase of implants there has been an increase in the infection rates (Klug et al., 2007). Research studies have evaluated pre-procedure, during procedure and after procedure risk and protocols. Studies have also evaluated operative factors, procedural related factors, intravenous …

The Perceptions Of Registered Nurse To Bachelor Of Science In Nursing Students Of Motivational Interviewing, Christie M. Smart

Doctoral Projects

Purpose: The purpose of this study was to collect information on the perceptions of motivational interviewing (MI) among Registered Nurse (RN) to Bachelor of Science in Nursing (BSN) students and whether or not the students felt it could increase holistic practice. Methodology: A qualitative descriptive study was used to collect data through semi-structured one on one interviews from six RN-BSN students post a module taught on MI. Qualitative content analysis was utilized to process the data. Findings: The students felt that MI was a useful tool for practice in improving patient communication and would contribute to holistic practice.

Antimicrobial Stewardship: Incentives And Barriers To Implementation In Skilled Nursing Facilities, Gloria M. Escalona

Doctoral Projects

This study was part of a quality improvement effort of a Skilled Nursing Facility (SNF) to develop and establish an antimicrobial stewardship program to comply with recently enacted California State Senate Bill 361 (SB 361), which went into effect January l, 2017 (Skilled nursing facilities, 2015). The division of the facility into two sections, one staffed largely by Licensed Vocational Nurses (L VNs) and another staffed largely by Registered Nurses (RNs) provided an study opportunity that easily differentiated the licensed nurses. This study used three methods: 1) an educational intervention to licensed nurses, 2) a post-educational intervention survey of licensed …

Acceptability Of The Md Anderson Symptom Inventory And Qualitative Analysis Of Barriers To Palliative Care Services For Rural And Non-Rural Populations, Daniel M. W. Johnson

Doctoral Projects

The United States health system strives to improve the care patients receive while reducing healthcare expenditures. A significant portion of the nation’s healthcare expenditure is spent on end of life care. Palliative care provides one solution to reducing healthcare expenditures while improving the patient experience. Reducing symptom intensity is one example of palliative care’s success. A midwest palliative care program was tasked to gather quality data on the service’s ability to manage patient symptoms.

The program selected the MD Anderson Symptom Inventory to improve symptom assessment and provide quality metrics for the organization. Additionally, research suggests rural populations have poorer …

Attitudes And Perceptions Of Advanced Practice Nurses Towards Health Information Technology And Its Effects On Caring, Debbie Ramos Shih

Doctoral Projects

Technology is rapidly, constantly evolving, and affecting healthcare. While it has the ability to improve healthcare outcomes, it is important to realize the impact this technology has on the relationships between patients and nurses (Korhonen, et al., 2015). Interactions with patients are increasing through computer technology and decreasing by physical presence and touch, potentially compromising the development of a trusting relationship and thus affecting patient quality outcomes (Sandelowski, 2002).

This cross sectional study explored the attitudes and perceptions of APRNs towards HIT and its effects on caring. 150 Advanced Practice Clinicians in a Northern California healthcare was surveyed, using the …

Preconception Care Of Women On Prescribed Opioids, Rebecca-Maria Norwick

Doctoral Projects

The landmark 2015 report from the Center for Disease Control (CDC) posited that too many women of reproductive age received prescribed opioids. This is significant because fetal exposure to a known teratogen can have catastrophic outcomes. Furthermore, women are often ambivalent about birth control and many pregnancies are unplanned. Fortunately, women identify interactions with health care providers as acceptable cues for preconception decision making. Data has shown that Medicaid populations are disproportionately prescribed opioids compared to insured populations. However, the CDC defines reproductive status by age only. Therefore, the purpose of this research project was to identify women’s actual risk …

An Assessment And Analysis Of The Complexity Of The Frontline Nurse Leaders' Role, Robert Alan Vos

Doctoral Projects

Purpose: The purpose of this research study is to identify frontline nurse leaders' perception of their role, to have them assess their skills in relationship to that role and to identify knowledge needs and gaps that they face in fulfilling their role.

Design: This doctoral research explored the role of the frontline nurse leader. The research was a quantitative survey, non-experimental, descriptive, cross-sectional onetime study. The survey studied the self-assessment of the frontline nurse leader's role and their rating of noted complexities and challenges in their role.

Methods: A survey tool was developed using thirty statements. The statements covered the …

An Assessment Of The Associate Degree Nursing Students’ Understanding Of Health Literacy Concepts When Providing Health Promotion For The Diabetic Patient, Donna L. Lebaron

Doctoral Projects

Health literacy (HL) concept deficiencies exist in undergraduate nursing curricula (Smith and Zsohar, 2011; Cornett, 2009; Jukkala, Deupree, Graham, 2009). As future nurses who will have a significant impact on client health literacy assessment, it is essential that health literacy-related content be integrated into undergraduate nursing educational curricula (Sand-Jecklin, Murray, Summers, Watson, 2010; McCleary-Jones, 2012). The prevalence of Type 2 diabetes (T2D) has significantly increased resulting in greater morbidity and mortality risks to the general public; therefore, programs for diabetes prevention, education, and health literacy assessments have become a national priority (Whittemore, Rosenberg, Gilmore, Withey, and Breault, 2013; Hemingway, Stephenson, …