Nursing Commons^™

Improve Intra-Operative Nurse-To-Nurse Communication Using A Safety Checklist, Silvinita Tadeo Rowe

Doctoral Projects

Poor and inadequate handoff, or transfer of care of the surgical patient care from the primary to the relief operating room registered nurse circulators, can result in irreversible patient harm, or sentinel events, such as retained foreign items. In this study, Rogers' diffusion of innovation theory was the framework for implementing the handoff safety checklist. Also, Donabedian's structure process and outcome was the model to investigate the feasibility, acceptability, and improvement in the quality of patient handoff communication and improvement of nurse satisfaction over time. Nineteen-statement surveys, conducted at multiple timeframes, were completed by volunteer operating room nurse participants. In …

Identifying Factors In Medication Non-Adherence In Teens Diagnosed With Juvenile Arthritis: A Pilot Study, Susan Viola Senzaki

Doctoral Projects

Purpose: The purpose of this study was to identify factors that correlate with medication non-adherence in teens diagnosed with juvenile arthritis. Background: The impact of medication non-adherence often begins in childhood where children depend and learn from their care-givers how to manage their health. Children with chronic disorders are among those at risk for a higher medication non-adherence. Juvenile arthritis (JA) is a chronic childhood disorder where often medication non-adherence is an issue. Methodology: This was a mixed-method qualitative and quantitative pilot study. Teens between the ages of 11 – 17 years, with juvenile arthritis were asked to volunteer in …

The Effectiveness Of A Standardized Positioning Tools And Bedside Education On The Developmental Positioning Proficiency Of Nicu Nurses, Arlene Spilker

Doctoral Projects

Developmental positioning for preterm infants is an essential skill for neonatal intensive care unit (NICU) nurses. The benefits of developmental positioning are evident in the literature, but less is known about how NICU nurses learn about developmental positioning. This study examined the effect of the Infant Position Assessment Tool (IPAT) and informal education on the developmental positioning skills of NICU nurses. This quasi-experimental study measured IPAT scores before and after an educational intervention, and found a statistically significant increase in the means of the two groups. The use of the IPAT and bedside education is useful for improving the developmental …

Chinese Community Physicians' Perception Toward Collaboration With Advanced Practice Nurses, Ivy Tan

Doctoral Projects

Effective interprofessional collaboration has been shown to be beneficial for both patients and providers. Yet collaboration between physicians and advanced practiced nurses (APNs) has been problematic. Little was known about such collaboration in an ethnic group like the Chinese community. This quantitative descriptive capstone project was to assess the perception among physicians, who are the members of the Chinese Community Healthcare Association in the San Francisco area, toward collaboration with APNs. The study also attempted to gain insight of collaborative attitudes of physicians in the Chinese community in order to fill the gap in the literature in this area. Data …

Attention Deficit Hyperactivity Disorder And Mindfulness Practice In Children And Adolescents: A Comprehensive Review Of Evidence-Based Research, Donna Nikander

Doctoral Projects

Attention Deficit Hyperactivity Disorder (ADHD) is the most common mental illness in the United States among male and female children and adolescents between the ages of 3 and 17. The emerging fields of neurobiology and neuroimaging have proposed a relationship between mindfulness meditation therapies—initially referred to as mindfulness-based stress reduction (MBSR) and now simply known as mindfulness—and improvements in attention and self-regulation, two major problem areas for ADHD sufferers. Furthermore, recent studies suggest that mindfulness therapies may be effective in reducing symptoms of ADHD in children and adolescents. The purpose of this paper is to review, analyze and synthesize the …

Admission Medication Reconciliation Process To Improve Patient Outcomes, Vanessa Ann Irwin

Doctoral Projects

Medication reconciliation is an important process in the acute care setting that has implications for patient safety and outcomes. The medication reconciliation process occurs at transitions in care and involves disciplines including; nurses, pharmacists, and physicians. The role of the nurse in the admission portion of the process includes collecting and entering home medication information into the electronic medical record. It is crucial for the medication information to be entered in an accurate, timely, and complete manner.

The addition of the electronic medical record has not solved documentation challenges related to medication reconciliation but has added more transparency of issues. …

Commercial Sexual Exploitation: The Role Of The Advanced Practice Nurse In Screening Patient At-Risk, Sheri Rickman Patrick

Doctoral Projects

Problem: Human trafficking or commercial sexual exploitation (CSE) is a global problem effecting every country including the United States. The impact of human trafficking while it is devastating to individuals, the impact goes well beyond individual victims and undermines the health, safety and security of all nations (U.S. Department of State Publication, 2007, p. 5).This research is an attempt to assess the knowledge of advance practice nurses or nurse practitioners (NP) in the subject of commercial sexual exploitation and their willingness to screen their patients who may be at-risk.

Methods: The design was web-based with advanced practice nurses who are …

Implementation Of A Patient Satisfaction Survey In A Federally Qualified Health Center, Ricardo Jose Ballin Ii

Doctoral Projects

Safety net FQHCs are typically challenged with initiating and sustaining standardized measurement of patient satisfaction. Baseline survey data establishing how patients rate their satisfaction at San Francisco General Hospital (SFGH) Urgent Care Center (UCC), a public safety net federally qualified health center, located in San Francisco, California is needed. Implementing an existing patient satisfaction survey instrument using a standardized method, with volunteer survey administrators, made this study unique and resulted in a higher rate of survey participation that any other method previously attempted. Survey results determine whether patients' needs and expectations were being met, adding value and allowing for comparison …

Perceived Barriers To Skin To Skin Care From Maternal And Nurse Perspectives, Rachel Alexandra Napoli

Doctoral Projects

The purpose of this doctoral project is to provide foundational data for a skin-to-skin (STS) policy at a community hospital. Two surveys were used to determine the barriers to STS. One survey was given to the nurses electronically in the maternal/child department and the second survey was given to the mothers who delivered at the same hospital during Fall2014. Following data collection, focus groups were formed. The groups consisted of volunteer nurses who reviewed the results of the surveys and developed preliminary data for a STS policy. The three identified barriers to STS by both nurse and maternal surveys were …

Factors Leading To Rapid Response Team Interventions In Adult Medical-Surgical Patients, Christine M. Tarver

Doctoral Projects

Rapid Response Team Intervention (RRTI) is a widely used intervention in acute care hospitals in the United States. Demonstrated effectiveness in preventing transfer to higher level of care or in decreasing in-hospital mortality has not been established. This exploratory study used a retrospective chat1 review to examine differences between medical-surgical acute care inpatients who had an RRTI and a control group. CutTent literature lacks information on proactive detection of patients who may be more likely to deteriorate and therefore require a Rapid Response Team Intervention. Therefore, this study's PICO question was: Are there statistically significant differences between medical-surgical adult inpatients …

Nurses Caring For Adults With Autism In An Emergency Department: A Survey Of Knowledge, Shauna Marie Miller

Doctoral Projects

Autism is a complex neurodevelopmental disorder characterized by social impairments, communication difficulties, and restricted, repetitive, and stereotyped patterns of behavior. The nurse (RN) in the emergency department (ED) plays an important role in the receiving, treatment, and management of the patient with autism. RNs must understand the unique challenges of caring for individuals with autism. Fortunately, autism is an active area of research, with copious resources available to assist those affected by this disorder; however, no studies were found evaluating nurses’ knowledge of autism and the number of resources for nurses caring for this population was limited. Nursing is an …

Pediatric Nurse Practitioner Home Visitation Is Associated With A Decrease In Home Care And Healthcare Utilization Errors In High Risk Infants, Rupalee Patel

Doctoral Projects

The Santa Clara Valley Health and Hospital System’s (SCVHHS) Babies Reaching Improved Development and Growth in their Environment (BRIDGE) program was developed in 2011 to optimize high risk infants' care transition from Neonatal Intensive Care Unit (NICU) to home. In addition to hospital discharge teaching and public health nursing efforts, NICU infants need further in home support given their medical vulnerability after discharge. The objectives of the SCVHHS BRIDGE program are to provide caregiver interventions to minimize home care errors after NICU discharge and to optimize health care access and utilization across the transition of care. SCVHHS NICU infants at …

Heath Care Providers’ Perceptions Of The Reproductive Challenges And Experiences Among Asian Indian Women Living In Silicon Valley, Olga Alexandra Libova

Doctoral Projects

Objective: To identify common reproductive challenges among Asian Indian (AI) women living in Silicon Valley as perceived by healthcare providers (HCP). Design: A 71-item investigator-developed survey Setting: The survey was available on-line to all HCPs in California Santa Clara county, 75% of respondents were affiliated with El Camino Hospital Mountain View. Participants: Convenience sample of 78 respondents: 34% mother-baby nurses, 24% labor-delivery nurses, 21% OB/GYNs, 7% CNMs, 14% other HCP; 89% female; 55% Caucasian, 24% Asian. Methods: Likert-type scales comparing prevalence of certain reproductive challenges among AI women and women from other race-ethnic groups and openended questions regarding HCPs’ experience …

Outcome Analysis And Quality Improvement For Inter-Hospital Transfers Of Pediatric, Carma Lynn Tobiassen

Doctoral Projects

Pediatric patients who initially present to a community hospital setting can be adequately cared for the majority of the time, in the emergency department (ED), on the pediatric ward (PEDS), and the post anesthesia care unit (PACU). When a pediatric patient is in need of specialized care or is decompensating and becomes critically ill, initial medical stabilization is required and the identification of a critical care bed and admitting physician are needed in a timely manner. Inter-hospital transfers (IHT) of pediatric patients are frequent occurrences, as more and more areas are consolidating their resources and Pediatric Intensive Care beds are …

Developing A Patient Care Standard For Adolescents Based On A Nursing Needs Assessment, Kathryn Blake

Doctoral Projects

Mental health patients often suffer from chronic medical conditions and psychiatric comorbidities requiring frequent emergency, primary care, and acute care visits (Douzenis et al., 2012). Caring for psychiatric patients in acute care hospitals has become an increasing burden on healthcare systems with processes in place to care for acute and critical care patients. Healthcare leaders, providers, emergency departments, and medical/surgical hospitals are straining to provide care for complex patients with acute medical conditions and complex mental health needs (Reiss-Brennan, Briot, Savitz, Cannon, & Staheli, 2010). Caring for children and adolescents with medical and psychiatric problems creates the need for a …

Exploring College Students' Perceptions Of College Gun Violence: A Meta-Analysis, Julia Chaw Chih Lee

Doctoral Projects

College gun violence has been one of our nation’s most forefront issues in recent years. The present meta-analysis reviewed studies reporting college students’ perceptions about school/college gun violence in order to summarize the total effect and direction of these research findings. There were only two studies identified for this research topic: Study A and Study B. Combining the effect sizes from both studies could not be accomplished because there was not enough data from Study A to calculate the correlation coefficient(r) or standardized mean difference (SMD). The summary of the results of the two studies as a metaanalysis was more …

Bio-Identical Hormones Utilized For Treating Menopausal Symptoms: Are They Safe?, Maria D. White

Doctoral Projects

The use of compounded bioidentical hormones in the various forms of gels, creams, and troches has increased in popularity. The population of menopausal women is at a crossroads with the cascade of symptoms and determining what are their options. The Endocrine Society, the Food and Drug Administration, and the National Menopause Society do not support the use of bioidentical hormones, despite the support for bioidentical hormone replacement therapy (BHRT) by the American Academy for Anti-Aging Medicine and other proponents for BHRT. The literature review reveals the need for studies documenting the safety of BHRT. The objective for this study was …

Pain Management At End Of Life When There Is A Co-Occurrence Of Substance Use Disorder: A Qualitative Metasynthesis, Kristina Olfson

Doctoral Projects

Pain management, end of life (EOL) care, and substance use disorder (SUD) are individually identified as National healthcare challenges and priorities. Despite 50 years of advances in the understanding of pain management, pain is still inconsistently assessed and undertreated in all populations, including those with life limiting illness. When a patient with a life limiting illness and history of SUD is encountered, pain management becomes further complicated. Effective pain management for all patients, regardless of coexisting complications, is an ethical obligation of health care providers. Given the lack of research into EOL pain management of patients with SUD, it is …

A Comparison Of Pedagogical Approaches To Error Communication Training, Marie Annette Gilbert

Doctoral Projects

Purpose: The purpose of this study was to compare the effectiveness of two different pedagogical approaches to error communication training.

Background: The literature advocates full, transparent communication following a medical error. However, many barriers to such disclosure exist. A significant barrier is healthcare providers do not feel prepared for these difficult conversations. This can be particularly challenging in a pediatric setting when the conversation with a parent may be more demanding than similar conversations in the non-pediatric settings.

Method: Individuals from three different professional groups were recruited; physicians, pharmacists, and nurses. A randomized controlled study was conducted to investigate …

Implementation Of Interprofessional Education And Physician Order Set Improves Compliance With Early Recognition And Treatment Of Maternal Sepsis, Lori Susan Olvera

Doctoral Projects

Septic shock is rare in pregnancy; however, sepsis remains an important contributor to maternal mortality. The perinatal patient can appear deceptively well before rapidly deteriorating to septic shock. There is a need for protocols regarding early recognition and management of maternal sepsis. The Surviving Sepsis Campaign developed guidelines to provide guidance for the clinician caring for patients with severe sepsis or septic shock. The purpose of this doctoral project was to evaluate compliance with early goal directed therapy before, during, and following the implementation of a standardized physician order set and interprofessional education for nurses and physicians in the perinatal …

Sexually Transmitted Disease Education And Effects On Condom Use In College Students, Patricia Alvarez

Doctoral Projects

In the United States, nearly 50% of the sexually transmitted diseases (STDs) reported each year occur in adolescents and young adults ages 15-24. An IRB approved, exploratory mix method research study was conducted in a California Community College to investigate participants' opinions on STD education tools, effectiveness, and to rank preferred instructional methods used in 51h-12'h grades. One hundred and thirteen students participated and reported use of variety of educational tools with the lecture technique selected by almost 80% surveyed. Demonstration of condom application had highest percent ranked as number one for the preferred educational tool; yet had the least …

Access To Care Barriers For Native American Veterans, Joanne Kristen Rhoads

Doctoral Projects

There are very few studies that examine Native American Veterans and access to care issues. Therefore, the researchers implemented an exploratory, descriptive, qualitative project to explore and identify the potential barriers that Native American Veterans have experienced with access to healthcare and participation in veteran benefit programs. A purposeful sample consisted of 14 Native veterans from the American Indian Veteran Association who were eligible for veteran services, and were willing to participate in the project. Fieldwork was performed in the natural environment of the Sierra Nevada foothills on the ancestral homeland of a California Tribe. The facilitator utilized a demographic …

Increasing Hpv Vaccination Rates Using Social Marketing Strategies, Sharon Wilson Catledge

Doctoral Projects

The human papillomavirus (HPV) is the most common sexually-transmitted infection (STI). Approximately 20 million Americans between the ages of 15 and 49 years currently have HPV with > 6.2 million new HPV infections estimated to occur each year. Yet, HPV vaccination rates remain relatively low. More than 40 strains of HPV are transmitted through genital contact during vaginal, anal, or oral sex and can infect males and females. In addition to causing genital warts, HPV is associated with cervical, vulvar, vaginal, anus, penile, and oropharyngeal cancers. In women, the most prominent type of cancer is cervical with > 12,000 diagnoses each year …

Psychiatric Mental Health Nurse Practitioner Workforce Development In Behavioral Healthcare Settings In Rural Mississippi, Arlen Davis Cooper

Doctoral Projects

Description and Significance of the Problem: The United States is facing a significant rural mental healthcare workforce shortage and an uneven distribution of mental healthcare professionals. The psychiatric mental health nurse practitioner (PMHNP) may increase access to mental healthcare in rural underserved regions (NRHA, 2012). However, little is known regarding their distribution. The lack of uniform and consistent data collection methods regarding the number and the geographic distribution of PMHNPs in rural areas, specifically in rural Mississippi, exists. The importance of better data collection and improving infrastructure through collaboration with state licensing boards and state nursing workforce centers is …

An Evaluation Of Fall Prevention Interventions Among Older Adults In A Long Term Care Facility, Courtney Anita Bennett

Doctoral Projects

Falls are serious unwanted events that are a common occurrence among older adults in long term care facilities (LTC). Fall prevention in LTC facilities requires the efforts of an interprofessional team that promotes safety within an organization. The purpose of this capstone project is to implement and evaluate evidence-based fall prevention interventions at a LTC facility. Specific objectives of the project include: (a) providing education to healthcare professionals on evidence-based practices to recognize, assess, and prevent falls among older adults in a long term care facility and (b) replacing the existing fall prevention policy and program with a falls and …

Evaluating The Perceptions Of Quality Of Life In Informal Caregivers Caring For Hospice Patients, Rashandra Fisher Laws

Doctoral Projects

Maintaining or improving quality of life for informal caregivers is important as they endure the burden of providing care to terminally ill loved ones on a daily basis. Caregivers are at a greater risk for depression, deteriorating physical health, financial difficulties, and premature death than demographically similar non-caregivers (Demiris et al., 2010). The goal of this capstone project was to determine the effectiveness of the creativity, optimism, planning, and expert information (COPE) intervention, which address specific needs of the family and caregiver.

Twenty informal caregivers completed the Quality of Life (QoL) Index tool, which measured their perceptions of five different …

Integrating A System Approach To Identify And Manage Aggressive Behaviors In Adult Males With Severe Mental Illness In A Psychiatric Hospital, Mitzie Alford-Jenkins

Doctoral Projects

Aggressive behaviors exhibited by patients with a serious mental illness (SMI) hospitalized in inpatient psychiatric hospitals are a challenging safety problem. Early identification of aggressive behaviors is vital to helping nursing staff develop proactive interventions that focus on prevention. Structured risk assessments identify the level of risk and allow for early interventions.

The purpose of the doctoral capstone project was to: (a) provide education to nursing staff on implementing a structured risk assessment tool in order to identify risk for imminent aggression, manage risk for imminent aggression, and record aggressive behaviors among adult males with severe mental illness (SMI); (b) …

Re-Engineered Discharge Planning In A Rural Mississippi Hospital To Reduce 30 Day Readmission Rates Among Heart Failure Patients, Roxie Mae Hogan

Doctoral Projects

The hospital discharge is a complex process that involves interdisciplinary efforts to avoid readmissions and decrease health care costs. The purpose of this capstone project was to take a leadership role in translating evidence into practice by successfully preparing NWMRMC discharge planning stakeholders to adapt Project RED for use with HF patients admitted to NWMRMC.

A comprehensive systematic improvement plan, Project RED is designed to improve the work flow process through the use of timelines and strategies. Project RED supports discharge planning, helps to prevent readmission, and facilitates knowledge transfer that promotes sustainable changes. Re-Engineered Discharge Planning (RED), 6 step …

Transitioning Traditional Acute-Episodic Primary Care Visits To Group Visits: An Evidence-Based Approach To Diabetes Care, Bridget Michelle Smith

Doctoral Projects

Diabetes is a national problem that has extended epidemic magnitudes. Its management difficulty impends to overwhelm acute-episodic healthcare systems and challenges the resources of current and future individual primary care providers. According to the Centers for Disease Control and Prevention (CDC) (2012), there are 25.8 million people in the United States or 8.3% of the population who have diabetes. Mississippi ranks second in the nation in the prevalence of diabetes and has the highest percentage of overweight and obese adults in the nation (CDC, 2012). In an effort to bridge the gap with delivery of quality care to patients with …

A Novel Method For Assessing Medication-Related Adverse Outcomes In A Community Hospital, Christopher M. Patty

Doctoral Projects

The use of medications for hospitalized patients is universal, and unfortunately medication-related adverse outcomes are common. The accurate assessment of medication-related harm in hospitalized patients is foundational to the development of an effective hospital medication safety program. Every hospital has its own unique "fingerprint" of harm, accurate determination of the nature of medication-related harm specific to each hospital is necessary to facilitate prevention of that harm with specific and effective interventions. This project has provided a community hospital with its first systematic methodology for assessing medication-related harm. The methodology is adapted from that used in a recent national-level study.

Several …