Nursing Commons^™

Nurses' Perceptions Of Structural Empowerment: A Practice Review Process Pilot, Andrea M. Lee-Riggins

Doctoral Projects

Nurses are professionally and morally obliged to monitor and evaluate nursing practice via active participation in review mechanisms that are designed to promote patient safety and care delivery, thereby improving patient care quality (American Nurses Association [ANA], 1988, 2001, 2004; O'Rourke, 2006). The purpose of this Doctor of Nursing Practice (DNP) project was to develop, pilot, and evaluate a nurse practice review process with frontline nurses within Fresno Heart & Surgical Hospital (FHSH), a small specialty hospital, affiliated with Community Medical Centers (CMC) in Fresno, California. A nurse practice algorithm was subsequently developed and structural empowerment was assessed with the …

Promoting Behavior Changes In Patients With Type 2 Diabetes Through Shared Medical Appointments, Shonda Lanette Williams

Doctoral Projects

Diabetes Mellitus (DM) is a chronic disease that affects many individuals in the United States. It was reported that a total of $245 billion is spent annually on both direct and indirect health care costs associated with the treatment of diabetes and diabetic related complications. Diabetes related complications can be prevented or delayed if proper education is done and individuals are willing to practice positive behavior changes and self-manage their disease. The purpose of this doctoral capstone project was to promote behavior changes in patients with diabetes through diabetes self-management education (DSME) in shared medical appointments (SMAs).

This project was …

An Evaluation Of The Effectiveness Of Providing Foot Care Education In A Rural Clinic Setting, Gloria Green-Morris

Doctoral Projects

Diabetes is one of the most frequently diagnosed metabolic disorders and is currently at pandemic magnitude. Approximately 1.4 million adults are diagnosed with diabetes each year. According to the American Diabetes Association (2011), the numbers of diagnoses will more than double by 2030. Because of the high prevalence of diabetes, the perceptions of risk factors and healthy behaviors are important. A good understanding of written and verbal healthcare instructions, healthcare accessibility, and socio-economic status have a direct effect on patient health outcomes and the overall health of the population (Jovic-Vranes, Bjegovic-Marinkovic & Marinkovic, 2009).

Diabetic foot complications are common concerns …

Bridging The Gap: Understanding, Anticipating, And Responding To The Needs Of Student Veterans In A Bachelor Of Science In Nursing Program, Larry Michael Stowers

Doctoral Projects

The passage of the Americans with Disabilities Act Amendment Act (ADAAA) of 2008 and the Post-9/11 Veterans Assistance Act of 2008 have afforded veterans the opportunity to pursue post-secondary education. Since October 2001, over 2 million American men and women in uniform have deployed in support of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). While thousands of returning combat veterans take advantage of recent legislation that helps pay for their education, they face new challenges in the classroom. This nation’s veterans represent a group of diverse individuals who bring different experiences, thus different perspectives than traditional college-aged students. …

Reducing "Failure To Rescue" Occurrences: A Pilot Project Incorporating High-Fidelity Simulation During Mock Codes, To Enhance Pediatric Nurses' Clinical Knowledge And Skills, Denise Dawkins

Doctoral Projects

Thanks to advances in technology, the survival rate of infants and children with critical illnesses has improved. One consequence has been an increase in the acuity levels of hospitalized pediatric patients, which may heighten the risk of in-hospital cardiopulmonary arrest. Patient safety can be compromised by nurses who do not detect subtle clinical changes in a patient's condition, do not perform accurate interventions, or do not apply critical thinking (failure to rescue). The Institute of Medicine (10M) in 1999 estimated that approximately 100,000 people died each year as the result of poor care.

Patients and families place great trust in …

Long-Acting Reversible Contraceptive Methods, Same-Day Initiation And Early Removal, Sandra Mary Loehner

Doctoral Projects

Objective: The study was conducted to identify the early removal rate of Long-Acting Reversible Contraceptive (LARC) methods and factors associated with early removal.

Study Design: A non-experimental descriptive design based upon retrospective chart review of electronic medical records (EMR) was used. There was a total of 96 subjects, ages 15-47 years who had a LARC method inserted within a 12-month time period and subsequent removal within 6-months of insertion date. Subjects were grouped according to same-day insertion versus non-same-day insertion.

Results: Seventy percent of study subjects with early removal had their LARC method inserted under a same-day protocol. Most subjects …

Electronic Medical Record In The Simulation Hospital: Does It Improve Accuracy In Charting Vital Signs, Intake, And Output?, Carel M. Mountain

Doctoral Projects

The introduction of electronic health records has created a shift in the way nursing care is delivered (McBride, Delaney, & Tietze, 2012; Furukawa, Raghu, & Shao, 2010). A factor which heavily influences a nurse’s ability to navigate and utilize EMR is adequate education in the use of computerized documentation (McBride, et al., 2012). There is an increased risk for error at the bedside without the correct knowledge and skills regarding EMR documentation (Kelly, Brandon, & Docherty, 2011). This skill should be introduced during the pre-licensure education of the nurse.

Two groups of associate degree nursing students attending a small community …

Self-Reported Neurogenic Bowel And Bladder Management In Acute Hospitalized Chronic Spinal Cord Injured Patients: Its Role In Clinical Practice, Mary Lupe Jimenez

Doctoral Projects

Patients with spinal cord injuries and disorders (SCI/D) are at risk for mismanaged bowel care during acute hospitalization, which can lead to numerous medical complications ranging from loss of personal dignity and privacy to many serious medical conditions, some of which are life threatening. Additionally, mismanagement of bowel care during acute hospitalization may lead to costly extended hospital stays. The project was to describe bowel and bladder care for SCI/D patients during acute hospitalization using a self-reported questionnaire submitted by approximately 46.6% of SCI/D patients from the Veterans' Affairs Central California Health Care System. The self-report questionnaire was designed by …

Chronic Non-Cancer Pain In The Ed: Are Nurses Sbirt-Ready?, Dorothy James Moore

Doctoral Projects

Emergency department (ED) Registered Nurse (RN) understanding of chronic pain management is critically important. By some estimates, 30% of all opioid pain medications in the United States (US) are prescribed from EDs. At the same time, prescription drug abuse is America’s fastest growing drug problem. While RNs have significant contact time with chronic pain patients who may also be drug abusers, RNs often use the stigmatizing label, “drug-seeking” for certain key patient behaviors and may not feel confident intervening constructively with these patients. This project reviews literature pertaining to SBIRT use for substance abuse in the ED and surveys ED …

Impact Of Cue-Based Feeding Protocol On Premature Infants' Outcomes And Hospital Length Of Stay, Diana Michele Easley Cormier

Doctoral Projects

The project was an oral feeding practice change from traditional, gestational-age/volume-driven feeding progression to developmentally-based, infant-driven feeding progression. The infant-driven (cue-based) feeding protocol was implemented with goals to improve premature infants' feeding outcomes, and decreased the infant's length of hospitalization. The project was designed to implement a cue-based feeding protocol for oral feeding initiation and progression, within the neonatal intensive care unit (NICU) at Community Regional Medical Center (CRMC), and then retrospectively evaluate the impact of the cue-based feeding protocol on feeding outcomes. In order to realize full implementation of a NICU feeding practice change, multiple components, such as electronic …

The Experience Of Latino Parents Of Hospitalized Children During Family Centered Rounds, Lisa Ann Walker-Vischer

Doctoral Projects

Problem: Hospitalization of a child is stressful. The parental role is altered and parents have a primary need to receive timely information. Family centered rounds (FCR) provide a mechanism to exchange information and facilitates shared decision making with the medical team while parents advocate for their child's needs. FCR has been linked to increased satisfaction and improved outcomes. A recent study suggests that Latino parents have a suboptimal experience related to language barriers and a lack of empowerment. The purpose of this study is to describe the experience of Latino parents of hospitalized children during FCR in a public safety …

Pilot Study: Avoiding Readmissions Of Heart Failure Patients Across Transitions Of Care, Analiza Baldonado

Doctoral Projects

Background: A major problem facing the U.S. healthcare system is avoidable hospital readmissions. Patients with Heart Failure (HF) face variety of barriers to health care and are at higher risk for readmissions. To address this problem, evidence-based interventions focused on safe transition from hospital to home are needed.

Methods: A quality improvement pilot project was implemented to evaluate the feasibility of evidence based interventions in preventing avoidable readmissions. The project setting was in a 900 bed health care system. The descriptive statistical methods were means and frequencies. The Transition Coordinator (TC) enrolled a convenience sample of 30 participants. The evidence …

The Development Of A Comprehensive Adhd Program For Elementary School Educators, Angie Lee Echoles

Doctoral Projects

On average, teachers will teach at least one student with Attention Deficit Hyperactivity Disorder (ADHD) in any given school year without receiving any instructions at all on ADHD. ADHD affects 3% to 7% of school-age students and one in every twenty children (Centers for Disease Control and Prevention (CDC), 2010). It is classified as one of the most common mental health disorders affecting school-age students. The American Psychiatric Association (APA, 2013) defines ADHD as a hereditary, non-curable, common childhood disorder. A triad of symptoms is associated with this disorder: inattention, hyperactivity, and impulsivity, which all have a major impact on …

Perceptions Of A Dedicated Education Unit In The Mississippi Delta, Jacquelyn Felecia Brownlow

Doctoral Projects

The highest health care disparities in the country plague the Mississippi Delta. A weakened economy, minimal access to healthcare and an outdated traditional clinical learning environment place enormous strains on nursing education in this area to provide more nurses. The office of Nursing Workforce reported a 14% to 16% nursing turnover in the Delta compared to the national average of 13.5%. As a result, the health care organization has encountered high nurse turnover, increased staffing shortages, and a decrease in nursing quality indicators. As an effort to improve clinical education and bridge gaps between education and practice, several schools in …

Severe Mental Illness In Adults And Physical Health Outcomes, Kathryn L. Speeter

Doctoral Projects

Adults with severe mental illness (SMI) experience higher morbidity and mortality rates than the general population due to poor physical health and because physical and psychiatric health are rarely addressed holistically. Two questions were posed for this project: (a) Will the use of a physical health screening tool and development of healthpromotion goals result in a change in healthy lifestyle behaviors for participants? (b) Will case managers see value in the use of the screening tool and health-promotion action plan development and incorporate the tool into their day-to-day work with clients? Fourteen adults with SMI, from a community case management …

Performance Differences Between Novice And Experienced Critical Care Nurses: A Replication Study, Josefina Inoturan Alejandro

Doctoral Projects

No abstract provided.

Continuing Professional Development Program On Second-Generation Antipsychotics For Psychiatric-Mental Health Staff Nurses, Brenda Lee Phillips

Doctoral Projects

The lack of continuous professional development education regarding second-generation antipsychotics (SGAs) at a regional state acute care psychiatric hospital limits the ability of psychiatric-mental health (PMH) staff nurses to provide care for patients with or at risk for metabolic syndrome and other medical problems. The goals of the evidence-based program were to (1) examine PMH staff nurses’ knowledge of treatment guidelines for schizophrenia and SGAs; (2) provide education on schizophrenia, SGAs, and metabolic syndrome; and (3) provide continuous professional development training modules on schizophrenia and SGAs electronically for PMH staff nurses in an acute care mental health hospital. The effectiveness …

Identification And Prevention Of Secondary Traumatic Stress In Mental Health Professionals Who Work With Child Sexual Abuse Victims, Abby Duckworth Mcneil

Doctoral Projects

Secondary traumatic stress (STS) is an issue that may be experienced by mental health professionals who are exposed to clients' trauma materials and become and become at risk of becoming traumatized themselves. Mental health professionals working with sexually abused children are more vulnerable to STS due to their empathic engagement and level of exposure to trauma. The impact of STS can result in poor productivity, increase in illness, and turnover rates for mental health professionals. Cumulative effects of STS make awareness and early intervention imperative. Research has shown that members of the helping profession suffer emotional and physical illness more …

Value Based Purchasing: Positioning A Healthcare Organization For The Future, James Dale Heard

Doctoral Projects

In 2005, the Deficit Reduction Act introduced Value Based Purchasing (VBP) into the healthcare system as a means of hospital reimbursement for acute care hospitals receiving reimbursements from the Centers of Medicare and Medicaid (CMS). The purpose of this Capstone Project was to increase the knowledge of healthcare executives concerning Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and VBP and the effect it will place on the organization though the utilization of a consultant program. The role of the consultant in this project is to provide expert advice to healthcare executives about the impacts of HCAHPS and provide …

Exploration Of Self-Care Following Distribution Of Acute Management Tool For Elder Heart Failure Patients In Clinic Setting, Sharon Elaine Vincent

Doctoral Projects

The aim of this study was to develop a broad understanding of heart failure patients’ perceptions about their lived experiences. An acute symptom management tool, Red Flags I Need to Know: Heart Failure Action Plan (Health Net Federal Services, 2011), was distributed to the patients prior to initiation of the project.

The problem of heart failure rehospitalization is significant. Cost of treatment for heart disease in the United States exceeds all other conditions. The national excessive 30-day readmission rate in elders post-discharge is 24.8%. Pay-for-performance initiatives will reduce reimbursement for excessive readmissions beginning FY 2013.

The project was a mixed …

Impact Of Social Marketing On Nurse Practitioners' Acceptance Of Clinical Video Telehealth For Elderly Patients In Rural Mississippi, Teresa Lynn Langley

Doctoral Projects

Elderly patients 65 years and older who have chronic illness and disabilities living in rural Mississippi have increased difficulty in obtaining timely cost-effective healthcare services from nurse practitioners. The purpose of the capstone project was to utilize social marketing strategies for promoting nurse practitioners’ acceptance of clinical video telehealth (CVT) in improving healthcare access for rural elderly patients in Mississippi. Clinical video telehealth is an innovative way to provide healthcare services to populations in need by reducing barriers to healthcare, such as distances, time, and transportation, and financial resources. However, providing healthcare through the use of technology has not always …

Improving Outcomes Of Acute Coronary Syndrome Patients Through Disease Specific Care Certification, Terri Ginn Lemon

Doctoral Projects

Cardiovascular disease remains the number one killer of Americans, accounting for over 800,000 deaths in 2008. Improving a hospital’s performance by obtaining and maintaining The Joint Commission Disease-Specific Care Certification is one method of impacting acute coronary syndrome patient outcomes. The purpose of this capstone project was to provide consultation services to ready the cardiology division of a large community hospital in south Mississippi for the process of obtaining Joint Commission Disease-Specific Care Certification in the area of acute coronary syndrome. The activities of the consultation included facilitating an examination of the current organization of ACS patient care; reviewing core …