Nursing Commons^™

Improving Mental Health Support For Nursing Students Through Mental Health First Aid (Mhfa) Training Of Clinical Faculty, Amy Sands

Graduate Theses, Dissertations, and Capstones

This project aimed to implement a process improvement program at the Louisville campus of Galen College of Nursing to improve the mental health support for nursing students through the training of Clinical Instructors (CIs) in using adult Mental Health First Aid (MHFA) and the ALGEE actions described within that program.

Enhanced Discharge Preparation To Decrease Discharge Delays: A Quality Improvement Project, Angela Graham

Graduate Theses, Dissertations, and Capstones

Increased length of stay (LOS) is a focus in hospitals as it has implications for decreased quality of care, increased cost of care, and results in care delays for other patients (Rojas-Garcia et al., 2018). LOS is a measure of a hospital’s efficiency and throughput, which is the process of admitting, treating, and discharging patients. Micallef et al. (2020) found a longer LOS can occur from having extra days due to inefficiency in delivering care or from delays in discharge once the patient no longer needs acute care. The longer a patient stays in the hospital, the greater the risk …

Effects Of An Evidence-Based Practice Bundle Project On Nurse Empowerment, Kevin Jay Inman

Graduate Theses, Dissertations, and Capstones

The project determined the effect of an Evidence-Based Practice bundle program on nurses’ perception of empowerment. The EBP bundle included 7 interventions implemented simultaneously throughout a small community hospital. There was a significant increase in nurses’ perception of empowerment (p<.001), EBP beliefs (p<.001), and use of EBP (p<.001) after the implementation of an EBP bundle.

Screening For Social Determinants Of Health In The Primary Care Setting: A Quality Improvement Project, Winifred Ann Shouse

Graduate Theses, Dissertations, and Capstones

Social determinants of health are the conditions in which individuals are born, age, work, and live that affect health status and outcomes (Rivich et al., 2019). These social and environmental factors can create barriers to patients being able to access and adhere to recommendations for chronic disease management (Gold, et al., 2019). Communication gaps between patients and primary care providers make it challenging for healthcare providers to be completely aware of the financial burdens their patients encounter (Patel et al., 2016). Research supports that identifying and addressing the barriers related to social determinants of health can improve the management of …

The Role Of Telehealth In Reducing Hospital Readmissions For Heart Failure Patients, Tommy Lee Bratcher

Graduate Theses, Dissertations, and Capstones

Heart failure affects over six million people annually, and is expected to increase to over eight million by 2030. Over 60 million people live in the rural United States. Telehealth is a tool to improve access to care, provide early intervention, and follow up with patients within 48 hours of a hospital discharge. Utilizing Telehealth to conduct a medication reconciliation within 48 hours of discharge to address any medication errors or admission, and reinforce adherence is a way to improve access to care to those living in rural areas.

Utilization Of A Multimodal De-Escalation Class To Improve Staff Confidence When Caring For Behaviorally Escalating Patients, Tara B. Neuner

Graduate Theses, Dissertations, and Capstones

Workplace violence is a common challenge seen in the healthcare settings across the world. This problem is steadily increasing in all types of hospitals, including a level one trauma center located in an urban area. There has been a steady rise in the number of assaults and workplace violence reported from bedside staff at this hospital. The leadership of the organization formed a work group to help combat the workplace violence and staff assaults that were occurring. In this process, a behavior response team was created to help nursing staff with escalating behavior in patients, and to help de-escalate the …

Telehealth And Hospital Readmissions For Heart Failure Patients: A Literature Review, Tommy Lee Bratcher

Graduate Theses, Dissertations, and Capstones

Currently heart failure affects over six million people and is expected to increase to over eight million people by 20230. The US Census Bureau estimates over 60 million people live in a rural setting. This literature review seeks to determine the state of the science regarding the utilization of Telehealth to reduce heart failure readmissions in rural areas.

Implementation Of Infant Driven Feeding™ In A Level Ii Nicu, Kelly Gardner

Graduate Theses, Dissertations, and Capstones

In the United States, currently, 1 in 10 babies are born premature. Due to the immaturity of their neurological, gastrointestinal, and cardio-respiratory functions, preterm infants can experience the inability to coordinate sucking, swallowing, and breathing that is essential to oral feed. Cue-based oral feeding methods are designed to give the caregiver the ability to recognize signs of readiness and respond appropriately to the infant cues to adjust the manner in which feeding intervention is performed to match the infant’s current state of physiologic tolerance. The Infant Driven Feeding™ program incorporates scales to assess readiness and quality of the oral feeding, …

Professional Development In Nursing Starting At The Bedside: An Evidence-Based Study, Annette Joyce Carlisle-Spotts

Graduate Theses, Dissertations, and Capstones

Frontline nurses are faced with a host of responsibilities requiring clinical skills to care for complex, and often, chronically ill patients. Nurses need leadership skills to communicate effectively with the interdisciplinary and multidisciplinary teams they are increasingly required to work alongside. The Institute of Medicine’s recommendation is to prepare bedside nurses with the advanced skills needed to collaborate with others to revolutionize healthcare (Institute of Medicine, 2010). With more than four million nurses in the United States serving a variety of patients and families and levels of need; the urgency for gaining advanced skills has never been greater. We also …

Improving Recognition And Treatment Of Depression Among Women Using Phq-9 During Office Visits, Victoria Nwokocha, Heather Owens, Chris Webb

Graduate Theses, Dissertations, and Capstones

Depression can affect productivity and earnings among women, slow down the pace of active participation in social and family life, and increase health costs as well as distract attention from optimal health targets. Depression is the highest source of disability in NYC, with billions of dollars annually in related productivity losses. Although healthcare spending on depression affected patients is largely on hospital admissions, an estimated 40% of affected persons in New York do not get the adequate attention and care needed, with women most often affected by depression. This is an indication that the bedrock of preventive medicine for mental …

Improving Patient Satisfaction And Preventative Health Service Utilization For Limited English Proficiency Immigrants At Pearl Medical Centr, Chioma Holland

Graduate Theses, Dissertations, and Capstones

Background: Despite research efforts to address health disparities within immigrant communities, immigrant health continues to lack the attention from healthcare stakeholders it needs. Many immigrants already face dire health threats like extreme poverty, political unrest, and mental health concerns in their countries of origin, making them even more vulnerable to poor physical, mental, and social health outcomes upon arrival to the United States (U.S.). The purpose of this project was to improve patient satisfaction and increase immigrant use of preventative care by utilizing appropriate interpreter services. Method: The Quality improvement (QI) project involved surveying limited English proficiency (LEP) immigrants older …

Reducing Immigration-Related Stress In An Immigrant Population, Stephanie Avdagic

Graduate Theses, Dissertations, and Capstones

Immigrants are a growing population in the United States and face stressors specific to immigration. Stress is associated with increased mental and physical health issues, so increased stress puts this population at risk for many health concerns. A review of literature showed that implementing community resource classes for immigrants may help decrease immigration-related stress. The purpose of this evidence-based project was to assess if implementation of community resource classes at a local day center for immigrants could help decrease immigration-related stress. The classes addressed issues such as limited English proficiency and lack of legal immigration status. The Stress of Immigration …

Improving Use Of The Stop And Watch Tool (Interact) To Decrease Rehospitalization Of Nursing Home Residents, Sebrena Chapman-Fitzsimmons

Graduate Theses, Dissertations, and Capstones

The purpose of this clinical quality improvement project was to determine if using the Stop and Watch tool (a tool used to identify change in resident condition) would improve communication between stakeholders and nurses, resulting in fewer re-hospitalizations. The evidence-based literature behind the problem of re-hospitalization shows that improving communication among stakeholders can positively affect long term care residents’ quality of life and decrease events that could result in re-hospitalizations.

The design for this study includes process development on the use of the Stop and Watch tool (a communication component of the Intervention to Reduce Acute Care Transfers tool [INTERACT …

Evaluation Of The Clarity, Usefulness And Willingness To Adopt A Joint Military Nursing Professional Practice Model By Military Nurse Leaders, Lozay Foots Iii

Graduate Theses, Dissertations, and Capstones

Abstract

The goal of this project was to evaluate the clarity, usefulness and willingness to adopt a Joint Military Nursing Professional Practice Model by military nurse leaders into the military health system. This paper specifically examined leader feedback and perceptions prior to implementation of the Joint Professional Practice Model (JPPM) into designated pilot sites within the Military Health System (MHS) Nursing environment. This project includes Chief Nursing Officer (CNO) discussions reflecting the clarity of definition of model components, usefulness of the model and its components, and willingness to adopt the JPPM. This information will be used to modify the new …

Introduction Of A Nursing Evidenced-Based Practice Model To Improve Heart Failure At A Rural Community Hospital, Brandi Fields

Graduate Theses, Dissertations, and Capstones

Abstract

BACKGROUND: This project took place at a community-based rural hospital in eastern Kentucky. During completion of a needs assessment, adoption of an evidence-based nursing practice model and improvement of clinical outcomes of the community’s heart failure patient population were revealed as opportunities.

PURPOSE: The purpose of this project was to introduce the organization’s key stakeholders to the Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP), encourage implementation of an evidence-based practice (EBP) committee, and to use heart failure as an exemplar to facilitate discussions and stakeholder education.

METHODS: The goal of this project was to develop a supportive EBP culture …

Peripheral Iv Bundle, Alicia Hanna

Graduate Theses, Dissertations, and Capstones

Abstract

It is estimated that over 90% of hospitalized patients require IV access during their hospitalization. Peripheral IVs (PIVs), while less risky than central lines, are not without risk to the patients. Intravenous (IV) infiltration in pediatric patients is a very common complication associated with IV access, accounting for about 67% of IV catheter removals; a less common complication, but much more serious complication of a PIV can be a blood stream infection (BSI) which can account for up to 35% of BSIs seen in patients. BSIs are associated with increased length of stay, increased morbidity and can result in …

Evaluation Of An Interdisciplinary Ketogenic Diet Clinic For The Treatment Of Pediatric Refractory Epilepsy, Britt Schloemer

Graduate Theses, Dissertations, and Capstones

Pediatric refractory epilepsy affects approximately 30% of all children diagnosed with epilepsy. Childhood refractory epilepsy patients pose a challenge for traditional approaches to epilepsy management due to their complex and unique needs. Refractory epilepsy negatively impacts a patient’s ability to attend school or hold a job, and patients have a generally poor health status related to seizures as well as pharmaceutical side effects (Conway et al., 2016). The ketogenic diet (KD) is an alternative option for the treatment of pediatric refractory epilepsy due to established efficacy, manageable side effects, and reduced health care-associated costs due to reduced emergency department (ED) …

The Implementation Of An Open Source Electronic Medical Record At A Faith-Based Community Clinic, Gabri Warren

Graduate Theses, Dissertations, and Capstones

Faith-based nursing and healthcare is increasingly gaining popularity as the industry looks to minimize costs and improve health outcomes. Historically, qualitative studies have not shown the extent to which individuals and communities are impacted by health initiatives initiated by faith institutions. Healthcare technology can help support the specialty by providing increased quantity and quality data to analyze. Traditional, proprietary EMRs are too costly; however, open source systems offer a low cost, and easily modifiable option to non-profit, or smaller organizations. The data collected by an open source system allows organizations to improve the care that patients receive, and helps guide …

Shared Governance Effect On Nursing Outcomes, Beverly Phillippe

Graduate Theses, Dissertations, and Capstones

Introduction

The economy has made it necessary for hospitals to consolidate into integrated systems. Government and private insurance stipulations for reimbursement have become rigorous and dependent on quality and readmission rates. Hospital-acquired infections or injuries are no longer reimbursable (Underwood & Hayne, 2017). The changing landscape has been challenging for the healthcare worker, affecting morale, and in turn, patient care. It is essential for hospitals to perform at the highest level for patient outcomes and safety, in addition to creating healthy work environments for employees. Shared/Transformational Governance is key to developing top functioning hospitals. Involving the staff in decision making …

Visual Boards To Improve Compliance With Administration Of Glucose Gel, Bonnie Hibbs

Graduate Theses, Dissertations, and Capstones

The purpose of this quality improvement project is to increase staff compliance of administering glucose gel for the treatment of newborn hypoglycemia through use of a daily management board. Through improved compliance to gel administration, the project further seeks to decrease NICU admissions for hypoglycemia, decrease formula supplementation of breastfed newborns, and improve exclusive breastfeeding rates at discharge.

Evidence Based Practice Implementation Of The Delirium Portion Of The Abcdef Bundle, Jessica Sumner

Graduate Theses, Dissertations, and Capstones

Background: Delirium is a common complication in the ICU setting and has serious long-term consequences. Increased mortality and long-term cognitive issues are associated with under-recognition and lack of treatment for delirium. Nursing staff must identify delirium and manage the event, in addition to providing care to other assigned patients.

Purpose: The purpose of this evidence-based project was twofold. First, the project set out to determine if implementation of the delirium portion of the ABCDEF bundle promoted delirium recognition and decreased ICU length of stay and ventilator days. Second, the project examined if the use of a structured delirium education program …

Implementation Of An Evidence-Based, Electronic Clinical Algorithm To Improve Screening, Evaluation, And Referral Of College Students For Depressive Symptoms And An Evaluation Of Differences Based On Sexual Orientation And Gender Identity Data, Chris Webb

Graduate Theses, Dissertations, and Capstones

The purpose of this project was to improve the screening, evaluation, and referral of college students (LGBTQ+/Heterosexual) for depressive symptoms through the implementation of an evidence-based, electronic clinical algorithm. There is evidence in the literature indicating that there are increased mental health disparities among college students and the LGBTQ+ population. The prevalence of depressive symptoms among university students is higher than the general population, requiring university student health centers to implement enhanced screenings for depressive symptoms and identification of depression predictors. Prior to implementation of this project, a student health clinic in the Southeastern part of the United States used …

Early Identification Of Frailty Predictors In A Vowed Religious Community Of Catholic Men: A Strategy For Successful Aging In Place, Julia Senn-Reeves

Graduate Theses, Dissertations, and Capstones

Background: The population in the United States is aging and experiencing age- and disease-related changes, leading to increased frailty, as well as increased disability, morbidity, and mortality. Timely recognition of these vulnerabilities, and intervention implementation, are crucial to prevent adverse outcomes and to support successful aging in place. Purpose: The purpose of this project is to develop and implement a multifaceted assessment process to identify early predictors of frailty among members of a vowed religious community of Catholic men to ultimately support successful aging in place. Participants: A single vowed religious community of Catholic men in the United States, living …

Failure-To-Rescue Simulations As A Risk Management Strategy For Registered Nurses, Trena K. Seago

Graduate Theses, Dissertations, and Capstones

In the hospital setting, prevention of failure-to-rescue (FTR) events is an important aspect of patient safety. The use of patient simulation as a strategy to educate nurses on the prevention of these events offers two modes of learning: 1) experiential learning through simulation and 2) reflection through debriefing. The act of practicing to recognize a deteriorating patient through experiential learning and reflection may help increase nurses’ self-efficacy in recognizing a similar situation in their future practice. This quasi-experimental, one-group, pretest-posttest pilot study investigated the use of patient simulation among registered nurses (RNs) in the hospital setting as an anticipatory educational …

Changing Health Care Policy By Utilizing Kingdon's Policy Stream Theory, Brittney Welch

Graduate Theses, Dissertations, and Capstones

The purpose of this paper is to describe the policy process of changing current regulations regarding rural health clinics (RHCs). Using Kingdon’s Policy Stream Theory for guidance, the change project was designed to amend current regulations regarding the directorship of the RHCs, consequently allowing Nurse Practitioners (NP) to act as medical directors for rural health clinics (RHCs). This change fulfills the Institute of Medicine’s charge to have nurses work to the highest level of their education, as well as a defined need to fill a gap in the health care system by decreasing rural health disparities. The Rural Health Care …

World Health Organization Decision Making Tool For Family Planning- Can We Increase Iud Use?, Kim Anna

Graduate Theses, Dissertations, and Capstones

Background and Purpose: Worldwide unintended pregnancy rates are reported at 40% of all pregnancies. The United States has an unintended pregnancy rate of 45%. Contraception is safe and available for most women. Many providers lack evidence-based tools and current information in assisting clients to choose a highly effective contraceptive method. Intrauterine devices (IUD) and implants are highly effective contraception. The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) recommend IUDs and implants as first tier contraception for most sexually active females.

Methods: Implementation of the World Health Organization Decision-Making Tool (WHO DMT) for contraceptive …

Advanced Disease Management In Home Healthcare: Palliative Integration, Missy Stober

Graduate Theses, Dissertations, and Capstones

Advanced Disease Management in Home Healthcare: Palliative Care Integration

Abstract

With home health caring for patients with serious illnesses and advancing disease states, palliative care in a community setting like the home, can provide many benefits. This population currently has a gap in the healthcare continuum at the point of advancing disease state to end of life care. Recently, new payment models based around clinical outcomes, including hospitalization scores and quality indicators, has caused home health to explore different ways to deliver quality and effective care, especially for those with the highest risk of hospitalization. A literature review was conducted …

A Demonstration Project To Address Juvenile Drug Addiction, Mary Ellen Broaddus

Graduate Theses, Dissertations, and Capstones

The rise in adolescent drug use and addiction is becoming a worldwide phenomenon. An eleven year study of youth in European countries found drug use widespread and increasing (Molinaro, Sicilian, & Curzio, 2011). In 2013 there were over 2.8 million new users of illicit drugs, over half of whom were under 18 years of age (‘Drug Facts’, 2015).

Adolescents are at unique risk because biochemical distinctions in their brains, when compared with adults, prompt more risk-taking behaviors (Gallager, 2014). Health risks are considerable and include hypertension, stroke, convulsions and seizures, and liver disease such as cirrhosis and hepatitis. In 2013 …

Implementing An Evidence-Based Education Program For Labor And Delivery Nurses In A Community Hospital Setting, Sara E. Humphrey

Graduate Theses, Dissertations, and Capstones

Many factors contribute to the success of an organization. The nursing workforce is the guiding strength behind the delivery of safe patient care resulting in quality outcomes. Preparing the nursing staff to deliver safe care begins with the introduction of evidence based practice as a viable partner to clinical expertise and knowledge. Implementing an evidence based education program is a critical step in the process of integrating evidence into clinical practice. This paper focuses on the implementation of an evidence based education program or Labor and Delivery nurses in a community hospital setting. Evidence based education can promote competency development, …

Text Messaging Appointment Reminders To Increase Patient Appointment Adherence Within A Prevention And Wellness Program, Janel Willingham

Graduate Theses, Dissertations, and Capstones

Abstract

Healthcare organizations want to provide quality care, decrease costs, and promote preventative services for the communities they service. Mobile health units have become an extension of many healthcare organizations and provide different types of services, such as mammography. Providing mammography and wellness exams on a mobile unit presents several challenges; appointment adherence is one of them. Mobile units typically travel to underserved areas to serve people at risk for various health conditions such as breast cancer. Breast cancer is estimated to affect over 250,000 women in the United States during 2017; women have a 1:8 lifetime risk of being …