Nursing Commons^™

Emergency Nurses' Department Design Recommendations For Improved End-Of-Life Care, Elise Megan Corbett

Theses and Dissertations

Introduction: Death occurs frequently in emergency departments (EDs). Obstacles present in EDs can make providing end-of-life (EOL) care stressful and challenging for emergency nurses. Although death is common in EDs, there is a paucity of research regarding ED design as an obstacle to EOL care. The purpose of this study was to identify emergency nurses experiences and recommendations regarding ways ED designs negatively or positively impacted EOL care for dying patients and their families. Methods: At 25-item questionnaire regarding ED design and EOL care was sent to a geographically dispersed, national random sample of 500 emergency nurses. Inclusion criteria were …

Emergency Nurses' Department Design Recommendations For Improved End-Of-Life Care, Elise Megan Corbett

Theses and Dissertations

Introduction: Death occurs frequently in emergency departments (EDs). Obstacles present in EDs can make providing end-of-life (EOL) care stressful and challenging for emergency nurses. Although death is common in EDs, there is a paucity of research regarding ED design as an obstacle to EOL care. The purpose of this study was to identify emergency nurses experiences and recommendations regarding ways ED designs negatively or positively impacted EOL care for dying patients and their families. Methods: At 25-item questionnaire regarding ED design and EOL care was sent to a geographically dispersed, national random sample of 500 emergency nurses. Inclusion criteria were …

Parental Attitudes Of Immunization In Children With Special Healthcare Needs: A Qualitative Study, Maren Topham

Theses and Dissertations

Background and Purpose: Just over 15% of children under 18 years of age in the UnitedStates, or approximately 11.2 million children, are estimated to have special healthcare needs.Although children with special healthcare needs (CSHCN) make up a small percentage of thepediatric population, they account for over one third of pediatric medical care. Parental attitudesregarding immunization play a significant role in vaccination rates among children. The purposeof this research is to explore parental attitudes regarding immunization of CSHCN.Methods: This qualitative study focused on parental perceptions and beliefs aboutimmunizations for CSHCN. Sixteen participants, who were parents of CSHCN from onepediatric specialty care …

Social Capital And Hospital Readmission Of Older Adults, Sheryl Emmerling

Theses and Dissertations

This dissertation is comprised of three manuscripts exploring the concept of social capital and hospital readmission of older adults. The first manuscript provides a review of the literature evaluating studies that measure the relationship between social capital and health, healthy behaviors, and access to and utilization of healthcare resources. Further research focusing on testing various types of individual social capital and their relationship to key outcomes including hospital readmission is needed.

The second manuscript is a description of the Social Capital and Health Framework that can serve as an outline for assisting nurses and other healthcare providers to consider older …

State Requirements For Childhood Vaccination Exemption Forms In The United States, Katherine Elizabeth Hill

Theses and Dissertations

In the United States, children must be vaccinated in order to attend school, although parents also have the right to request a vaccine exemption. The type of vaccine exemption varies by state but can include exemption for religious, philosophical, medical, and temporary medical reasons. The purpose of this research was to identify the use of provider signature requirements and fees in states during the vaccine exemption process. A questionnaire was sent to immunization managers in the 50 United States, District of Columbia, the United States Indian Health Service, and eight United States territories. The managers were asked if their states …

The Supervision Of School Nurses In New Jersey: Parallel Needs, Actions, And Impacts On Student Care, Lee-Ann Halbert

Theses and Dissertations

New Jersey Certified School Nurses (NJ-CSNs) practice in an environment of parallel needs and actions where the primary goal is the education of the students in the building, yet the health and safety of each student are paramount. The research presented here evaluates how the supervision provided to the NJ-CSNs affects their clinical practice and other areas of decision-making in the school setting. This mixed methods research study of 557 NJ-CSNs reveals that school nurses who are supervised by an educator whose background includes being a registered nurse are better able to provide the optimal support for the nurses, and …

Critical Care Nurses' Experiences Of Family Behaviors As Obstacles In End-Of-Life Care, Caitlin Brook Mallory

Theses and Dissertations

Background: Critical care nurses (CCNs) frequently provide end-of-life care for critically ill patients. CCNs may face many obstacles while trying to provide quality EOL care. Some research focusing on obstacles CCNs face while trying to provide quality EOL care has been published; however, research focusing on family behavior obstacles is limited. Research focusing on family behavior as an EOL care obstacle may provide additional insight and improvement in care. Objective: What are the predominant themes noted when CCNs share their experiences of common obstacles, relating to families in providing EOL care? Methods: A random geographically dispersed sample of 2,000 members …

Opioid Prescription And Use After Laparoscopic Cholecystectomy, Valynn Christina Haslam

Theses and Dissertations

Background: Opioid abuse has become a serious public health issue. While adequate pain management is an ethical responsibility for health care providers, responsible stewardship of controlled substances is of equal concern. Opioids are often prescribed for treatment of acute pain post-operatively. The purpose of this study is to examine opioid prescription practices and use of opioids after laparoscopic cholecystectomy. Methods: A convenience sample of 42 patients scheduled for laparoscopic cholecystectomy were enrolled in the study. Using a descriptive study design, patients were interviewed by phone 6-10 days post-operatively using a scripted questionnaire. The average number of excess prescribed opioid medication …

Parents Advising Parents: Raising A Child With Type 1 Diabetes, Becky Jean Rasmuson

Theses and Dissertations

Background and Purpose: Children diagnosed with Type 1 Diabetes face significant challenges in the day to day management of their disease. Parents play an important role in supporting children at every stage of their lives and helping them transition to independence in the management of T1D. The purpose of this study was to learn from parents who have raised their children with T1D to adulthood and identify strategies for parents who are currently raising a child with T1D. Methods: Using a biographical method, a qualitative design, two in-depth interviews with open-ended prompts were completed with purposively selected parents of children …

The Nicotine Content Of A Sample Of E-Cigarette Liquid Manufactured In The United States, Barrett H. Raymond

Theses and Dissertations

Background: Use of electronic cigarettes (EC) has dramatically increased in the United States since 2010 with a forecasted growth of 37% between 2014 and 2019. There is little research on e-liquid nicotine concentration from domestic manufacturers. However, limited research outside of the U.S. found wide inconsistencies between the labeled concentration of nicotine in e-liquids and the actual nicotine concentration. Methods: The seven most popular online manufacturers or distributors were identified. E-liquid samples of the five most popular flavors from each manufacturer were purchased in nicotine concentrations of 0 mg/ml and 18 mg/ml. Of the samples purchased (n=70), all were labeled …

Development Of An Effective International Medical Disaster Relief Team: A Qualitative Descriptive Study, Nicolette Broby

Theses and Dissertations

Natural and manmade disasters are occurring at an unprecedented rate. Injuries and sickness are among the most widespread types of suffering caused by disasters, making medical aid essential. However, medical response depends on multiple factors to be timely and effective. The process of building a competent international medical disaster relief organization is complex, yet many well-intentioned, charitable organizations react hastily after a disaster, sending medical teams without truly understanding what an effective response requires. Consequently, in their genuine effort to help, they may end up hindering the response effort more than helping. Meanwhile, successful organizations implement principles conducive to an …

Smoking Behavior In Arab Americans: Acculturation And Health Beliefs, Roula Ghadban

Theses and Dissertations

Background: Arab Americans, a growing population in the U.S., tend to have high rates of smoking and low rates of smoking cessation. Arab Americans and their families are at a high risk for poor health outcomes related to smoking.

Objective: The purpose of this study is to better understand the smoking behaviors of Arabs in the U.S., using the two publishable manuscripts format. The first manuscript is a systematic review of the literature exploring the smoking behavior, prevalence and use among Arab Americans and examining studies addressing the effect of acculturation on this behavior. The second manuscript is a cross-sectional …

Evaluation, Treatment, And Education In The Hospice Setting By Initiating A Formalized Pain Card, Alyssa M. Soprano

Theses and Dissertations

The purpose of this DNP quality improvement project was to evaluate the use of a formalized pain card that Nurse Practitioners could use to assist clients and caregivers in making the decisions necessary for safe and effective pain management with improving outcomes by using the Brief Pain Inventory Form for measuring: 1) decreased pain, 2) increased pain, 3) pain relief. The appraised evidence suggested that there was a need for a policy standard for patients to notify when pain is unrelieved despite exhausting all other efforts to control pain (Glowacki, 2015). Forty-one (n=41) hospice patients were surveyed pre and post …

Losing Weight With Five A’S (5 A’S): Assess, Advise, Agree, Assist, Arrange Framework And Motivational Interviewing (Mi) For Health Behavior Change Counseling, Jacqueline Baer

Theses and Dissertations

According to the Centers for Disease Control and Prevention (CDC), obesity has reached epidemic levels and has associated with increased risk of morbidity and mortality rates. The increasing prevalence of obesity is a major public health concern. Researchers calculate that health care costs are 44% higher among moderately and severely obese older persons than for persons at normal weights. Seventy-five percent of African American (AA) women are overweight and obese according to data from the CDC and The State of Obesity: Better Policies for a Healthier America. Compared to any other racial ethnic group, AA women are more likely to …

Nurse Educators’ Perceptions Of Using High-Fidelity Simulation In Teaching, Marlene Whigham

Theses and Dissertations

Nurse Educators’ Perceptions of Using High-Fidelity Simulation in Teaching. Marline Whigham, 2017: Applied Dissertation, Nova Southeastern University, Abraham S. Fischler College of Education. Keywords: nursing education, learning strategies, simulation, staff development, teaching styles.

High-fidelity simulation in nursing refers to the use of computerized manikins to offer realistic hands-on training to nursing students. The problem addressed by this dissertation was resistance among some faculty to the use of new computerized simulation technology in the nursing curriculum. The research question for this case study investigated how faculty members can incorporate simulation into the curriculum and barriers faced in setting the stage for …

Barriers To The Use Of Guardrails On Iv Smart Pumps, Ivory Williams

Theses and Dissertations

Medication errors involving hospitalized patients have been an evolving challenge for decades. Moreover, errors related to intravenous (IV) medication administration continue to rise in hospitals despite implemented policies governing the use of Guardrails™ for safe IV medication infusion via smart pump technology. An organizational investigation was performed to identify barriers to the use of Guardrails™ among nursing staff. From 2015 through 2017, multiple interventions that aimed to identify barriers and increase nurses’ use of the safety features on IV smart pumps were implemented in the hopes of reaching a compliance goal of 90-100%. This quality improvement project assesses Guardrails™ compliance …

Improving Leadership Communication In Nurse-Physician Dyad Teams, Lisa James

Theses and Dissertations

Background: Changes in the delivery of healthcare services in the United States have been driven by cost containment over the last 20 years. To have a thriving organization within the current healthcare environment, nurses and physicians need to closely collaborate. As healthcare organizations prepare for the value-based era, new leadership models need to be implemented. This project addressed collaboration between nurse and physician leaders with a focused communication strategy to improve team performance, engagement, and quality outcomes in the acute care setting.

Method: A quality improvement project was designed to improve communication between front line team members and …

Identifying United States And Territory Requirements For Childhood Vaccination Exemptions, Emily Groth Dunn

Theses and Dissertations

Background: Children are required by law to receive vaccinations to enter school. States and territories offer exemptions for parents who refuse to vaccinate their children. Types of exemptions vary by state or territory, as does the exemption claiming process. The purpose of this research was to identify the various education-related processes implemented by states and territories which allow parents to exempt children from vaccinations. Methods: A questionnaire was distributed to immunization managers in the 50 United States, District of Columbia, the United States Indian Health Service, and eight United States territories. Managers reported vaccination requirements for their jurisdiction (collectively referred …

Simulation-Based Interprofessional Education In A Rural Setting, Ann D. Scott

Theses and Dissertations

The purpose of this project was to examine the feasibility and acceptability of a simulation-based IPE experience for pre-licensure nursing, pharmacy, and medical students on a rurally-located campus. Using a mixed-methods, explanatory sequential approach, this project: 1) examined the feasibility of implementing a simulation-based IPE experience using telehealth tools; and 2) evaluated student perceptions of inter-professional teamwork, roles and responsibilities, and patient outcomes for collaborative practice, both pre- and post-scenario.

Quantitative data were analyzed using SPSS. Results revealed 94% agreed/strongly agreed the IPE experience resembled a real-life situation. 100% of nursing/medical students and 80% of the pharmacy students indicated they …

An Evidence-Based Process Change To Improve Mammography Adherence, Tara E. Smalls

Theses and Dissertations

Breast cancer is a significant disease—affecting 12% of American women in a lifetime. Breast cancer costs $180 billion annually in healthcare expenditures and productivity. Mammography has been identified as the greatest tool to mitigate morbidity, yet in many organizations, mammography compliance rates are decreasing. This process improvement was conducted to address the barriers to patient follow through with mammography and to recommend strategies to improve the current breastscreening process.

Principles of the Six Sigma DMAIC framework were utilized to analyze the breast-screening clinic process. Chart reviews and organization databases were applied to determine mammography adherence. The opportunities to improve current …

Developing And Implementing A Quality Assurance Strategy For Electroconvulsive Therapy, Jessa Hollingsworth

Theses and Dissertations

The literature provides scant guidance in effective quality assurance strategies concerning the use of electroconvulsive therapy (ECT) for the treatment of psychiatric conditions. Numerous guidelines are published that provide guidance in the delivery of care, however, little has been done to determine how a program or facility might ensure compliance to best practice for safety, tolerability, and efficacy in performing ECT. The objective of this project was to create a quality assurance strategy specific to ECT. Determining standards for quality care and clarifying facility policy were key outcomes in establishing an effective quality assurance strategy. An audit tool was developed …

Tuberculosis Screening In New Healthcare Employees: A Comparison Of Quantiferon®-Tb Gold In-Tube Test And Tuberculin Skin Test, Mary C. Giovannetti

Theses and Dissertations

Background: Streamlining onboarding processes for new hires to maximize efficiency and reduce costs while meeting regulatory requirements is a constant challenge for healthcare systems’ Employee Health staff. Health screening is a required step and includes obtaining a detailed health history, tuberculosis screening, drug screens, immunizations, fit for duty examinations, obtaining medical records, clarification of disability accommodations, pre-work screens, and other tests which are time consuming and result in delays in hire dates. Faced with a high volume of potential new employee hires a major southeast healthcare system was concerned about delays in new hire start dates. The two-step tuberculin skin …

Scribes Impact On Patient And Provider Experience In The Outpatient Setting, Kimberly A. Taylor

Theses and Dissertations

The purpose of this project was to evaluate the effectiveness of using scribes in the outpatient setting on patient and provider experience. A mixed methods approach with a convenience sample of voluntary patient participants scheduled for an outpatient appointment was utilized. Two primary care physicians volunteered to receive scribes. Four hospital corpsmen were selected and trained to serve in the scribe role.

This quality improvement project evaluated two aspects of experience during the implementation of the scribes. These included: 1) patient experience as indicated via a pre and post implementation questionnaire; and 2) provider experience as indicated via a pre …

Picturing Rest: A Photovoice Study Of African American Women’S Perceptions And Practices Of Rest, Eboni T. Herbert Harris

Theses and Dissertations

African American women are consistently identified as being less likely to participate in sustained leisure time physical activity (Tussing-Humphreys, Fitzgibbon, Kong, & Odoms-young, 2013), yet more likely to be overweight or obese (Levi, Segal, Laurent, & Rayburn, 2014). There has been a wide range of initiatives directed towards preventing and/or reducing obesity among African Americans, such as targeted physical activity and nutrition interventions involving goal setting, group and individualized counseling, and social support. Previous research focused on African American women’s perceptions toward physical activity, nutrition, and weight; emphasize the consideration of cultural attitudes like placing a high value on rest …

A Quality Improvement Project To Reduce The Incidence Of Clostridium Difficile Infection Through Implementation Of Evidence-Based Terminal Clean Procedures, Tamara Cook

Theses and Dissertations

Hospital-acquired infections (HAIs) are a huge economic burden and threat to patient health and outcomes. Clostridium difficile is the most common HAI. Effective hand hygiene and proper environmental cleaning procedures are significant to preventing the spread of C. difficile infections. The research question used to guide this project is: Does the use of a monitoring system for post C. difficile isolation terminal clean procedure reduce the rate of hospital-acquired C. difficile in the acute care population? A thorough organizational assessment was performed and directed this project to identify causes that may contribute to the recurrences of C. difficile infections. The …

Adherence Of Nurse Practitioners To Jnc 8 Guidelines, Stephanie E. Averette

Theses and Dissertations

The purposes of the evidence based project were to implement a best practice algorithm for treatment of hypertension (HTN) based on JNC 8 guidelines; compare nurse practitioners HTN pharmacotherapy prescribing practices before and after implementation of a HTN algorithm; and compare hypertensive adult patients’ systolic blood pressure (SBP) readings before and after the implementation of a HTN algorithm. A quasi-experimental pre-test and post-test design was used to collect and analyze data from 61 patient charts to compare nurse practitioner adherence to JNC 8 guidelines for NPs’ prescribing practices and subjects’ blood pressure (BP) outcome before and after the implementation of …

Best Practice For Screening Adult Patients With Psoriasis For Polyautoimmunity: Celiac Disease, Rheumatoid Arthritis And Crohn’S Disease, Susan Danielle Ashbaugh

Theses and Dissertations

The purpose of this quality improvement project was to determine if screening primary care patients with psoriasis will improve early detection of celiac disease (CD), rheumatoid arthritis, and Crohn’s disease (CrD). The aim of this project is to assess the utility of early screening in patients with psoriasis in order to facilitate earlier diagnosis of CD, RA and CrD, which would consequently initiate earlier treatment and improve long-term patient outcomes. Genetic and population-based studies suggest that individuals with psoriasis have a greater risk of also having CrD, CD or RA, than do individuals without psoriasis. The literature also suggests that …

Assessment Of Providers’ Perception And Knowledge Of Overactive Bladder In Women: A Quality Improvement Project, Helen Wambui Ngigi

Theses and Dissertations

Background: OAB is defined by subjective symptoms, rather than objective measure, the patient’s perspective is important in managing OAB (Hung et al., 2013). As such providers need to capture the patient’s perspective of their OAB symptoms and their impact on the quality of life. A patient work up helps providers determine the cause of the symptoms as well as the degree of bother to the patient (Barkin, 2016). The diagnosis of OAB is essentially clinical and can be performed through structured questionnaires (Juliato et al., 2016). When conducting a patient history, it is important to determine the onset and severity …

Utility Of The Modified Early Warning System Score In Early Sepsis Identification, Lisa E. Hart

Theses and Dissertations

The purpose of this quality improvement project is to improve outcomes for patients presenting to the emergency department with sepsis, realizing that time is a key factor. The appraised evidence indicates that early recognition and prompt treatment improve outcomes and decrease mortality. The evidence further highlights that use of an early warning system, like the Modified Early Warning Score, can assist nurses and providers with recognizing deterioration more quickly and lead to a reduction in time to interventions. Between January 2016 and March 2017, the author conducted a retrospective chart review to compare time to antibiotic administration and lactate measurement …

A Biobehavioral Approach To Examining Moral Distress In Critical Care Nurses, Marian Altman

Theses and Dissertations

Moral distress is a complex and challenging problem that may cause negative biopsycohosical and professional outcomes for critical care nurses. The purpose of this work was to explore the relationship between the ethical climate of the work environment and moral distress as experienced by critical care nurses; and to explore relationships among mediators of stress (nurse characteristics e.g. education (BSN, nonBSN), years certified as a critical care nurse, and tolerance of ambiguity) and their relationship with perceived stress, moral distress, health status and salivary alpha amylase. A descriptive correlational cross-sectional design was used for this pilot study of 100 critical …