Nursing Commons^™

Perinatal Staff Education On Opioid Use Disorder, Theresa J. Engle

Walden Dissertations and Doctoral Studies

According to the Centers for Disease Control and Prevention, opiate use disorder (OUD) crosses all demographic areas, ethnicities, and social classes. In 2016, over 42,000 Americans died from opiate overdose with more than two million Americans having OUD. The need to care for patients with OUD has crossed all realms of nursing, including the perinatal specialty. Framed within the Iowa model of evidence-based practice, the purpose of this project was to develop a perinatal staff education program on OUD focusing on addiction as a brain disorder with care of the perinatal woman and identification and treatment of the newborn with …

A Systematic Review Of The Literature On Bedside Shift Reports, Dana Wickersheim

Walden Dissertations and Doctoral Studies

AbstractIn 2017, The Joint Commission issued a sentinel event alert regarding inadequate nurse hand-off communication. Inadequate hand-off communication can lead to medication errors, delay in treatment, falls, and wrong-site surgery. To help ensure safe handoff of care between nurses by involving the patient and family, bedside shift report was created. Bedside shift report was developed to help improve patient safety and quality, patient experience of care, nursing staff satisfaction and time management, and accountability between nurses. Despite the implementation of bedside shift report in nursing practice, it continues to be inconsistently applied, which poses risks to patients and can lead …

Hospital Nurses’ Perceptions Of Computer-Assisted Instruction For Professional Development, Katherine Irizarry

Walden Dissertations and Doctoral Studies

Computer-assisted instruction (CAI) is increasingly being used for professional development. However, at one hospital in the northeast region of the United States, it was observed that nurses were not completing their CAI professional development modules and were failing to meet continuous education requirements. This qualitative case study explored professional nurses’ perspectives regarding the usefulness of CAI as a mode of professional development. The conceptual frameworks used to guide this study were Davis’ theory of technology acceptance, and Knowles’s theory of andragogy. The research question explored how professional nurses perceived the usefulness of CAI to assimilate new learning. The participants in …

Preventing Aspiration Pneumonia Using An Aspiration Prevention Protocol, Lee James-Pettway

Walden Dissertations and Doctoral Studies

Hospital-acquired pneumonia, which includes aspiration pneumonia (AP), is a preventable condition that is costly to all healthcare institutions (more than $17,000 to $ 30,000 per episode), because insurance no longer covers the cost of hospital-acquired harms. Each episode in the hospital setting can lead to patient complications, increased use of antibiotics, patient mortality, as well as decreased patient survey scores. Several factors put patients at risk of developing AP, and screening for these risk factors on admission and implementing preventative nursing interventions can decrease the incidence. Based on an extensive literature review, an evidence-based, clinical practice guideline (CPG) was identified …

Increasing Primary Care Nurse’S Recognition Of Symptoms Related To Job-Related Stress, Beverly Diann Butler

Walden Dissertations and Doctoral Studies

AbstractMany nurses become accustomed to stressful situations and often do not recognize the signs of stress until it has in some form affected them. Nurses often lack education for recognition of signs regarding job-related stress. The practice-focused question for this doctoral project addressed whether knowledge of stress recognition increase in nurses after an evidence-based educational program (EBP) regarding signs of job- related stress.” The purpose and significance of this project was to develop, deliver and evaluate an EBP regarding recognition of signs regarding job-related stress. The project was guided by the Job Demands-Resource (JD-R) theory and Lewin’s Change Theory to …

Parents’ Perceptions Of Healthcare Influences On Their Decisions To Vaccinate Their Children, Patricia Frances Badiola Harris

Walden Dissertations and Doctoral Studies

Declining immunization rates are associated with higher incidents of vaccine-preventable diseases. The purpose of this qualitative phenomenological inquiry was to explore the perceptions of vaccine-hesitant parents regarding their healthcare experiences. Ajzen and Fishbein‘s theory of reasoned actions and its key concepts (the intention to perform behaviors, attitudes, subjective norms, and external variables) was used as a framework to understand influences on parents' decisions to vaccinate their children. The research questions for the study examined the healthcare experiences of vaccine-hesitant parents, how these experiences influenced their decisions to vaccinate their children, and how this group perceived the current strategies promoting vaccinations …

Hypertensive Self Care: An Educational Tool For Advanced Practice Nurses, Kelisia Burks Mckay

Walden Dissertations and Doctoral Studies

Poorly controlled hypertension is a serious public health problem. Persons with high blood pressure are required to perform a variety of self-care behaviors. Advance practice nurses can improve health outcomes for hypertensive patients when they provide self-care education along with prescribing appropriate medications needed to treat high blood pressure. The purpose of this study was to educate rural advance practice nurses about hypertension medication and self-care management using the Hypertension Self-Care Activity Level Effects (H-SCALE) and the 8th National Joint Committee (JNC- 8) hypertensive guidelines. Twelve primary care advanced practices nurses (APN's) participated in an educational presentation that included pre …

Evaluation Of A New Nurse Mentor Program, Corinne Romano

Walden Dissertations and Doctoral Studies

Novice nurses in the facility had a turnover rate of 32% in 2017 and 2018, despite participation in a novice nurse residency program. This project was the 3-month formative evaluation of a 1-year mentor program designed for novice nurses. The mentor program had been created to augment the residency program and support practice transition for novice nurses. The project questions explored the results of the process evaluation at the 3-month mark of the year-long mentorship program for the first cohort and recommendations to the mentor coordinators for continuous quality improvement. This quality improvement project followed the PDSA (plan-do-study-act) methodology. The …

Nursing Administration And Faculty Perceptions Of Their Self-Efficacy With Active Learning Methods, Lindsey Ann Helm

Walden Dissertations and Doctoral Studies

A lack of active teaching was identified in a small, rural college in a midwestern state, resulting in negative course evaluations that referenced students’ learning preferences as not being met. This qualitative case study was aligned with Bandura’s theory of self-efficacy to explore the perceptions of nursing administrators and nursing faculty about their teaching methods and self-efficacy regarding the implementation of active learning strategies. A purposeful sampling method was used to select a total of 8 participants: 6 nursing faculty and 2 nursing administrators. Selection criteria included nurse educators and administrators who had worked at the college within the last …

Enhancing Nurse- Patient Communication Through Commit To Sit, Cherrielyn E. Quiambao

Walden Dissertations and Doctoral Studies

The patient experience is considered by healthcare policy experts as one of the essential components of healthcare quality. The project site implemented a program called “Commit to Sit” to help promote direct bedside communication with patients. This quality improvement project examined the impact of the Commit to Sit program on patient experience in an acute care setting. The purpose of this evaluation focused on determining whether communication between the frontline nurses and patients improved through the implementation of “Commit to Sit” campaign on a pilot unit in a community hospital. The Duffy’s Quality Caring Model was utilized because it encourages …

A Mentorship Program For Newly Licensed Registered Nurses, Omin Chandler

Walden Dissertations and Doctoral Studies

The retention of new nurses remains a challenge for most healthcare organizations. Approximately 75% of newly licensed registered nurses (NLRNs) resign their positions within the first year of employment due to transition shock from the academic setting to the practicum setting. Other reasons for resignation include lack of confidence, poor critical thinking skills, and feeling overwhelmed to provide quality patient care. This loss of retention among NLRNs poses a significant threat to the delivery of quality and safe patient care. Nurses who assume the role of mentor to newly licensed nurses face many barriers to fulfilling their role effectively, including …

Evidence-Based Practice Guideline: Breastfeeding Support Of The Active Duty Servicewoman, Heidi A. Koslo

Walden Dissertations and Doctoral Studies

There is no policy on breastfeeding support of the active duty military servicewoman at the targeted military treatment facility, and no global policy serving active duty personnel applicable at the Department of Defense and Defense Health Agency (DoD/DHA) level to span across branches of the U.S. military. Nurses, as members of the most trusted profession, are often expected to know how to assist a mother in meeting her feeding goals. Creation of an evidence-based practice guideline (EBPG) for support of the active duty servicewoman in the military health system was the purpose of this project. The project was conceptualized within …

Education Toolkit On Restraint Reduction In The Intensive Care Unit, Sharon Watkins

Walden Dissertations and Doctoral Studies

The use of physical restraints in hospitals has been in practice for the better part of a century despite the many adverse effects it can have on patients. Socially, restraint use can strip the patient of their dignity in addition to their freedom. This evidence-based project was to build a toolkit to educate intensive care unit (ICU) nurses regarding the negative effects physical restraint use can have on their patients and to present alternatives to their use. Tools developed from prior research were included in the toolkit, and the Neuman systems model was applied to the overall education project. The …

Tool Kit To Address Communication On A Mental Health Unit, Carol L. Barclay

Walden Dissertations and Doctoral Studies

Effective communication by newly graduated, hired nursing staff is a significant issue affecting patient care on mental health units. The rising prevalence of mental illness in the United States has not only increased the healthcare burden, but has also affected the overall economy. The lack of training of new nursing staff regarding communication diminishes the effective recovery rate of patients, further increasing the burden to the healthcare field and the economy. A tool kit for newly graduated mental health nurses working on mental health units may help to improve communication skills and enhance patient safety and quality of care. Therefore, …

Addressing Bullying And Incivility Among Nurses, Caroline Holland Combs

Walden Dissertations and Doctoral Studies

For decades, nurses have experienced some form of bullying and incivility throughout their careers. Incivility contributes to behaviors that constrain the sense of empowerment among nurses and directly encroach upon Provision 6 of the American Nurses Association code of ethics, which addresses sustaining a moral environment and the need to create a contagious culture of respect that is free from uncivil behavior. The nature of this staff education project was to bring awareness to the bullying behaviors and incivility that exist within an organization’s culture by assessing for the incidence of bullying and by providing an educational program for the …

Evidence-Based Pediatric Diabetic Ketoacidosis Education, Sonya Sandhu

Walden Dissertations and Doctoral Studies

Pediatric patients with diabetic ketoacidosis (DKA) are a unique subset of patients who arrive to the emergency department (ED) for care, and differ from adults regarding symptomology, treatment, and adverse effects. Nurses who will encounter this patient population must have adequate knowledge and confidence to care for them, yet research continues to show a gap in practice. The purpose of this doctoral project was to determine if a staff education project would increase ED nurse knowledge and confidence in caring for pediatric emergency patients with DKA. Utilizing Kirkpatrick’s evaluation model, an evidence-based staff education program was formulated, reviewed by an …

Systematic Review Of Loss-Frame Messaging And Change In Health Behavior, Eddie Jean Simmons

Walden Dissertations and Doctoral Studies

Recent analysis estimates Type II diabetes affects 23.4 million people in the US. Approximately 30% of these patients are not in optimal control of their diabetes, raising risks for blindness, amputation, and cardiac disease. A gap in diabetes education practice is that traditional positive-framed messaging has not persuaded many patients to modify their self-management behaviors. There is a need for alternative ways to communicate the risks of not managing the disease to patients who may have different health beliefs. The purpose of this systematic review was to examine the best available evidence regarding the efficacy of loss-frame messaging when used …

Nurse Leaders’ Perspectives On Animal-Assisted Interventions, Samantha Vita Abate

Walden Dissertations and Doctoral Studies

Knowledge deficits and unfavorable attitudes are commonly cited barriers that prevent adoption of animal-assisted interventions (AAIs). Nurse leaders’ (NLs’) knowledge of and attitudes toward AAIs have not been well documented in the literature. The purpose of this study was to identify NLs’ perspective on AAI, including their usage, knowledge, and attitudes. This information may be helpful in overcoming common barriers to AAI usage. The theory of transformational leadership guided this 3-manuscript dissertation study, which included 3 studies on NLs’ use of AAIs, the relationship between NLs’ knowledge of AAIs and NLs attitudes toward AAIs, and the potential impact of AAI …

Improving Suicide Prevention In The Emergency Department, Crystal Hartis Andrews

Walden Dissertations and Doctoral Studies

Suicide is a leading cause of death and a significant public health problem in the United States, especially among the youth population. The wide variability of screening practices and limited educational programs for nurses in terms of identification and management of individuals at risk for suicide exists. The purpose of this project was to conduct a systematic review to identify evidence available in support of adequately preparing nurses to conduct suicide screening and inform suicide prevention efforts for youth in emergency departments. Results from the literature review were correlated to formulate recommendations for improving suicide screening practices through the provision …

Evaluating An Incentive Program To Improve Teamwork And Productivity In The Operating Room, Christopher Bejil

Walden Dissertations and Doctoral Studies

The operating room (OR) is a complex system that must run efficiently to remain profitable and of value to its multiple stakeholders who include the patient, surgeon, OR staff member, and hospital administration. The OR at the practice site struggled with teamwork and efficiency in the areas of first-case on-time starts, turnover time, and last-case out times, resulting in a less than favorable impact on the organizational bottom line. The practice-focused question asked if a performance-based incentive bonus program can improve OR efficiency in the department’s three major problem areas. Using Gittell’s relational coordination theory as a framework, the practice …

Pain Assessment Strategies For People With Cognitive Impairment In Nursing Home Settings, Meskelo Tsegaye Bobo

Walden Dissertations and Doctoral Studies

Assessment of pain in patients with a diagnosis of dementia or cognitive impairment continues to be underdiagnosed as there are no objective ways of assessing their pain. Available evidence also indicates that these patients are not receiving satisfactory pain management. Due to a lack of self-reporting of pain, accurate assessments of pain are challenging. This systemic review aimed to find a pain assessment strategy effective in identifying pain in patients with a diagnosis of dementia. Kolcaba's theory of comfort was used as the theoretical framework for the study. The databases of Medline, Cochrane Database of Systematic Reviews, Embase, and Cumulative …

Hiv/Sti Screening, Testing, And Prophylaxis Among Sexual Assault Survivors In U. S. Emergency Departments, Elizabeth A. Cita

Walden Dissertations and Doctoral Studies

Use of HIV screening/testing and prophylaxis has been found to be low in the general emergency department (ED) population. Less is known about the use of HIV/sexually transmitted infection (STI) screening, testing, and prophylaxis among sexual assault survivors who present to EDs. The main research questions asked whether there was a relationship between race, socioeconomic status (SES), geographic region, or age, HIV/STI, treatment, and prophylaxis among sexual assault survivors that present to U.S. EDs. This study was a secondary analysis of data collected in the NHAMCS years 2010 to 2016 and included 112 geographic primary sampling units, about 480 hospitals. …

Educating Registered Nurses On Decreasing Missed Care Events, Marie St. Clair Dixon-Brown

Walden Dissertations and Doctoral Studies

Abstract

Missed care or partially completed nursing care is a prevalent problem in healthcare with negative consequences for patients, nurses, and healthcare organizations. This project was developed to address a gap in practice by providing staff education regarding the current evidence about missed care along with practical evidence-based strategies to decrease missed care events. Kalisch’s missed nursing care model framed the project. The staff education program used a PowerPoint presentation with interactive discussion and role-play opportunities for nurse participants to engage in and employ strategies to prevent missed care events. A 10-item multiple-choice post-education quiz and 4-point Likert-type program evaluation …

A Guide For Effective Home Health Education, Dianne M. Nissen

Walden Dissertations and Doctoral Studies

Older adults afflicted with chronic conditions present a unique set of challenges for home health nurses. In addition to caring for many of the patient’s physical problems, patient education is needed to enable patients to manage themselves. Patient education focuses on complicated medication and treatment adherence, safety, and preventing complications. The purpose of this oral presentation and supplemental guide was to increase the knowledge and skills of home health nurses by formally preparing them for the responsibility of patient educator. The practice-focused question was whether the provision of education and a supportive guide for individualizing patient education would improve the …

Use Of The Smoking Cessation Power Plan In An Observation Unit, Joycelyn Kennedy Land

Walden Dissertations and Doctoral Studies

Of 34.2 million adults who use tobacco, nearly 50% of the population living in the United States, or 16.5 million people, have a smoking-related disease. The purpose of this DNP project, conducted on an observational unit located in an acute care hospital, was to address the evidenced-based practice gap of the limited use of assessing tobacco use and the initiation of a readily available smoking cessation power plan (SCPP) intervention by nurses and healthcare providers. The practice-focused questions were whether an educational intervention for nursing staff would increase use of the 3As assessment (Ask and record smoking status; Advise patient …

Improving Sedation Management In Mechanically Ventilated Patients, Jannette Lord

Walden Dissertations and Doctoral Studies

Abstract

In the intensive care unit (ICU), sedation management of the critically ill, mechanically

ventilated patient is a source of concern. Optimal sedation management is integral to

critical care practice, yet optimal levels of sedation are not consistently applied.

Suboptimal sedation carries significant risks for patients, as inadequate sedation or

oversedation may lead to prolonged ventilator days, ventilator-associated pneumonia

(VAP), extended length of ICU stay, and costs. The purpose of this quality improvement

(QI) project was to improve sedation management of mechanically ventilated patients by

improving staff nurses’ knowledge of and attitudes toward sedation management,

ultimately achieving a zero-ventilated associated …

Effects Of Short-Term Intensive Insulin Therapy In Type 2 Diabetes Mellitus Management, Ernest Mwathi

Walden Dissertations and Doctoral Studies

Diabetes is a chronic illness affecting millions of individuals in the United States and is the seventh leading cause of death. Most of the Type 2 Diabetes Mellitus (T2DM) patients manage their illness with non-insulin therapies resulting in inadequate glycemic control but there are times when they experience inadequate glycemic control and require short-term intensive insulin therapy (SIIT). Despite proven effectiveness of SIIT, there is a lack of research focusing on the effectiveness of clinical practice where providers revert their clients to non-insulin therapy after SIIT. The focus of this quality improvement (QI) project was to evaluate pre/post data and …

Professional Development For Nurse Educators, Samdaye Ramdial

Walden Dissertations and Doctoral Studies

At a large university on the outskirts of Toronto, Canada, there was an influx of students entering the nursing program. Therefore, the need arose for an updated, restructured, and professional development training guideline with current knowledge for nurse educators to achieve high quality learning and critical thinking. The purpose of this study was to explore professional development leaders’ perceptions of quality training guidelines for nurse educators. The conceptual framework of this study was Knowles’s adult learning theory. The research questions were centered on what professional leaders perceive to be quality professional development. A qualitative case study design was used in …

Staff Education On Depression Screening In An Outpatient Psychiatric Setting, Naiga Dohnji

Walden Dissertations and Doctoral Studies

Depression is among the common mental illnesses in the United States affecting 1 in 10 Americans. The U.S. Preventive Services Task Force recommended screening for depression irrespective of the risk factors. Yet, providers struggle to implement depression screening. Inadequate use of Patient Health Questionnaire-9 (PHQ-9) screening tool to identify and manage depression can lead to poor patient outcomes. PHQ-9 is valid and reliable tool used to diagnose depression and monitor treatment response. The purpose of this project was to develop, deliver, and evaluate an educational program for providers on the use of the PHQ-9 screening tool for the identification of …

An Educational Activity For Primary Care Providers Treating Older Veterans With Sexually Transmitted Infections, Beatrice Fannie Grant

Walden Dissertations and Doctoral Studies

AbstractComprehensive sex education is an effective method of promoting sexual health. Because primary care providers conduct the initial health need assessment of veterans, it is important that providers understand how to approach the subject of sexual health and the prevention of sexually transmitted infections. The purpose of this evidence-based project was to implement and evaluate an educational activity for primary care providers. The health belief model was used as theoretical framework. This project was introduced to a federal primary care clinic in the Mid-Atlantic United States. Twenty-five participants completed a pretest prior to the start of the educational activity that …