Nursing Commons^™

Increasing Compliance With Sequential Compression Devices To Reduce Venous Thromboembolism, Randy Mcclain

Walden Dissertations and Doctoral Studies

Venous Thromboembolism (VTE) is a life-threatening complication. Approximately 900,000 people in the United States are affected by VTE with a mortality of 300,000 cases per year. Although potentially preventable, VTE remains the leading cause of hospital deaths in the U.S. The practice problem addressed in the Doctor of Nursing Practice (DNP) project was evidence of an increased incident of VTE events on a trauma surgical unit. The practice-focused question evaluated the extent to which a nurse-driven protocol for VTE prophylaxis could improve adherence to mechanical prophylaxis with sequential compression devices and compliance with nursing documentation. The purpose for the doctoral …

Flipped Classroom Approach To A Critical Care Educational Program For New Graduates, Deborah Ann Smithers

Walden Dissertations and Doctoral Studies

Of the new graduate registered nurses hired to work in critical care areas, a few percent do not receive a formal critical care orientation. Furthermore, there is a high attrition rate of new graduates hired to work in high acuity patient care units. Many resign before their first work anniversary due to a lack of education and training. An initiative was put forth by critical care administration, at the study site, to critical care clinical leadership to significantly revise a critical care educational offering known as critical care core. The revision would allow for the satisfaction of the novice nurses …

Exploring The Lived Experiences Of The Prelicensure Hispanic Nursing Student, Mary Valerie Santos

Walden Dissertations and Doctoral Studies

AbstractNursing constitutes the largest group of healthcare professionals in the United States. Despite decades of discussion about the need to diversify the nursing profession, there continues to be a significant lack of diversity, particularly in the number of Hispanic nurses. The purpose of this qualitative study was to explore the lived experiences of Hispanic nursing students who have enrolled in a pre-licensure nursing program using Leininger’s culture care theory as the theoretical framework for this phenomenological study. This study sought to explore the lived experiences of the prelicensure Hispanic nursing student attempting to complete nursing school successfully and what factors …

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 …

Implementing A Diabetes Optimization Protocol For Elective Surgery Patients, Barbie Denise Harbaugh

Walden Dissertations and Doctoral Studies

Diabetes is a recognized risk factor for postoperative infection, acute renal failure, ileus, and lengthy hospital stay. Optimal screening, management, and scheduling of elective surgery for diabetic patients has been shown to improve quality care, decrease complications, and increase the efficiency and lower the costs of preoperative patient care. However, surgery cancellations are common due to inadequate preoperative glycemic control and poor intraoperative glycemic control, which is a recognized risk factor for perioperative or postoperative complications. There were no clinical practice guidelines or optimization protocols for elective surgery patients at a small rural hospital in the Northeast United States. The …

Cannabis As A Safer Alternative To Opioid Management Of Chronic Pain, Loren Nedelman

Walden Dissertations and Doctoral Studies

Chronic pain affects approximately 100 million American adults and costs the United States upwards of $635 billion each year in medical treatments and lost productivity. Opioid prescription for pain has increased exponentially over the past several years, with the CDC estimating 20% of prescriptions lasting longer than 3 months for patients with noncancerous pain. Opioid addiction has become a national public health crisis with mortality surpassing 100,000 deaths annually due to overdose. As States have begun to deregulate the use of cannabis and cannabis derivatives for medical purposes; oversight and regulation by the federal government on its use as a …

Improving The Ethical Use Of E-Health And Emr, Josephine Tafie

Walden Dissertations and Doctoral Studies

Improving the Ethical Use of E-health and EMR

by

Josephine Tafie

MS, Walden University

BS, Washington Adventist University

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

August 2020

Abstract

The healthcare industry is experiencing ethical problems with the integration of new technological applications, such as e-health and electronic medical records (EMRs) in service delivery. Thus, the purpose of this capstone project was to conduct a systematic literature review to determine the best practices that are well suited to a large urban hospital, to ensure patients’ privacy with the continued use …

Nurses’ Aesthetic Responses And Emotional Judgements To Senior Leaders’ Symbolism, Lucinda A. Easler

Walden Dissertations and Doctoral Studies

Stress can be heightened during a merger; understanding how acute care nurses who work in a hospital undergoing a merger, experience senior leaders’ use of symbolism may help to promote hospital and leader sustainability. Executive symbolism unfolds into aesthetic experience, normally considered a response to art, with few studies of its existence and benefit to organizational life. The purpose of this phenomenological-hermeneutic study guided by Parker’s aesthetic theory was to examine acute care nurses’ emotional responses and experiences with senior leaders’ use of executive symbolism in the midst of the organizational change. Interviews with 11 acute care registered nurses were …

Evaluating The Impact Of Nurse Leader Professional Development, Celeste Rogers Romp

Walden Dissertations and Doctoral Studies

A health care organization’s success is impacted by its leaders’ knowledge, confidence, and training. A quality improvement (QI) project was undertaken by a 300-bed acute care medical center to determine the impact of providing nurse leaders with education and training in increasing the leader’s knowledge and confidence in their role and in improving nursing satisfaction, catheter-associated urinary tract infection (CAUTI) rates, and fall rates. The FOCUS-PDSA QI model and the nurse manager leadership collaborative learning domain framework were used to guide the QI project and its evaluation. There were four primary sources of evidence. A nurse leader professional development pre- …

Evaluation Of A Shared Governance Model, Gorda Peters-Joseph

Walden Dissertations and Doctoral Studies

AbstractShared governance (SG) has been defined as a style of management in which frontline staff and managers work together to improve clinical practice. Guided by the PLAN-DO-STUDY-ACT cycle, the purpose of this project was to evaluate the implementation of the SG model for pediatric services in a US acute care hospital. The practice question explored whether the implementation of the SG model would demonstrate improvements in nurse satisfaction using the culture of safety survey, a change in nurse staff turnover reported as numbers hired, retired, resigned, or transferred, and changes in patient satisfaction measured by survey scores from the Hospital …

African Americans Beliefs Regarding Skin Cancer And Prevention, Tamara Wesley

Walden Dissertations and Doctoral Studies

Skin cancer is becoming more prevalent in African Americans. African Americans' mortality rate is significantly higher than any other race due to lack of awareness. The purpose of this qualitative study, guided by Rosenstock's health belief model, was to gain an understanding of African Americans' beliefs and perceptions regarding skin cancer. Ten telephone interviews were conducted with African Americans who were 18 years old or older, no history of cancer, and who were members of a church in a rural town in the southeastern United States. The interview transcripts were manually transcribed verbatim. The data were analyzed by using codes …

Effects Of Full Practice Authority On Chronic Disease Outcomes And Costs, Nichole Marie Alegria

Walden Dissertations and Doctoral Studies

Rising medical costs and increasing shortage of qualified primary care providers has left hundreds of thousands of Texans with limited or no access to primary care services. One way to bridge the gap is to use advanced practice registered nurses who function as nurse practitioners (NPs). Current evidence indicates that by expanding the scope of practice (SOP) of NPs, access to care and patient outcomes improve. The aim of this DNP project was to analyze the current health care policy and examine the relationship and impact SOP has on patient outcomes and health care costs associated with hypertension and diabetes. …

A Comparative Analysis Of Job Satisfaction, Burnout, And Intent To Leave Among Nurses, Randall Lee Mcelreath

Walden Dissertations and Doctoral Studies

There is a significant shortage of qualified registered nurses in the United States which, in part, is due to a lack of job satisfaction and burnout with an intent to leave nursing, especially among nurses who work in specialty areas such as intensive care. There is limited research as to how job satisfaction and burnout contribute to intent to leave among the specialty areas of nursing working at the bedside in an acute care environment. The purpose, guided by the modeling and role modeling theory, was to determine the relationship that exists between burnout, job satisfaction, and intent to leave …

Examining Icu Nurses' Knowledge Of Ventilator-Associated Events And Ventilator-Associated Pneumonia, Dorothy J. Sanders-Thompson

Walden Dissertations and Doctoral Studies

Ventilator-associated events (VAEs) are patients' complications of respiratory conditions including ventilator-associated pneumonia (VAP). Research shows that VAP is the most common hospital-acquired infection among ventilated patients and a leading source of mortality. With greater risk for complications among ventilated- supported patients, nurses working in the ICU must keep abreast of new knowledge and update expertise to develop technical and clinical skills in daily practice. The purpose of this project was to assess whether an educational intervention would increase the ICU nurses' level of knowledge of the evidence-based intervention. Knowles' adult learning theory was chosen for this project. A paired-samples t-test …

Review Of A Remediation Program In An Associate Degree Nursing Program, Christopher Thomas Young

Walden Dissertations and Doctoral Studies

New nurse graduates must pass the National Council Licensure Examination (NCLEX) in order to achieve nursing licensure. In Northern New Mexico associate degree nursing program with a large disadvantaged student population, the average pass rate for the licensure exam often falls below the state board of nursing mandated 80% pass rate. This study's purpose was to evaluate the effect of an NCLEX remediation program on students' ability to pass the NCLEX, using Knowles adult learning theory to guide this work. The research questions investigated the relation between the remedial instruction and the 2 dependent variables KAPLAN predictor scores and NCLEX …

Adolescent Substance Abuse Screening, Wesley W. Lynch

Walden Dissertations and Doctoral Studies

Adolescent substance use is a key public health problem in rural Ohio. Primary care nurses lack substance use screening knowledge and skills. Early screening and detection of possible substance use issues aids in directing patients to appropriate health services. This project involved the implementation of an educational intervention on the CRAFFT screening tool for primary care nurses in rural Ohio. Guided by Kurt Lewin's 3-step model to emphasize prevalence of substance use and need for screening among adolescents, the purpose of this project was to provide training on the CRAFFT screening approach and share guidelines to implement routine substance abuse …

Review Of A Remediation Program In An Associate Degree Nursing Program, Christopher Thomas Young

Walden Dissertations and Doctoral Studies

New nurse graduates must pass the National Council Licensure Examination (NCLEX) in order to achieve nursing licensure. In Northern New Mexico associate degree nursing program with a large disadvantaged student population, the average pass rate for the licensure exam often falls below the state board of nursing mandated 80% pass rate. This study's purpose was to evaluate the effect of an NCLEX remediation program on students' ability to pass the NCLEX, using Knowles adult learning theory to guide this work. The research questions investigated the relation between the remedial instruction and the 2 dependent variables KAPLAN predictor scores and NCLEX …

Nurse Practitioner-Led Education Program For Heart Failure Patients, Shay Felecia Clarke

Walden Dissertations and Doctoral Studies

Heart failure (HF) affects 5.7 million Americans and continues to be a leading cause of hospitalizations and deaths in the United States, posing an enormous burden on patients, families, and the health care system. Readmission rates for HF within 30 days post hospital discharge at small rural acute care facility in the southeast are consistently higher than the national average. The gap in nursing practice was the lack of up to date patient education postdischarge guidelines on HF for the socioeconomically disadvantaged, culturally diverse patient population located in this small rural town. The purpose of this project was to use …

A Provider Education Program Addressing Barriers To Diabetic Patients’ Self-Care, Henrietta O. Emokidi

Walden Dissertations and Doctoral Studies

Diabetes is the leading cause of death among American Indian/Alaskan Natives and the 7th leading cause of death in the United States. Type 2 diabetes (T2DM) affects 9% of the U.S. population and costs the United States an estimated $245 billion annually. The purpose of this project was to identify patients’ concerns related to their disease and to develop an education program for providers to address these concerns. The project was framed using Orem’s theory of self-care and the middle-range theory of self-care of chronic illness. Five providers in an underserved clinic in Alaska conducted assessments during a primary care …

Decreasing Hiv Stigmatization For Care Of Young Men Of Color Who Have Sex With Men, Alethea Arnett Miller

Walden Dissertations and Doctoral Studies

HIV-related stigma from healthcare provider attitudes, beliefs, perceptions, or misconceptions has been a barrier to healthcare delivery. This project was conducted to examine whether an HIV-related stigma education provided to healthcare clinic staff with a focus on advance practice registered nurses can improve knowledge and empathy toward young men of color who have sex with men (MSM), which can lead to improved overall quality of healthcare through increased health behaviors and retention in care. An educational intervention was conducted utilizing a blended-learning environment focused on social cognitive theory to influence social behavior change among healthcare professionals, increasing their exposure, knowledge, …

Effect Of Bundled Interventions By Patient Type To Reduce Falls, Celia Nurse

Walden Dissertations and Doctoral Studies

Despite consistent efforts in the healthcare field, 700,000 to 1 million patients fall in hospitals each year. There is a gap in the literature regarding identification of optimal bundles of fall prevention interventions (FPIs) for patients by type, and though patients of all ages fall in hospitals, older adults fall more, which may mean that the influence of FPIs may differ for patients by age. The purpose of this descriptive, retrospective, quantitative secondary data analysis study, guided by Virginia Henderson’s need theory, was to examine the differences in the influence of bundled FPIs in reducing the number of falls (NOF) …

Increasing Staff Knowledge On Obesity In Pediatric Patients With Asthma, Oluwakemi Taiwo

Walden Dissertations and Doctoral Studies

Asthma is a chronic life-long lung disease that contributes to morbidity and mortality around the world. The increased prevalence of asthma, particularly in children who are obese, inadequate assessment of obesity in pediatric patients, and a gap in staff knowledge regarding the Centers for Disease Control and Prevention (CDC) body mass index (BMI) percentiles resulted in a need for strategies to minimize this health concern. The purpose of this staff education project was to increase staff’s knowledge about identifying asthma patients who are clinically obese using the CDC BMI percentiles. The framework for the project was based on Knowles’s adult …

Effectiveness Of A Standardized Fall Assessment Tool In Reducing Falls Among Elder Home Health Clients, Terica M. Woods

Walden Dissertations and Doctoral Studies

Because of the physiological changes that occur with the normal aging process, falls tend to have more serious consequences in individuals age 65 and older. The purpose of this systematic review of literature was to analyze studies that addressed the impact of a multifactorial fall risk assessment tool on decreasing falls in the elderly home health patient population following hospitalization. The conceptual model for this project was Roper, Logan, and Tierney’s activity of daily living model. A narrative analysis was used to analyze 16 selected articles from the CINAHL, ProQuest and MEDLINE databases. Results indicated that implementing fall assessment tools …

Registered Nurses’ Assessment Of Clinical Leadership Knowledge And Competence, Valerie D. Wright

Walden Dissertations and Doctoral Studies

As a prevalent component of the health care workforce, clinical nurse leaders play a vital role in reducing costs and promoting quality patient outcomes. The purpose of his project was to assess clinical leadership skill of nurses at a 160-bed rehabilitation hospital in a metropolitan city in the southeast United States. Guided by the Academy of Medical-Surgical Nurses model (AMSN), the practice-focused question explored the extent to which nurses perceived that they held clinical leadership knowledge and leadership competencies which impact positively on the nurse workforce and patient care. Thirty clinical registered nurses (RN) participated. According to the clinical leadership …

Evaluation Of Nurse-To-Nurse Handoff With The Use Of A Tablet, Maria Bessie Ziegenfuss

Walden Dissertations and Doctoral Studies

According to recent studies, many medical errors are caused by ineffective hand-off communication, which leads to patient harm and poor outcomes. Researchers have demonstrated that accurate and timely communication improves patient outcomes. The purpose of this quality improvement project was to evaluate the necessity, planning, implementation, outcomes, and transferability of the site quality improvement project, “Improving Nurse-to-Nurse Handoff With the Use of a Tablet.” The context/input/process/product model was used to provide a systematic approach to the evaluation of the site quality improvement project. A paired t test was used to analyze the pre- and post-survey results and demonstrated improvement in …

Staff Instruction On Patient Health Questionnaire And Collaborative Care Model In Primary Care, Jennifer Carton

Walden Dissertations and Doctoral Studies

The DNP project examined the effectiveness of the Patient Health Questionnaire-9 (PHQ-9) and the Collaborative Care Model (CCM) as a practice protocol for patients suffering from depression in primary care to address the problem of a shortage in mental health specialists. Research reveals an increase in Americans suffering from depression. Many primary care clinics do not have a practice protocol in place to screen and manage depression. The project's purpose was to develop a lesson plan to instruct staff on the PHQ-9 and CCM to implement into their practice. The project questions were if the lesson plan developed by the …

Best Practices For Screening And Early Treatment For Hiv In The Hispanic Community, Juliana Deboviel

Walden Dissertations and Doctoral Studies

The Hispanic community is among the ethnic minorities that are adversely affected by HIV/AIDS in the United States. HIV transmission rates and rates of death are high among Hispanic communities because of delays in HIV testing and late participation in HIV treatment, especially in the state where this study was conducted. However, advanced practices for screening and early treatment of HIV can improve patient outcomes and inform practice. Thus, this systematic review was conducted to identify the best available evidence for HIV screening and care in the Hispanic population in the Western United States that shares a border with Mexico. …

Educating Staff On The Benefits Of Vitamin D Therapy For Multiple Sclerosis, Cheniece Harris

Walden Dissertations and Doctoral Studies

Clinical competency is an important factor when delivering care to those with chronic conditions such as multiple sclerosis. Vitamin D therapy through diet, supplements, and sunlight may decrease physical complications. The gap in practice this doctoral project addressed is the lack of education provided to healthcare professionals to promote the benefits of vitamin D. The project examined whether registered nurses who are provided education on the benefits of vitamin D therapy can apply the knowledge into the plan of care for patients with MS within 6 months versus those provided no education. Paradigms and models that were used include the …

Promoting The Recognition Of Depression In The Geriatric Population, Rose L. Hodge

Walden Dissertations and Doctoral Studies

Depression is a chronic condition that has both physical and mental consequences, complicating the elderly’s health status and interfering with daily functioning. Depression is not a normal part of aging and the elderly frequently seek mental health care in outpatient clinical settings where there is need for effective screening and prompt recognition leading to decreased morbidity and mortality. It is critical for psychiatric care settings to provide the most effective screening tools for recognizing depression as quickly as possible. This Doctoral Nursing Project quality improvement (QI) evaluation project resulted from observation of lack of a tool for recognizing depression in …

Nurse Directed Palliative Care Discussions In The Emergency Department, Shannon Lorince Landefeld

Walden Dissertations and Doctoral Studies

Emergency department (ED) nurses are in a unique position to discuss with patients who have life-limiting illnesses. However, due to lack of training, ED nurses are often reluctant to have these conversations. Although ED patients receive written information about advanced directives, there is a gap in practice with discussing palliative and end-of-life care, resulting in increased potential for patient isolation, inconsistencies in treatment modalities, and delayed opportunities for patient-centered goal setting. Therefore, the purpose of this project was to address what resources are available to guide evidence-based practice for ED nurses in a small inner city hospital to implement nurse-directed …