Nursing Commons^™

Barriers To Physical Activity Among Asian Indian Women In The United States, Anjana Mathews

Walden Dissertations and Doctoral Studies

Asian Indian women have a higher prevalence of cardio-metabolic diseases compared to women from other ethnicities and Asian Indian men in the United States. This is due to the lower level of physical activity behaviors among this population. The purpose of this study was to explore the perceived barriers to physical activity among Asian Indian women living in the United States. The theoretical framework that guided this study was Bandura’s social cognitive theory and the research design used was qualitative ethnographic approach. Participants were recruited from 2 Christian churches in Southern California using purposive and snowballing sampling strategies. Fifteen participants …

Personality, Job Satisfaction, And Turnover In Long-Term Care Nursing Assistants, Sarah Elizabeth Shanks

Walden Dissertations and Doctoral Studies

There is a clear association between nursing assistant (NA) turnover and resident outcomes which may be caused by poor compensation, organizational culture, and staffing mix. However, very limited literature is available exploring intrinsic variables of NAs, specifically personality, leading to turnover. Guided by the five-factor personality theory and Herzberg’s two-factor motivation hygiene theory, the purpose of this quantitative study was to examine the relationship between the five-factor personality traits of open-mindedness, conscientiousness, agreeableness, extraversion, and neuroticism; length of employment; and job satisfaction among NAs working in long-term care. The Nursing Home Certified Nursing Assistant Job Satisfaction Questionnaire was used to …

Revisions Of A Clinical Practice Guideline For Diabetes Management Protocol, Daniel O. Huston

Walden Dissertations and Doctoral Studies

Management of type 2 diabetes mellitus (T2DM) is essential from cost and treatment perspectives. In 2017, costs associated with diabetes management in the United States amounted to approximately $327 billion. The treatment of T2DM has been in a dynamic state for the past several years with the arrival of new classes of medications and new data supporting the use of diabetes medications to reduce risks from cardiovascular disease and slow the decline of renal function. This project explored the current evidence on treatment of T2DM to support changing either the flow of the current protocol algorithm or the medications identified …

Perceptions Of Nurses’ Abilities To Provide Safe Care In Unhealthy Work Environments, Jacqueline Flannery

Walden Dissertations and Doctoral Studies

As many as 90% of nurses report working in an environment where their peers engage in passively and overtly violent activities against other nurses. Working in such an environment is unhealthy and has consequences for the career trajectory of nursing. There is a lack of literature available that specifically addresses nurses’ perceptions of their abilities to provide safe patient care in unhealthy work environments. The purpose of this phenomenological study was to explore the lived experiences of nurses who have experienced lateral violence and their perceptions of their ability to provide safe care. Husserl’s philosophy of phenomenology was used as …

The Differences In Nurse Preceptor Role-Frequency And Overall Job Satisfaction, Wendy Fordham

Walden Dissertations and Doctoral Studies

For newly licensed registered nurses (NLRNs), a nurse preceptor is an essential resource in a successful transition-to-practice from a nursing education program. Serving in the preceptor role is often performed in addition to a nurse’s primary patient care responsibilities. There is a gap in knowledge about the frequency with which a nurse performs this role and how that frequency affects overall job satisfaction. Using Herzberg’s motivator-hygiene theory as a framework, the purpose of this descriptive, cross‐sectional, comparative study was to examine how frequently nurses serve as preceptors to NLRNs in the hospital inpatient setting and whether the frequency affects their …

Evidence-Based End-Of-Life Care Education For Intensive Care Nurses, Kimberly Ann Hare

Walden Dissertations and Doctoral Studies

Most nurses have limited education on end-of-life care (EoLC), which can affect their ability to provide care to meet the needs of the dying patient. Nurses in a critical care unit in a hospital in the Southeastern United States lacked education on EoLC for their patients. The purpose of this study was to develop a project guided by Kolcaba’s theory on caring. The staff education project addressed the attitudes and knowledge of 36 nurses before and after an educational presentation on EoLC. Data were analyzed descriptively. Results indicated that 56% of the staff nurses had never received prior education on …

Relationship Between Skepticism And Nursing Experiences When Treating Chronic Noncancer Pain Patients, Emily Jabour

Walden Dissertations and Doctoral Studies

Chronic pain is common, costly, challenging to manage, and affects patients’ quality of life. High confidence is placed in the nurses caring these patients. Nurses displaying skepticism or doubt about patients’ motives for seeking pain treatment contribute to the challenges of effective pain management. The purpose of this quantitative study was to determine if there was a relationship among the nurses’ professional skepticism, level of compassion, and years of experience during the treatment of chronic noncancer pain patients in the acute care setting. The communications model of pain guided the understanding of factors influencing nursing treatment of this patient population. …

The Promotion Of Safety And Quality In Fall Prevention, Sheila J. Mercado

Walden Dissertations and Doctoral Studies

Falls in a hospital setting are considered one of the most frequent, preventable adverse events that need to be addressed through the creation of safer environments. Nurses play a key element in the prevention and management of injuries related to falls. The focus question for this quality improvement initiative (QII) was whether an evidence-based QII program could reduce falls in the inpatient population. The objective of the project was to improve the practices related to fall prevention to reduce the number of inpatients falls. The change model of Kotter and the Preventing Falls in Hospitals: A Toolkit for Improving Quality …

Clinical Nurse Experts' Experience Of Transitioning To The Novice Nurse Educator Role, Crystal Toll

Walden Dissertations and Doctoral Studies

Clinical nurse experts are often recruited into educator roles based solely on clinical expertise. Without support and mentorship, clinical nurse experts struggled with transitioning into the educator role. The purpose of this study was to understand the experience of new nurse educators’ transition from a clinical nurse expert to novice nurse educator and to examine the perceptions of supports and barriers. Transitional theory provided the conceptual framework and informed the development of the interview protocol. The research questions focused on the experience of transitioning from expert to novice and on identifying supports and barriers that influenced transition. Using a case …

Nutritional Assessment Of Patients In The Intensive Care Unit, Jennifer Maureen Brown

Walden Dissertations and Doctoral Studies

Impaired nutrition is associated with prolonged hospitalization, poor patient outcomes, high mortality, and increased health costs. Nutritional assessment in intensive care unit (ICU) patients is important in recognition of changes in the patient’s nutritional status from admission to discharge and may promote early nutritional interventions by the health providers to prevent complications of poor nutrition. The purpose of this staff education doctoral project was to assess ICU nurses’ knowledge of nutritional assessment for critically-ill patients and to provide education on an assessment tool for patient nutritional assessment- the malnutrition universal screening tool (MUST). The guidelines from the American Society for …

Educational Program For Decreasing Catheter-Associated Urinary Tract Infections, Josephine Crentsil

Walden Dissertations and Doctoral Studies

Catheter-associated urinary tract infection (CAUTI) is the most common hospital-acquired illness. Insertion and maintenance of urinary catheters are critical factors that predispose patients to CAUTI. Studies have shown that many nurses have a knowledge deficit regarding evidence-based practices in the insertion and management of urinary catheters, which can help prevent CAUTI. This is a concern because nurses are typically the first point of contact with patients and are responsible for the promotion of evidence-based practice and preventative measures. Therefore, this project aimed to develop an educational intervention for nurses with a focus on proper insertion and maintenance of indwelling urinary …

Improving Glycemic Control For Post-Orthopedic Surgery Patients With Type 2 Diabetes, Allison Dale

Walden Dissertations and Doctoral Studies

Type 2 diabetes is a growing problem within the United States and a leading cause of mortality. The complications and comorbidities associated with type 2 diabetes cause a great financial and resource burden on the healthcare system, and cause negative mental and physical health outcomes for the individual living with it. The complications of poor glycemic control are especially notable following a surgical procedure that requires an inpatient stay. The practice problem for this project is glycemic control following an orthopedic surgery requiring hospitalization. To further analyze the practice problem and to create a clinical practice guideline a robust literature …

Motivating Factors For Nurses Aged 65 Years And Older To Extend Their Work Life, Dr. Cynthia M. Dobek

Walden Dissertations and Doctoral Studies

Nurses age 65 years and older who retire will leave a knowledge gap in the workforce unless motivated to continue working. A knowledge gap in the workforce is of concern to human resource professionals because healthcare professionals may not be able to keep pace with the increase in patients needing medical care. Grounded in Maslow’s hierarchy of needs theory, the purpose of this qualitative single case study was to explore what factors motivated nurses aged 65 years and older to extend their work life. The participants comprised 6 nurses aged 65 years and older who were still working or semiretired …

Moderate-Intensity Risk Reduction Counseling And Acquisition Of Sexually Transmitted Infection, Cindy M. Farina

Walden Dissertations and Doctoral Studies

Sexually transmitted infections (STIs) are a public health problem in the United States, with adolescents and young adults to age 25 bearing a disproportionate burden of infection. Risk reduction counseling (RRC) as a strategy to decrease STI incidence has been a focus of scholars. Research examining RRC efficacy has suggested that RRC is effective for 6 to 12 months after treatment. However, study samples have varied by age, ethnicity, race, gender, and geographic location. Whether RRC is effective for more than 1 year is unknown. The purpose of this post hoc chi-square study was to examine the efficacy of moderate-intensity …

Incivility Among Nurses, The Influence Of Structural Empowerment: A Systematic Review, Jennifer Gardner

Walden Dissertations and Doctoral Studies

Workplace nurse-on-nurse bullying is a well-known phenomenon in health care organizations at both national and global levels. Healthcare organizations struggle to find effective solutions to help nurses to mitigate bullying and incivility and create safer work environments. The purpose of this systematic literature review doctoral project was to critically appraise the literature to find the best research evidence to show that higher levels of structural empowerment lead to lower levels of incivility and increase nurses’ ability to create safer and more positive work environments. Kanter’s theory of structural empowerment served as the theoretical framework for this review. The evidence-based question …

Perceptions Of Clinical Adjunct Instructor Preparedness In Nurse Education, Melissa Ann Harvey

Walden Dissertations and Doctoral Studies

This project study addressed the perceptions of novice adjunct clinical instructors as they transition from clinician to novice educator within an associate degree nursing program in Ohio. Lack of formal training in educational preparation has caused the disorientation of effective supervisory practices in the clinical setting and prevents the optimal transfer of knowledge from educators to nursing students. Mezirow’s transformative adult learning theory and Schoening’s nurse educator transition model were the two conceptual frameworks that guided this study. A qualitative exploratory research design was used to study the role transition process and perceptions of supervision, challenges, and strategies or support. …

Clinical Practice Patient Education Guideline For Elective Induction Of Labor, Allison Keleske

Walden Dissertations and Doctoral Studies

In 2018, the state of Florida had a cesarean section birth rate of 38.3% which was the 3rd highest in the nation with the national average being 31.9%. Elective induction of labor (EIOL) involves the initiation of labor for convenience and not because of medical necessity. EIOL carries risks for the mother and fetus, including an unplanned cesarean section. The problem identified in this project was the lack of informed decision-making by pregnant women related to risks, benefits, and management of EIOL. Using the Informed Decision-Making through Engagement Model, the purpose of the project was to develop an evidence-based clinical …

Evidence-Based Colorectal Cancer Screening Staff Education, Chantal Navalah

Walden Dissertations and Doctoral Studies

Colorectal Cancer (CRC) is the leading cause of cancer-related death, although it is considered preventable with adequate routine screening. Despite the decline in prevalence and mortality of CRC in the United States, the African American population persist in having the highest rates of death and shortest survival for CRC. This doctoral project focused on the gastrointestinal (G.I.) staff knowledge gap about the importance of CRC screening to achieve better patient outcomes. The purpose of this project was to address the knowledge gap among the G.I staff as it relates to CRC screening. The health belief model served as a guide …

Using Patient-Staff Ratio To Improve Patient Care Outcomes, Fadekemisola Oludayo Timothy

Walden Dissertations and Doctoral Studies

The persistence of nurse scarcity has been documented by many researchers as the leading problem in the critical care setting. A high nurse to patient ratio leads to poor healthcare outcomes associated with increased nurse burn out, medical errors, and low-quality care services. Solving the issue of nurse scarcity is still a challenge due to lack of an effective multidimensional staffing model. In this project, a multidimensional staffing model was developed based on the relationship between patient-to-staff ratio, together with and other factors in the care environment which impacts patient outcome. The project was framed on Donabedian's structure, process, and …

Systematic Review Of Family Nurse Practitioner Utilization Within School Environments, Luz Elena Zapien

Walden Dissertations and Doctoral Studies

The American Academy of Pediatrics and the Institute of Medicine recommend school health screening programs to detect problems that might interfere with a student’s education and general well-being, and many U.S. states require compliance with enrollment requirements such as updated immunizations and physical exams prior to attendance. In low-income areas, however, there is often a shortage of physicians available to meet the healthcare needs of the population. Family nurse practitioners (FNPs) can be utilized in school health settings to deliver health care services that support school attendance and the well-being of school students, yet little is known about their impact. …

Nursing Home Caregivers’ Knowledge Of Decubitus Ulcer Prevention Strategies, Shola Akinfiresoye

Walden Dissertations and Doctoral Studies

Decubitus ulcers (DUs) were a constant concern among the residents of the nursing home in this project. Prolonged immobility, sensory impairment, and urinary incontinence are some of the factors found in the literature as the causes of the disease. However, the lack of useful knowledge regarding evidence-based practices (EBPs) to prevent and treat DUs also contributed to the higher incidence rates at the nursing home. The purpose of this DNP- project was to evaluate the caregivers’ knowledge of EBPs to prevent and treat DUs at the facility. The IOWA Model of Evidence-Based Practice, which healthcare practitioners use to guide clinical …

Health Care Providers’ Use Of Nudging With Families Of Older Patients Making Discharge Decisions, Tabatha Bowers

Walden Dissertations and Doctoral Studies

The health care system has focused on reducing costs associated with longer lengths of

stay while facilitating safe and appropriate discharges. The purpose of this educational

project was to increase awareness among health care providers regarding nudging and

how it influences discharge planning decisions by patients and families. Enhancing health

care providers’ understanding of the impact of discharge communication may address the

issue of alternate level of care (ALC). Transition theory was used to frame the project.

Practice-focused questions addressed how the use of evidence-based case studies about

nudging could improve discharge planning for patients in a large community hospital …

A Staff Educational Model For Prevention Of Type 2 Diabetes In The Primary Care Setting, Mieshia Staples Clark

Walden Dissertations and Doctoral Studies

Type 2 diabetes is a chronic, debilitating disease affecting millions of Americans. Though preventable, it is the most common form of diabetes in the United States, costing the U.S. health care system billions of dollars annually. Lifestyle modifications taught, encouraged, and supported in established, evidence-based diabetes prevention programs (DPP) are proven to be more effective than medications alone in preventing Type 2 diabetes. While DPPs are cost-effective and can reduce or delay the incidence of Type 2 diabetes, they are greatly underutilized due to primary care providers’lack of knowledge about the benefits and availability of these programs and also due …

Nurse Educator Perceptions Of Using Simulation For Evaluation Of Nursing Competencies, Angela Elizabeth Horton

Walden Dissertations and Doctoral Studies

Over the past 10 years, simulation technology has been increasingly used in clinical settings to evaluate nursing competencies and ensure safe patient care. However, not all simulation laboratories are used consistently by hospital nursing education departments to support learning. The purpose of this qualitative case study, framed by constructivist theory, was to identify nurse educators’ perceptions of the value of using simulation to evaluate nurse competence. Research questions addressed how nurse educators decided what teaching methods to use when evaluating nursing competencies. The participant sample included 8 nurse educators responsible for the education of new and practicing nurses in the …

Improving Care Of Patients With Asthma Through Staff Education, Nicholas Moscatelli

Walden Dissertations and Doctoral Studies

Chronic asthma is a health epidemic and an increasing problem in the pediatric population. The purpose of this project was to raise nursing staff awareness of symptom recognition, treatment protocols, preventive measures, and detrimental effects of asthma for children. Adult learning theory provided the framework to support the staff education program on asthma. The project site stakeholders and the DNP student identified educational opportunities to assist staff in meeting caregiver needs, improving symptom recognition, and improving asthma outcomes. Prior to presentation of the educational program to the clinic nursing staff, it was reviewed by an expert panel including the clinic …

Fall-Related Patient Education: An Essential Feature Of A Fall Prevention Program, Immaculata Okonkwo

Walden Dissertations and Doctoral Studies

This project documented the evaluation of a voluntary patient falls prevention education

program (VPFPEP) of a rehabilitative facility in a Mid-Atlantic US state and ascertained

its sustainability. The project was designed using the customized Moore et al. evaluation

model and Lippitt’s planned theory of change to encourage patient engagement in

physical activity (PA) through fall prevention education to allay patients’ fear of falling.

The sample included patients who opted into the facility’s VPFPEP. Evaluation was

performed using run charts to visually and quantitatively monitor trends and patterns of

fall incidents over time. Run charts also facilitated comparison of injuries sustained …

The Impact Of Faculty Bullying On Associate Degree Nursing Students, Angela M. Vitale

Walden Dissertations and Doctoral Studies

Bullying is prevalent in the profession of nursing, impacting the quality of health care and health care costs. The foundation of bullying, in the profession of nursing, may be attributed to bullying behaviors in nursing academia among nursing faculty and nursing students. Using Bandura’s social learning theory, the purpose of this study was to determine the relationship between bullying behaviors of nursing faculty and bullying behaviors of nursing students in associate degree nursing programs. Seventy-one randomly selected registered nurses who graduated from associate degree nursing programs in the past 5 years completed an online Incivility in Nursing Education-Revised survey. Spearman’s …

Faculty Evaluation Of Underperforming Nursing Students In Clinical Settings, Melody Lynn Bethards

Walden Dissertations and Doctoral Studies

Difficulty in evaluating underperforming nursing students in clinical settings is a problem for many nursing programs. The subjective nature of evaluations and faculty reluctance to provide negative evaluations have implications for subsequent patient care. A descriptive single case study research design was used to explore the experiences of clinical faculty evaluating underperforming nursing students in clinical settings at a U.S. Midwest community college. Gagné's learning outcomes and the National League for Nursing (NLN) Clinical Nurse Educator Core Competency: Implements Effective Clinical Assessment and Evaluation Strategies provided the conceptual framework for the study. The research questions focused on how nursing faculty …

Prevention Of Care Of Catheter-Associated Infections In Long Term Care, Maureen Edozie

Walden Dissertations and Doctoral Studies

The incidence of catheter-associated urinary tract infections (CAUTI) in long-term care settings ranges from 1.5 to 3.3 per 1,000 catheter days for adult. Over 380,000 nursing home residents are hospitalized due to infections each year. Staff education using Agency for Healthcare Research and Quality (AHRQ) practice guidelines showed knowledge gained. The use of an evidence-based practice guideline developed AHRQ has been shown to significantly reduce the rate of CAUTI in the long-term care residents. The clinical practice problem was a CAUTI rate higher than the national average in the long-term care facility of interest due, in part to inconsistent nursing …

Group Education Program To Increase Obesity Knowledge In Cardiac Care Nurses, Ethel Emenogu

Walden Dissertations and Doctoral Studies

Obesity increases the severity of cardiac disease, leading to increased mortality and morbidity. The need to address obesity is critical in reducing obesity-associated complications such as heart failure, strokes, heart attacks, and even death. Obesity is also a risk factor for many chronic diseases such as heart disease, cancer, diabetes, hypertension, and depression. Evidence has shown that obese individuals with cardiac disease are at increased risk of developing complications. The practice-focused question for this doctoral project asked whether a group educational program could increase obesity knowledge among cardiac care clinic nurses. The purpose of this DNP project was to provide …