Nursing Commons^™

Systematic Review: Barriers To Primary Care For The Transgender Individual, Charles David Mccormick

Walden Dissertations and Doctoral Studies

Representing a diverse group, the transgender community defies conventional norms expected by society resulting in discrimination and denial of essential goods and services necessary to maintain personal health, safety, and well being. The identification of the barriers to primary care faced by the transgender individual has the potential to reduce healthcare disparities and improve the compliance with national screening and treatment guidelines. The purpose of this project was to examine available literature incorporating the systematic review method to determine the barriers to primary care faced by the transgender individual. Using Leininger’s transcultural nursing theory to guide the process to determine …

Staff Education On Heart Failure Guidelines And Self-Care Management Practices, Mary Mitcheltree

Walden Dissertations and Doctoral Studies

Heart disease is the leading cause of death in the United States with heart failure (HF) being one of the more prevalent diseases associated with heart disease. HF is reported to have a high mortality rate and presents an economic burden to the U.S. healthcare system. To improve patient outcomes and reduce the costs of treatment for HF-related symptoms, infusion nurses need adequate education and training. The purpose of this project was to train home infusion nurses on self-care management practices based on current HF guidelines. The Donabedian model, known for quality assurance, provided the framework to support the educational …

Development And Validation Of A Sepsis Course For Burn Intensive Care Unit Nurses, Colleen Melisa Reid

Walden Dissertations and Doctoral Studies

Sepsis is the most common cause of death in burn patients. Optimal recovery from sepsis requires early recognition and prompt treatment. When sepsis is suspected or detected, the 2016 Surviving Sepsis Campaign guidelines endorse immediate initiation of the Hour-1 Sepsis Bundle. Unfortunately, a random audit of hospital system compliance with the Centers for Medicare and Medicaid Services sepsis core measure was less than 50%. A 2019 performance improvement project uncovered delays in antibiotic administration, and a search of scientific and burn center literature did not elucidate a course that educated burn intensive care nurses about sepsis. The purpose of this …

Promoting New Graduate Registered Nurse Retention Through A Staff Preceptorship Program, Sheba Saelee

Walden Dissertations and Doctoral Studies

The transition from classroom to the clinical setting is challenging for most new graduate nurses (NGRNs). They often report being unprepared and lack confidence in their skills. Preceptors play a significant role in the success of the NGRNs and overall quality of care provided on the floor. However, the training they are provided is lacking. Preceptors tend to view their role as a daunting task and an assigned burden. The purpose of this project was to implement a NGRN preceptor training program. The practice focused question explored if a preceptor education program in a long-term acute care hospital increased the …

Clinical Practice Guideline For Transitions Of Patients With Chronic Obstructive Pulmonary Disease, Thomas Stewart

Walden Dissertations and Doctoral Studies

Chronic obstructive pulmonary disease (COPD) is a public health challenge and a leading cause of readmissions in the United States. Research suggests that many patient readmissions could be prevented by using a multidisciplinary approach to develop quality, evidence-informed clinical practice guidelines. A retrospective review of the electronic health record by the project site’s quality committee revealed a lack of consistency in adhering to best practice recommendations, as evidenced by increased readmission rates. The purpose of this project was to develop a clinical practice guideline with input from a collaborative expert advisory committee for the discharge care of COPD patients. The …

Job Satisfaction, Engagement, And Motivation For Nursing Leadership Among Millennial Registered Nurses, Oluwaseyi Stover

Walden Dissertations and Doctoral Studies

There is a shortage of nursing leaders because current nursing leaders who are in the baby boomer generation are retiring. Millennial RNs are needed to fill vacant nursing leadership positions, but millennial RNs are not satisfied in their jobs and lack motivation and engagement, which impedes their interest in nursing leadership positions. The purposes of this quantitative, descriptive, correlational study, guided by King’s theory of goal attainment, were to examine the relationship between job satisfaction, motivation, engagement, and the aspiration of millennial RNs for nursing leadership positions in the acute care hospital setting, and the combined effects of job satisfaction, …

Optimizing The Use Of Antibiotics:Evaluation Of A Quality Improvement Project, Elaine Marie Summers

Walden Dissertations and Doctoral Studies

The overuse and inappropriate use of antibiotics for residents in long-term care facilities (LTCFs) is associated with significant unintended treatment harm with 50% to 70% of residents prescribed an antibiotic at least once in 12 months. The purpose of this project was to evaluate data from a quality improvement quality improvement initiative conducted at a 168-bed LTCF to implement a protocol of an antibiotic stewardship program (ASP) to reduce the overuse of antibiotics. The John Hopkins nursing evidence-based practice model guided this project to analyze health care provider compliance with implementation of protocol guidelines before and after the ASP program …

The Relationship Between Emotional Intelligence And Assessment Technology Institute Nclex- Rn Predictor Score, Debra Ann Wallace

Walden Dissertations and Doctoral Studies

The ability to pass a rigorous nursing curriculum and subsequently pass the National Council Licensing Examination for Registered Nurses (NCLEX-RN) exam is a requirement for nursing students to enter the nursing profession. Test anxiety may lead students to perform poorly on exams but emotional intelligence (EI) may buffer stress, improve communication, decrease anxiety, and improve nursing performance. The purpose of this descriptive, correlational study, guided by the EI theory, was to determine if there was a relationship among EI, the ATI -RN Comprehensive Predictor score, and first time pass rates on the NCLEX-RN among registered nurses who had graduated from …

Nurse Practitioner Approach To Care For Peripheral Vascular Disease, Jessica R. Wozniak

Walden Dissertations and Doctoral Studies

The Amputation Coalition indicates that there were approximately 2 million people with limb loss in the United States primarily caused by peripheral vascular disease in 2019. Those with amputation related to vascular disease have a 5-year mortality rate. The gap in clinical practice at the facility used for this project is that there were no comprehensive program guidelines for nurse practitioners and other health care professionals working with people who are at risk for vascular intervention or limb loss. The practice-focused question was answered that an interprofessional team did develop a prototype for a comprehensive peripheral vascular program that serves …

Registered Nurse Engagement And Patient Falls In The Acute Care Setting, Jenna Zaliauskas

Walden Dissertations and Doctoral Studies

Falls are a critical problem for inpatient medical-surgical adult patients. Past research has indicated a link between nurse disengagement and unsafe care. The purpose of this study was to improve the understanding of the relationship between nurse engagement and patient falls with injury on medical surgical units in health care facilities in the United States using the National Database of Nursing Quality Indicators. Retrospective data were reviewed from 13 U.S. hospitals in the Midwest covering Q1 (2018) and Q2 (2018) on medical-surgical units related to nurse engagement and patient falls. A correlational and MANOVA design was used to determine the …

Retail Pharmacy Clinic Antibiotic Stewardship Program And Guidelines, Abdulrahman Sudi Amiri

Walden Dissertations and Doctoral Studies

Overuse of antibiotics poses serious consequences for patient's well-being, including the risk for antibiotic resistance and adverse effects from inadequate and timely treatment. The emergence and frequency of multi-drug resistant bacteria are alarming global public health care experts, as these strains are resisting effective management of life-threatening infections. The gap in practice was that a retail pharmacy clinic did not have a practice guideline for the implementation of a wait-and-see prescription program as part of an antimicrobial stewardship program. The purpose of this project was to coordinate an interprofessional team to develop guidelines for this primary care setting. The practice-focused …

Recovering Illicit Substance Users' Perspective About Mandatory Drug Testing In Schools, Julie Bowser

Walden Dissertations and Doctoral Studies

The purpose of this exploratory qualitative study was to examine recovering substance

abusers' perceptions about the usefulness of mandatory drug testing in schools for adolescent substance abuse. Illegal substance abuse has reached epidemic proportions as more than half of U.S. adolescents, aged 12 to 17 years, have engaged in illicit drug use. Substance abuse information has been a part of school health education programs since the United States Drug Free Schools and Communities Act of 1986. Despite substance abuse education and school programs about the effects of drug use, many high school students abuse illicit drugs. Face-to-face interviews were conducted …

Experiences Of Postpartum Women With Nurse-Delivered Education And Postpartum, Krystal Evans

Walden Dissertations and Doctoral Studies

Postpartum depression affects many women globally, yet largely remains underdiagnosed. It is thus important for nurses to have all available tools when delivering education and care to the postpartum patient. Yet, there is a lack of information on the experiences of postpartum women related to postpartum education and postpartum depression. The purposes of this quantitative study, for which Beck's postpartum theory was the framework, were to explore postpartum women's perceptions of education experiences and to determine if a correlation exists between the satisfaction with education and scores on the Edinburgh Postnatal Depression Scale. Sixty study participants who were 6-8 weeks …

Introducing Exercise And Home Safety Check To Decrease Falls In Older Adults, Alie Theresa Massicot-Gray

Walden Dissertations and Doctoral Studies

The lack of education related to causes of, complications from, and interventions for falls is associated with the high rate of falls and fall-related injuries in older adults (OAs) beginning at age 65. The purpose of this project was to develop a fall prevention program that included components of the Stopping Elderly Accidents Deaths & Injuries Algorithm to increase fall prevention awareness and reduce falls in OAs at one community senior center. The project practice question asked whether introducing a fall prevention program that focused on exercise and home safety checks to educate OAs could decrease the rate of falls. …

Nurse-Driven Protocols In The Pediatric Emergency Department: A Systematic Review, Roberta Miller

Walden Dissertations and Doctoral Studies

Long wait times in emergency departments across the United States contribute to overcrowding, and adverse patient outcomes. Adult emergency departments use nurse-driven protocols to decrease time to treatment and wait times. However, nurse-driven protocols are not commonly used in the pediatric emergency department (ED). The purpose of this project was to evaluate and appraise current evidence to determine if nurse-driven protocols can be safely implemented to improve ED wait times, time to disposition, patient/family satisfaction, and patient outcomes in the pediatric emergency setting. The Iowa model of evidence-based practice (EBP) was used to guide the mixed methods systematic review. A …

Clinical Practice Guideline: Maintaining Skin Integrity In The Surgical Patient, Erin Renne Price

Walden Dissertations and Doctoral Studies

The purpose of this project was to develop clinical practice guidelines for intraoperative positioning that will help prevent deep tissue injury and skin breakdown. Maintaining skin integrity in the surgical patient by preventing deep tissue injuries and skin breakdown is an identified gap in practice for surgical patients in the Operating Room environment that a clinical practice guideline could positively impact. To assist in achieving the development of a clinical practice guideline to maintain skin integrity, Benner's novice to expert theory addressing the educational needs for novice operating room nurses was applied. The clinical practice guideline, based on evidence, should …

Compassion Satisfaction, Burnout, And Intent To Stay Among Nurse Leaders, Lisa Denile Surby

Walden Dissertations and Doctoral Studies

Nurses in leadership roles have a substantial influence on the quality of the work environment and on safety, quality, and patient outcomes. However, compassion satisfaction (CS) and burnout (BO) have historically been understudied, and evidence is lacking regarding the existence of a relationship between CS, BO, and intent to stay among nurse leaders. The purpose of this cross-sectional descriptive study, guided by Stamm's theory of CS and compassion fatigue (CF), was to determine if there was a relationship between CS and BO and intent to stay among nurse leaders. An anonymous online survey was conducted using the Professional Quality of …

Evaluation Of Telehealth Applications For Patients Seeking Hospice Care, Victoria Emma Surujlall

Walden Dissertations and Doctoral Studies

Telehealth (TH) is one of the newest avenues for improving accessibility and healthcare accommodations for patients with chronic health issues and terminal illness. The purpose of a quality improvement (QI) initiative at the project site was to align current evidence-based practice to address the disparities in the admissions process experienced by patients seeking hospice care from remote locations. The health belief model and Roger's diffusion of innovation theory were used to inform this doctor of nursing QI evaluation project to determine whether using a standardized evidence-based intake assessment process delivered by TH would increase accessibility for patients seeking hospice services. …

Self-Efficacy Of Registered Nurse Faculty To Facilitate A Flipped Classroom Pedagogy, Sharmeta L. Gibbon

Walden Dissertations and Doctoral Studies

Nurse educators struggle with developing innovative teaching strategies that improve learners’ critical thinking, sound clinical judgment, and ability to provide safe patient care. In the local setting, nurse educators relied on passive teaching strategies. The purpose of this study was to explore the perceptions of nursing faculty members concerning their self-efficacy with implementation of a flipped classroom. The conceptual framework was transformative learning theory. The research question explored how nurse educators described their self-efficacy with implementing student-centered, active teaching methods. Participants included 9 experienced nursing faculty members at the local setting from the Associate Science of Nursing program. Data were …

Clinical Practice Guideline: Maintaining Skin Integrity In The Surgical Patient, Erin Renne Price

Walden Dissertations and Doctoral Studies

The purpose of this project was to develop clinical practice guidelines for intraoperative positioning that will help prevent deep tissue injury and skin breakdown. Maintaining skin integrity in the surgical patient by preventing deep tissue injuries and skin breakdown is an identified gap in practice for surgical patients in the Operating Room environment that a clinical practice guideline could positively impact. To assist in achieving the development of a clinical practice guideline to maintain skin integrity, Benner’s novice to expert theory addressing the educational needs for novice operating room nurses was applied. The clinical practice guideline, based on evidence, should …

Nursing Students' Perceptions About Membership In Professional Organizations, Kimberly Ann Seaman

Walden Dissertations and Doctoral Studies

The importance of developing professionalism in the new nursing graduate has been discussed in the nursing literature and identified as a goal in the Future of Nursing competencies. However, the understanding of undergraduate nursing students'perceptions of membership in professional organizations is unknown. This study was conducted to better understand nursing students' views of membership. Social identity theory was used to explain how membership in a professional organization promotes exposure and adaptation of preferred professional behaviors. Novice-to-expert theory was selected to explain the maturation process of professionalism in the new graduate. Twelve nursing students enrolled in an undergraduate nursing program participated …

Coping And Support Strategies Portrayed In Rheumatoid Arthritis Illness Blogs, Folasade Bolanle Alagbada

Walden Dissertations and Doctoral Studies

The symptoms of rheumatoid arthritis (RA), such as pain, fatigue, stiffness, and inflammation, limit individuals’ abilities to care for themselves, participate in social events, and complete tasks associated with gender norms. RA is a chronic and debilitating disease that people struggle to cope with physically, mentally, emotionally, socially, and financially, but many have not established effective coping and support strategies. The purpose of this hermeneutic phenomenological qualitative study guided by a combination of Orem’s theory of self-care and Watson’s theory of the human caring was to explore the coping mechanisms and support strategies of women and men with RA as …

Student Nurse Perceptions Of Horizontal Violence During Clinical Hospital Rotations, Phoebe Marie Burda

Walden Dissertations and Doctoral Studies

The nursing profession is facing its largest professional nurse deficit in history. With nursing schools unable to produce enough new nurses to replace the number of nurses retiring, it becomes increasingly important to retain as many nurses as possible within the profession. Nursing research literature has reported that up to 60% of newly registered nurses will leave their first job within their first year of practice citing horizontal violence as a contributing factor. The literature does not address if or how early student nurses might perceive exposure to horizontal violence. The purpose of this qualitative, interpretive, phenomenological study was to …

Therapeutic Communication Skills For Nurses Working With People Living With Hiv, Charaine Ferguson

Walden Dissertations and Doctoral Studies

Internalized stigma experienced by people living with HIV (PLWH) has been associated with numerous untoward health outcomes. Nurses' and healthcare professionals’ ability to effectively communicate can significantly affect the experience of stigma in PLWH. The practice-focused question was whether an interactive educational project could improve the knowledge and intent to use collective communication skills in nurses. This project uses concepts from Peplau's interpersonal relationship theory, principles of therapeutic communication, and unconscious bias. Online training content included patient testimonials related to stigma, discussions of unconscious bias by the Institute for Healthcare Improvement and Mayo Clinic professionals, review of Harvard University’s Implicit …

Providing Evidence-Based Education About Caring For Patients With Atrial Fibrillation, Rose M. Happy

Walden Dissertations and Doctoral Studies

Abstract In a multidisciplinary health care team, nurses are often the initial contact when patients present for clinical evaluation. Thus, it is of great importance that these nurses provide education to patients that is current and evidence-based. The target population of this project was nurses who care for patients with atrial fibrillation (A-Fib). The practice problem was the knowledge gap related to A-Fib. The purpose of the project was to provide an evidence-based, nursing education intervention to increase their knowledge. The practice-focused question sought to determine whether participation in the evidence-based education intervention increased nurses’ knowledge scores about providing care …

Exploring Staff Nurse Interactions In Their Role As Student Nurse Educators, Jennifer Nafarrete

Walden Dissertations and Doctoral Studies

The majority of nurse education occurs in academic settings, but up to 40% can occur in hospital settings. Nurse education programs rely on the staff nurses who work in the hospitals to serve as student nurse educators and fulfill the clinical education requirement of their academic programs. The problem for this study is that staff nurses in their role as student nurse educators often have negative interactions with student nurses that do not promote learning in the clinical setting. The purpose of this qualitative study was to better understand how student nurse educator interactions with student nurses are positively influenced …

Implementing A Cauti Bundle In The Adult Hospitalized Trauma Population, Sabrina Marcella Braun

Walden Dissertations and Doctoral Studies

The use of an indwelling catheter is a common occurrence in the hospital setting. Careful evaluation of the initial indication for catheterization and need for continued catheterization is necessary to mitigate the complications of catheter insertion, which includes urinary tract infection. Catheter associated urinary tract infections (CAUTI) are the most common healthcare-associated infection in the United States, with > 30% of these infections reported. More than 560,000 hospital acquired urinary tract infections occur annually. CAUTI and its complications increase morbidity and mortality, hospital length of stay, readmission rates, cost, and the use of antimicrobial medication. CAUTI was identified as an outlier …

Increasing Compliance Of Chlorhexidine Wipes To Prevent Hospital-Acquired Infections, Kelly Jean Dunn

Walden Dissertations and Doctoral Studies

AbstractHealthcare-acquired infections (HAIs) are complications of healthcare linked to increased mortality, morbidity, and length of stay. Assiduous surveillance and constant reeducation can decrease HAI incidence and reduce the healthcare burden caused by these events. Evidence has demonstrated that using 2% chlorhexidine wipes instead of bathing with soap and water greatly reduces the bacteria on the skin and prevents infections such as catheter-associated urinary tract infections and central line-associated bloodstream infections. The practice-focused question for this quality assurance doctoral project was to evaluate if an educational intervention improved compliance of chlorhexidine wipe use among ICU nurses with the hope of improving …

Family Functioning During Deployment And Reintegration Of Military Members, Heather Graham

Walden Dissertations and Doctoral Studies

Military members and their families face unique stressors related to separation and reintegration. These life-changing events can lead to domestic violence, divorce, depression, suicide, and behavioral problems within the family. It was unknown whether the implementation of a nursing clinical practice guideline (CPG) would help nurses to identify family functioning concerns or psychosocial issues enabling earlier interventions. The purpose of this doctoral project was to create a CPG that can be used at military treatment facilities (MTFs) to screen military members and their families to identify family functioning concerns so that the provider can make referrals as needed. The circumplex …

The Lived Experiences Of Clinical Nursing Faculty With Student Performance Anxiety, Heather Lapoint

Walden Dissertations and Doctoral Studies

The nursing shortage in the United States has led to a call for nursing education reform. Current clinical educational methods precipitate nursing student performance anxiety (PA). PA can inhibit the clinical judgment, reasoning, critical thinking, and the adaptability required for advancing healthcare initiatives and reducing the nursing shortage. PA has not been defined nor addressed in undergraduate nursing education. The purpose of this descriptive phenomenological study was to explore the lived experiences of associate degree (AD) nursing program faculty in addressing student PA as it occurs in the clinical setting. Specifically, how faculty define PA and recognize, address, and assess …