Nursing Commons^™

Program To Prevent Subsequent Fragility Fractures, Kathleen Jean Forti-Gallant

Walden Dissertations and Doctoral Studies

One out of 2 women and 1 out of 5 men over age 50 will sustain a fragility fracture (FF) in their lifetime. The risk of a 2nd FF increases dramatically after the 1st fracture and can lead to pain, disability, and mortality. Despite the evidence that secondary prevention programs are effective, the local facility did not have a formal mechanism to address this need. The purpose of this project was to design a program for secondary prevention of FFs and to address the need for a program for secondary FF prevention that was sustainable locally. The program was designed …

Colorectal Cancer Awareness And Screening Guideline For African American Populations, Keyna Omenukor

Walden Dissertations and Doctoral Studies

Colorectal cancer is the 3rd leading cause of cancer-related deaths. Early screening

provides the best prospects for preventing the morbidity and mortality associated with the

disease. Nurses have the duty to promote health and prevent diseases. However, low rates

of colorectal cancer screening continue to be reported, especially among African

Americans who continue to suffer disproportionately from the disease. There is a need for

a culturally-sensitive clinical practice guideline that nurses can use to educate patients

appropriately on colorectal cancer. The practice focused question for this project was

designed to explore whether a culturally-sensitive clinical practice guideline to increase

colorectal …

Postpartum Hemorrhage Evidenced-Based Registered Nurse Staff Education Project, Jessica Powell

Walden Dissertations and Doctoral Studies

Despite medical technology and research advances postpartum hemorrhages (PPH) continue to be a leading cause of morbidity and mortality for pregnant women, even in developed countries. One possible explanation for PPHs continuing to be a leading cause of maternal death is inconsistent recognition and timely treatment of women experiencing a PPH. This doctor of nursing practice project attempts to improve labor and delivery nurse knowledge through an educational intervention which will contribute to rapid identification and treatment of PPH. Knowledge change was demonstrated though change in pretest and posttest scores. The educational information and process was guided by adult learning …

A Practice Change In Adult Obesity Primary Care, Jasmine Tinsley

Walden Dissertations and Doctoral Studies

The rate of obesity in American adults has increased dramatically over the last decade. Obesity has reached epidemic proportions and demands attention to reverse the current trend. This project was developed to evaluate a quality improvement initiative implemented in 2016 to address the problem of obesity in a rural southeastern primary care clinic setting where underserved populations are treated. The quality improvement (QI) initiative was developed using the plan-do-act-check model and the evaluation of the initiative was the focus of the current project. The project question asked if a quality improvement initiative for weight loss monitoring and counseling could improve …

Association Between Work-Related Safety And Work-Related Injuries Among Home Health Care Providers, Sania Mohammed Saleh Abdulkhaleq

Walden Dissertations and Doctoral Studies

Home care nurses (HCNs) have reported a high rate of exposure to work-related injuries (WRIs). Nurses are challenged by the multidimensional problems associated with home care safety. These contextual risk factors increase the physical and social health problems of health care workers and of community suffering as a whole. This quantitative, cross-sectional study was designed to examine the relationship between the organization-related factors (ORFs) and the environment-related factors (ERFs) and their influences on safety behaviors (SBs) and the WRIs of HCNs. The PRECEDE framework was used to guide the study. Self-reported data were obtained from 74 home health care (HHC) …

Implementing A Smoking Cessation Educational Module For Clinical Staff Members Who Care For Mentally Ill Outpatients, Anthonia Okeani

Walden Dissertations and Doctoral Studies

In the United States, cigarette smoking is the main contributor to preventable death in all populations; and, among the mentally ill, the prevalence of smoking is a clinical practice concern. Nearly half of all smokers also have a diagnosis of mental illness compared with 23% of the general population. In an effort to reduce the problem of tobacco use within mentally ill populations, this project sought to create an educational module on smoking cessation for staff in a mental health clinic. The theory of planned behavior was used to guide the project that focused on implementation of a behavior change …

Hand Expression With Lactation Support: Effect On Self-Efficacy And Breastfeeding Duration, Florence Omekara

Walden Dissertations and Doctoral Studies

Breastfeeding is the best infant feeding method, and breastmilk has many immunological and anti-inflammatory properties that protect babies against illnesses and diseases. It protects the health of the mother and saves society substantial economic costs, as demonstrated in many studies. Studies show that if 90% of U.S mothers breastfed for 6 months, up to $13 billion in healthcare costs could be saved. Despite the health and economic benefits of breastfeeding, most women stop breastfeeding before 6 months postpartum, which falls short of the recommendations of the World Health Organization, U.S. Surgeon General, and American Academy of Pediatrics. This study explored …

Systematic Review Of The Literature On Why There Is Hospice Underutilization, Maria J Garcia

Walden Dissertations and Doctoral Studies

Despite hospice and palliative care services being available for patients at the end-of-life, it remains an easily accessible health care service which has been mostly underutilized and/or misunderstood. For this project, the practice problem was underutilization of hospice and palliative care services. A systematic review of the literature which focused on under usage of end-of-life care was conducted. MEDLINE, CINAHL, and ProQuest Nursing and Allied Source databases were searched (2005 to 2017). Studies that evaluated interventions for increasing hospice and palliative care services were selected. Conceptual variables included studies that addressed the under usage of end-of-life care. Kolcoba's comfort theory, …

Hardiness, Adult Attachment Style, And Burnout In Nurses, Kristy A. Negri

Walden Dissertations and Doctoral Studies

The current nursing shortage is a pressing crisis that is expected to worsen over time. A key reason nurses leave nursing is burnout. The purpose of this study was to investigate personality hardiness and adult attachment style in relation to the development of burnout in licensed professional nurses. Hardiness theory and attachment theory indicated that each provided protection against burnout, but no research has been conducted to examine both factors in relation to burnout in nurses. Research Question 1 asked if there was a relationship between attachment style and total hardiness score; Research Question 2 asked if there was a …

Transitional Care For The Cardiac Surgery Population: Development Of A Clinical Practice Guideline, Sheila Davies

Walden Dissertations and Doctoral Studies

Recovering from a cardiac surgery procedure and the transition to home can be an overwhelming experience for patients and caregivers. A tertiary care hospital's cardiothoracic surgery department suspended a nurse-practitioner-coordinated transitional care program in the 1st quarter of 2016. Following this decision, the readmission rate increased from its previous rate of 15.6% in quarter 1 to 20% in quarter 3. The purpose of this scholarly project was to develop a clinical practice guideline (CPG) that can bridge the gap in the transitional care process. The transitional care model informed the design of the project. A draft guideline was distributed to …

Development Of A Scholarly Educational Intervention To Improve Inpatient Diabetes Care, Sharon.Hasfal Hasfal

Walden Dissertations and Doctoral Studies

Advanced practice providers (APPs), consisting of nurse practitioners and physician assistants, face many challenges in the provision of evidence-based practice in their management of hospitalized adult patients with diabetes. Some of the barriers faced by APPs at a Northeast acute care facility are poor communication between disciplines, lack of confidence in initiating insulin, limited understanding of the management of insulin and the insulin pump, and insufficient treatment of the hospitalized patient with diabetes that aligns with current clinical guidelines for the management of inpatient hyperglycemia. This quality improvement project focused on the development of an evidence-based theory supported educational intervention …

Perceptions Of Stress: Employee Participation In A Yoga Class, Rosemarie Lee

Walden Dissertations and Doctoral Studies

Abstract

Employees experience workplace stress that can affect their health resulting in chronic diseases such as diabetes, stress, hypertension, and cardiovascular diseases. Stress also contributes to staff presentism, absenteeism, and high turnover rate. The employee wellness program (EWP) yoga class at a metropolitan teaching hospital has not been evaluated for its effectiveness in employee stress reduction and improvement in employee health. The practice focus question for this project explored employees' perception of the impact of a metropolitan teaching hospital's EWP yoga class on their stress reduction and health promotion activities. The theoretical framework for this project is Lazarus' transactional model …

Improvement In The Retention Of Graduate Nurses In A Long-Term Acute Care Hospital, Angie Lim Torres

Walden Dissertations and Doctoral Studies

The high turnover rate of graduate nurses is a challenge in the United States' hospitals because of high job dissatisfaction rates. The premature disaffiliation of the graduate nurses is costly for organizations and can significantly affect the quality and safety of patient care due to the inadequate supply of adequately prepared staff nurses, particularly in the long-term acute care hospitals. The purpose of the project was to decrease the turnover rate of graduate nurses in a long-term acute care setting from 40% to 20% through modification of the nurse residency program by applying an intervention based on Bauer and Erdogan's …

Improving Care Transitions In Patients With Heart Failure: An Integrative Literature Review, Heather Mae Mclain

Walden Dissertations and Doctoral Studies

Heart failure (HF) hospital readmission reductions are linked to nursing interventions that include scheduling a hospital follow-up appointment with the patient's health care provider within a week of discharge. Yet, patients often leave the hospital without an appointment scheduled. The focus of this integrative literature review was on analyzing data that associated follow-up within 7 days with reduced 30-day readmissions. A search of articles using CINAHL, MEDLINE, Cochrane Database of Systematic Reviews, and ProQuest databases resulted in 4,813 articles retrieved using the following search terms: heart failure, readmissions, follow-up appointments, and heart failure guidelines. Scholarly articles selected for inclusion were …

Effects Of Simulated Clinical Experiences On Empathy, Self-Confidence, And Satisfaction In Nursing Students, Dawn Riess

Walden Dissertations and Doctoral Studies

Empathetic communication enhances the nurse-patient relationship and improves patient outcomes and needs to be taught and evaluated during simulated clinical experiences. Experience in healthcare education has shown students' empathy levels decrease over time. The purpose of this quasi-experimental pretest posttest, study was to compare nursing students' empathy levels, self-confidence, and satisfaction with simulation between the use of the high-fidelity manikin simulator (HFMS) and a standardized patient (SP) used during their simulated clinical experience. Kolb's experiential learning theory was used to guide the study through the four phases specific to simulation and learning. Convenience sampling was used to recruit 135 nursing …

Discharge Calls And Avoiding Hospital Readmissions, Wanda Lee Cassavettes

Walden Dissertations and Doctoral Studies

Hospital readmissions are disruptive and costly for patients and hospitals. As hospital discharge instructions are a key nursing responsibility, this project implemented a nurse follow-up phone call intervention within 12-48 hours of patient discharge from an indigent care facility in the Great Lakes region of the United States. The project was designed to understand whether follow-up phone calls from nurses that clarified discharge instructions, symptom management, and medications would be associated with decreased readmission rates within 30 days post-discharge among chronic care patients. The theoretical framework was the health belief model, which proposes that the patient's knowledge of illness severity, …

Antibiotic Prescribing Habits Of Urgent Care Providers, Mellisa Thompson

Walden Dissertations and Doctoral Studies

Antibiotics are commonly prescribed and requested for viral illnesses despite evidence-based research studies and societal guidelines that advise against this practice. Literature has indicated that antibiotic decision-making comes from a provider's experience or exposure to illness, uncertainty of illness, or from being pressured by the patient. Nurses and advanced practice nurses are important participants in the antibiotic stewardship initiative. The purpose of this project was to examine potential knowledge deficits responsible for inappropriate antibiotic prescribing at a rural urgent care clinic in the southeastern United States, which when addressed could promote an educational in-service to decrease the number of antibiotics …

Improving The Care Of Patients With Urinary Catheters Through A Quality Improvement, Ashley Nicole Holmstrom

Walden Dissertations and Doctoral Studies

Catheter-associated urinary tract infections (CAUTI) significantly increases patient morbidity and mortality, length of stay, and organizational cost. In the 2 years prior to project implementation, the incidence of CAUTI increased by 15% in the local acute care, inpatient facility that served as the project site. Nursing leaders at the project site linked the increase in CAUTIs to a nursing knowledge deficit related to CAUTI prevention principles. The clinical question focused on the impact of CAUTI prevention staff training on the incidence of CAUTI, length of stay, and cost to the local acute care organization. After a review and critical appraisal …

Validating A Home Health Care Staff Educational Module For Wound Treatment And Documentation, Kimberly Sanders Hebert

Walden Dissertations and Doctoral Studies

Although guidelines and minimal standards for the care and documentation of wounds in home health care settings in the United States are available, there is a lack of compliance among many home health care agencies (HHAs) with regard to the accuracy of wound documentation and care of wounds. Failure to follow guidelines for wound care according to Centers for Medicare and Medicaid Services and Home Health Outcome and Assessment Information System standards could result in loss of revenue for HHAs, improper treatment of wounds, and legal ramifications. The purpose of this doctoral project was to develop and validate a staff …

Empowering Cultural Competency In Healthcare Providers, Betty Antoinette Dement

Walden Dissertations and Doctoral Studies

Racial and ethnic health disparities are highest in communities of color; providing culturally competent care could address these disparities. Culturally competent communication between the healthcare provider and the patient is an essential behavior that may improve health in racially and ethnically diverse women. A quality improvement project was completed with guidance from the 5 constructs of the Campinha-Bacote model as the conceptual framework, and the method used was the Consumer Assessment of Healthcare Providers and Systems survey. The perspective of 20 Mexican American and 20 African American women in El Paso, Texas between ages 45 and 72 with menopausal symptoms …

The Relationship Between Nurse Staffing And Quality Outcomes In Georgia Nursing Homes, Tamara Kathleen Stephens

Walden Dissertations and Doctoral Studies

The quality of care in United States' nursing homes has been of concern to consumers, government agencies, and researchers for several decades. Nurse staffing has been identified as a key factor influencing the quality of care in nursing homes. The purpose of this quantitative, correlational research was to determine if relationships existed between nurse staffing levels and three quality care outcomes in the state of Georgia. Donabedian's quality conceptual framework guided the study. The framework encompasses three interrelated dimensions of quality including structure, process, and outcomes. Nurse staffing levels and facility bed size represented the structure of nursing homes and …

Predicting The Nclex-Rn Pass Rate At An Associate Degree Nursing Program, Dawne Devoe Olbrych

Walden Dissertations and Doctoral Studies

The National Council Licensure Examination for Registered Nurses (NCLEX-RN) first-time pass rate for an associate degree in nursing (ADN) program was below the national mean, presenting a problem for graduates who failed the NCLEX-RN and could not enter the workforce as registered nurses. Knowles's assumptions of adult learning, Ebbinghaus's forgetting curve, and Zull's neuroscience research served as the theoretical frameworks for this study. The purpose of this study was to identify which academic and time-lapse variables predict the graduate's first-time passage for the NCLEX-RN. Archived academic records and NCLEX-RN results for all 786 graduates from one ADN program who took …

Improving Advanced Practice Nurses' Knowledge Of Cerebral Hemorrhage Assessment And Management, Kimberly Marie Lombardo

Walden Dissertations and Doctoral Studies

Cerebral hemorrhages are a type of stroke causing bleeding in the brain from a ruptured brain vessel or an aneurysm. In the emergency department (ED), advanced practice nurses (APNs') play a pivotal role in identifying cerebral hemorrhages. Many APNs' lack the skills necessary to assess, diagnose, and manage this type of stroke. A delay in diagnosis of cerebral hemorrhages carries a high risk of morbidity and mortality and can lead to lifelong disability or death. The framework of this project is the Patricia Benner theory of novice-to-expert, which is a 5-step approach designed to strengthen nursing skills with the goal …

Reducing Congestive Heart Failure Hospital Readmissions Through Discharge Planning, Lacy Rebaka Thomas

Walden Dissertations and Doctoral Studies

Every year, thousands of congestive heart failure (CHF) patients are readmitted to the hospital within 30 days of discharge. There is a gap in practice in the care continuum of patients with CHF within the transition from hospital to home. One of the factors known to increase a patient's risk for readmission is the lack of patient engagement and self-efficacy regarding the treatment plan. The purpose of this project was to implement a transition of care practice guideline that consisted of the use of a risk identification tool, a customized care plan for patients at high risk for readmission, and …

Intensive Care Unit Nurse Education To Reduce Sepsis Mortality Rates, Corina Meade

Walden Dissertations and Doctoral Studies

Sepsis causes major health care problems in the United States, resulting in long hospitalizations, complications, and even patient death. Lack of nursing knowledge regarding sepsis signs and symptoms is a significant problem at a hospital in the northeast. Local hospital data showed a high patient mortality rate for patients diagnosed with sepsis. The purpose of this project was to develop an educational module on sepsis for intensive care nurses. The educational module was developed using current sepsis evidence-based guidelines. The practice-focused question for the project asked whether an educational module on sepsis would increase the intensive care nurse's knowledge on …

Nurse Navigator Role Description And Processes For Best Outcomes Among At-Risk Patients, Judean Leroy

Walden Dissertations and Doctoral Studies

The nurse navigator role developed in the 1990s to support African American female oncology patients' access to services. Successful in oncology, the role has expanded to support patients with diabetes, heart failure, and chronic obstructive pulmonary disease. A unique cost-effective opportunity exists for nurse navigators to fill the gap in transitional care, between the acute care setting and home, for chronically ill and other at-risk patients who are often readmitted within 30 days for treatment of the same disease. The purpose of the project was to refine the job description of the nurse navigators in a Midwestern acute care hospital. …

Enhancing The Nurse Aide Student's Knowledge Of Evidence-Based Geriatric Care Practices, Vivienne Mcdaniel

Walden Dissertations and Doctoral Studies

Certified nurse aides provide approximately 65% of care to more than 1.4 million older adults residing in nursing homes who have been diagnosed with 1 or more chronic illnesses or debilitating conditions. Licensed nurses rely on nurse aides to report potentially harmful status changes in geriatric residents. Nurse aides often receive limited education and do not have a structured care process to guide them in their practice in the geriatric population. The purpose of this educational quality improvement project was to develop a geriatric-specific nurse aide care process to increase the knowledge of student nurse aides regarding processes to identify …

Developing An Impella Education Program For The Critical Care Registered Nurse, Sara Jackson

Walden Dissertations and Doctoral Studies

Every year, hundreds of thousands of patients have coronary angiograms performed in the United States. The Impella is a percutaneous ventricular support device that provides hemodynamic support for patients if hemodynamic instability occurs during the procedure. The critical care nurse is responsible for the recovery and management of the patient with the Impella device in place. The purpose of this scholarly project is to provide registered nurses (RN) who have not previously managed the Impella device with the appropriate education in order to demonstrate competency. The program demonstrated improved RN knowledge about the Impella and increased confidence when managing the …

Pilot Texas Red Cross Virtual Disaster Health Services Model-Case Study, Kathryn Elaine Weseman

Walden Dissertations and Doctoral Studies

The Red Cross traditional method of Disaster Health System (DHS) response is ' boots on the ground.' Texas, the 2nd largest state by population and land mass, has only 15 DHS volunteer nurses who were not able to meet the needs of disaster victims in Texas with the traditional response method. The Texas Red Cross DHS volunteer nurses began piloting a virtual DHS model in 2014. The research question was how Texas Red Cross nurses designed, developed, implemented, and evaluated the Texas Red Cross virtual DHS Model. The purpose of this case study was to provide this information in a …

Educating Oncology Nurses On The Benefits Of Patient Exercise, Roberta Anderson

Walden Dissertations and Doctoral Studies

Exercise benefits patients with cancer during and after treatments. A formalized educational program is lacking at the project's site for oncology nurses on the benefits of exercise for their patients during and after treatment. The purpose of the project was to address the identified gap in practice at the project's site by providing education to oncology nurses on the benefits of exercise for their patients during and after treatment. The ARCS model of motivational design was used as a theoretical foundation to develop and guide the educational program presented to the oncology nurses. The question addressed in the project was: …