Nursing Commons^™

Enhancing Urinary Catheter Skills Among Clinically Practicing Nurses, Arvella Derisa Battick

Walden Dissertations and Doctoral Studies

Catheter-associated urinary tract infections (CAUTIs) contribute to increased patient length of stay and health care costs. The literature has shown that one plausible cause of CAUTIs is improper Foley catheter insertion techniques among nurses. The purpose of this project was to answer the project-focused question that asked if there was a difference in nurses' practice skills following an educational intervention involving aseptic Foley insertion. Benner's novice-to-expert theory was the conceptual model for the study. Nurses from a college nursing program were asked to demonstrate Foley catheter insertion on a simulation model, and their technique was evaluated using a standardized checklist. …

Health Literacy As A Measure To Reduce Cost, Improve Health And Access, Vivian Dee

Walden Dissertations and Doctoral Studies

The United States dedicates greater than 17% of its gross national product to healthcare. This percentage is expected to go up to 20% by 2018. Despite the high cost of care, the health care system remains inefficient and ineffective. Barriers include reduced access to care related to low health literacy. Complicating low health literacy is the high readability score of patient education materials. The high readability score is in part due to tools that are not standardized and measure different aspects of education materials creating varying readability scores. The purpose of this quality improvement project was to adopt a tool, …

Educational Training Of Staff Nurses For Evidence-Based Practice, Tina June Theriaque

Walden Dissertations and Doctoral Studies

Translating research into practice takes 10 to 20 years or more. Evidence-based practice (EBP) integration remains at 10% to 20%, despite recommendations requiring EBP-guided decisions. Up to 30% decreases in health care system spending, improved quality outcomes, and increased staff satisfaction result from EBP integration. Nurse leaders, who rate quality and safety as the highest priority but EBP as the lowest, are accountable for EBP enculturation; a desire to support bedside registered nurses in EBP exists, yet this EBP use knowledge gap supersedes this goal. The purpose of this project was to provide an EBP education program introducing the use …

Coping With Sickle Cell Disease Using Cognitive Behavior Therapy, Helen Alexander

Walden Dissertations and Doctoral Studies

This project focused on identifying the best evidence available on the use of cognitive behavior therapy (CBT) for pediatric patients and families with sickle cell disease (SCD) to improve their coping skills with pain management. This resulted from an identified gap in nursing practice regarding psychosocial support for this subset of hospitalized pediatric patients. The practice-focused question was whether there was evidence in the literature on the use of CBT techniques to improve parental coping skills with children who have chronic and life-threatening illness that could be utilized with sickle cell disease. The theory of stress and coping guided the …

Perceptions Of Nursing As A Career By African American College Students Attending Historically Black Colleges And Universities, Brenda Marie Owens

Walden Dissertations and Doctoral Studies

Previous studies and official organizations have indicated that African Americans are underrepresented in the healthcare workforce and that patients belonging to minority groups feel they are treated slightly differently in healthcare settings. Limited research examines perceptions of the nursing profession among a variety of demographic groups, and exploratory investigations into the perceptions of nursing as a career by African Americans are limited. The purpose of this quantitative descriptive study was to explore perceptions of nursing as a career by African American students who attend an undergraduate program at a historically black college or university (HBCU) in an attempt to further …

Evaluating Nursing Pain Assessment Documentation With The Pediatric Client, Aziza Alexander

Walden Dissertations and Doctoral Studies

Pain is often seen as a primary complaint in the pediatric emergency department (ED). Assessment and documentation of pain are integral to effective pain management, and nurses are responsible for documenting pain assessment. Nursing documentation is essential for ensuring continuous, safe, high-quality care. Evidence shows nurses are inadequately documenting pain assessment and reassessment and not always using appropriate pain scales in a busy, cosmopolitan children's hospital ED. The practice-focused question that guided this project was: How does an educational module and change in electronic health record pain assessment flowsheet increase the nurses' compliance with initial documentation of pain? An educational …

Patient Navigation Program In Oncolgy Clinical Practice, Mercy George

Walden Dissertations and Doctoral Studies

Cancer diagnoses affect millions of people in the United States each year. Today, cancer patients face many challenges when trying to navigate the complex healthcare system. Patient navigation programs were developed to address and overcome barriers patients may face as they make their way through the healthcare system. The purpose of this project was to provide an analysis and discussion of the current published literature to provide evidence for improving care coordination and patient satisfaction in the oncology clinical setting with a patient navigator program. The practice-focused question for this project asked if a patient navigator program for adult cancer …

Implementation Of The Crafft Cannabis Screening Tool, Barbara Loeprich

Walden Dissertations and Doctoral Studies

Cannabis use among teenagers in Canada is a concern because of the long-term and irreversible effects cannabis has on the developing body and mind. Nurses can be instrumental in screening for cannabis abuse by implementing a tool to assess for substance use disorder (SUD) and triage drug users to appropriate treatment. This project focused on how to implement the CRAFFT screening tool while gaining insight of the practitioner's knowledge base about the tool and how SUD is being screened for, currently. The CRAFFT screening tool aligns with the DSM-IV's SUD diagnosis criteria, allowing for efficient identification of those at risk …

Incorporating Technology To Decrease Heart Failure Readmission Rates, Vernell Thames

Walden Dissertations and Doctoral Studies

The rate of hospital readmissions within 30 days of discharge of heart failure (HF) patients affects patient outcomes, the financial stability of the health care facility, and the economy. Hospitals focus on strategies that will decrease the HF readmission rates by cultivating evidence-based interventions that improve patients' transition from the hospital to the community, including promoting self-management of their condition. The purpose of this quality improvement project was to develop, implement, and evaluate the use of health information technology along with written forms of plans of care to assist HF patients in managing their care, divert the HF patients to …

Child Sexual Abuse And Prenatal Care: Understanding Screening, Modifications, And Proper Care, Wendy Abbott-Egnor

Walden Dissertations and Doctoral Studies

Research has shown that 1 in 9 women in prenatal care have a history of childhood sexual abuse. Pregnant women with a history of childhood sexual abuse are at increased risk of depression, somatization, preterm contractions, posttraumatic stress symptomology, and re-traumatization. The purpose of this study was to bridge the gap in literature between research and practice. Data was collected from practitioners regarding the care and treatment of pregnant women with a childhood sexual abuse history. It was hypothesized that screening practices and modification to care and treatment based on practitioner knowledge of prior sex abuse history will vary by …

Transition Of Care Guideline For Reducing Heart Failure Hospital Readmission, Geeti Farrahi

Walden Dissertations and Doctoral Studies

Heart failure (HF) patients are among the populations with the highest rates of hospital readmission within 30 days of discharge. Because of the 2010 Health Care Reform legislation, healthcare organizations are subject to financial penalty when a patient population exhibits excess readmissions. A significant reason for readmission of HF patients is a gap in the transition of care from hospital to home. The purpose of this doctoral project was to develop a practice guideline of best practices for transitioning HF patients from hospital to home. The transitional care model and care transitions intervention provided the theoretical underpinnings for developing this …

Predicting Certification Success For The Family Nurse Practitioner, Tammy Lee Gravel

Walden Dissertations and Doctoral Studies

High-stakes licensure or certification examinations are required for many health professions disciplines to ensure safe entry-level practice. Accrediting agencies set a benchmark for graduates' first-time licensure or certification success as a measure of program effectiveness. Failures of graduates on licensure or certification examinations may directly affect the school's recruitment and retention of qualified students and faculty, as well as institutional financial viability. A health science university has added Health Education System, Inc. (HESI) standardized examinations using computer adaptive testing into the family nurse practitioner (FNP) master's program to support certification success, although research on these advanced practice examinations as related …

Assessing Nurses' Safety Attitudes In Preventing Clabsi, Seraphine Ikwueme

Walden Dissertations and Doctoral Studies

Central line-associated bloodstream infection (CLABSI) has been widely studied because of its impact on patient morbidity, mortality, and overall health care costs. Research has shown that nurses' attitudes and perceptions regarding safety are critical to developing and maintaining clinical environments that are safe, prevent CLABSI, and assure better health outcomes. The practice-focused question for this project sought to determine the safety attitudes exhibited by registered nurses on a medical-surgical unit at the practice site. The Stetler model was used as a framework to guide the study. The Safety Attitude Questionnaire (SAQ) measured attitudes and perceptions regarding teamwork, safety, job satisfaction, …

Increasing Patients' Understanding Of Prescribed Medication Adherence, Valarie Finley Thomas

Walden Dissertations and Doctoral Studies

The cost of healthcare in the United States has increased due to growing numbers of patients who live with chronic health problems, such as heart disease. The cost of healthcare is compounded by the cost in terms of complications of cardiovascular disease secondary to medication non-adherence. Education about medication use and adherence, safety, and side effects was needed for patients in a cardiovascular unit to improve adherence to medications as prescribed. Results of a health care provider (HCP) and nursing staff needs assessment provided by the site showed the need for improved cardiovascular medication education. The project focused question asked …

Progression Of Clinical Self-Efficacy Among Baccalaureate Nursing Students, Christine Lee Hamilton

Walden Dissertations and Doctoral Studies

Clinical self-efficacy, or the confidence that nursing students have in their ability to successfully perform nursing clinical skills, is imperative for the safe and effective practice of nursing. A gap in knowledge exists about the change in clinical self-efficacy as baccalaureate nursing (BSN) students move through a nursing program, in which they learn and practice clinical skills in laboratory and clinical settings. Guided by Bandura's social cognitive theory, the purpose of this quantitative study was to determine the relationship between clinical experience within a nursing program and the reported clinical self-efficacy of BSN students in the sophomore, junior, and senior …

Evaluation Of The Bedside Swallow Screen, Ruby Ben

Walden Dissertations and Doctoral Studies

Dysphagia is a leading complication of a stroke. A nurse-driven bedside swallow screen can identify dysphagia and decrease the risk for complications such as aspiration pneumonia. At the project site, the use of the bedside swallow screen was at 33%; there was noncompliance with the use of the bedside swallow screen by the emergency department nurses. The purpose of the doctoral project was to increase the use of the bedside swallow screen. Published outcomes, research, and reports generated from archived data were the sources of evidence. The six sigma methodology was used to inform the quality improvement doctoral project. At …

Staff Education And Training For The Maternal Cardiac Arrest, Kimberly Sue Gililland

Walden Dissertations and Doctoral Studies

Maternal cardiac arrest is among the most frightening events that can happen on the labor and delivery unit. A maternal arrest can have catastrophic results. Staff must be vigilant, competent, and ready to handle the maternal arrest emergency at all times. A maternal cardiac arrest requires coordination among multiple disciplines and precise performance is paramount in saving not one life, but two. The purpose of the project was to establish a clinical training course for maternal arrest intended for education to improve staff knowledge during a maternal cardiac arrest. Evaluation of the knowledge and skills were through an exam, participation …

Early Recognition And Treatment Of Acquired Pneumonia, Michael Lamorgese

Walden Dissertations and Doctoral Studies

Sepsis is a life-threatening organ dysfunction disease process that costs the healthcare system millions of dollars each year. By using existing assets, the number of patients admitted to the hospital suffering from sepsis secondary to community-acquired pneumonia can be reduced. The purpose of this project was to improve and expand the scope of practice of the registered nurse working in a private medical office to initiate treatment for suspected CAP using evidence-based practice. Data from the last quarter of 2017 and the first quarter of 2018 were compared. The purpose of comparing these data sets was to examine outcomes of …

Department Structure And Leadership Functions For Advanced Practice Providers, Deondela Love

Walden Dissertations and Doctoral Studies

Department structure and leadership functions can influence work climate. In one healthcare system, advanced practice providers (APPs) worked in a decentralized structure with multiple leaders. This project explored the impact of the change to centralized leadership for APPs working in an academic healthcare system in which employee turnover was high and satisfaction was low. An ad hoc committee led by the chief medical officer created a centralized department with a designated leader. Surveys and interviews were used to identify the benefits of the strategies implemented and understand whether the change in organizational structure resulted in an improved work climate for …

A Transition Quick-Guide For Educating Youth With Hemophilia, Joetta Smith

Walden Dissertations and Doctoral Studies

A 2009-2010 National Assessment Survey of youth with special needs such as hemophilia showed that 40% of youth between the ages of 12 and 17 had a transition plan before transitioning to adult care services. The lack of a transition plan caused youth to fall into a fragmented care gap when transition services are inadequate. During the gap, youth with hemophilia increased use of the emergency room and were hospitalized for complications such as frequent joint or muscle bleeding and joint disability. As a result, the health status of affected youth becomes fragile and health care costs escalate. The practice …

Educating Staff Members In An Outpatient Clinic On Hypertension Management, Helen Anyiam

Walden Dissertations and Doctoral Studies

An educational module on hypertension was created in response to the recurring pattern of patient visits with hypertension and an observed knowledge gap among nursing staff in an outpatient clinic located in the southern United States. The educational module was patterned after Joint National Committee-8 and American College of Cardiology guidelines involving patient lifestyle modification and provided clinic staff with information on hypertension diagnosis and self-management for use in patient education. The module was reviewed by a panel of 3 experts who approved it for appropriateness and clarity of content and made one minor recommendation for revision. The education materials …

Exploring The Cultural Intelligence Of Nurse Leaders, Valerie D. Campbell

Walden Dissertations and Doctoral Studies

Today, nurses represent many cultures and ethnic backgrounds. In their leadership style, nurse leaders must learn to embrace cultural intelligence or cultural quotient (CQ), that is, an extension of emotional intelligence that affords them the ability to manage a culturally diverse workforce. Historically, CQ has been relevant to business, locally and globally. But it is also important to explore the CQ of nurse leaders. Scholarly studies show that leaders with CQ are responsible for developing innovative employee behaviors, forward-thinking ideas, and creativeness in the workplace. CQ has a theoretical foundation in the 2003 research of Early and Ang who focused …

Stress, Anxiety, And Depression: Role Of Campus Connectedness, Social Support, And Coping Among Nepalese Nursing Students, Priscilla Samson

Walden Dissertations and Doctoral Studies

High levels of stress, anxiety, and depression (SAD) can adversely influence physical health, psychological well-being, and academic and clinical performance of nursing students. Numerous studies have identified the factors associated with SAD; however, a paucity of empirical research addresses the relationship of SAD with campus connectedness (CC), perceived social support (PSS), and coping. The purpose of this quantitative cross-sectional study, guided by Lazarus and Folkman's theory of stress, coping, and adaptation, was to determine the prevalence of SAD and examine its relationship with CC, PSS, and coping among undergraduate nursing students of Nepal. Survey research was conducted using depression anxiety …

Nursing Candidates' Perceptions Of The Greatest Challenges To Becoming A Professional Nurse, Lee Ann Williams

Walden Dissertations and Doctoral Studies

Nursing candidates' overall goal is to become a professional nurse. To reach this goal, the student must graduate from an associate or baccalaureate nursing program and pass the state board, National Council Licensure Examination (NCLEX). Student retention in nursing programs and passing the NCLEX continue to be a problem for educational institutions throughout the United States. The purpose of this study was to examine nursing candidates' perceptions of their greatest challenges in becoming a professional nurse. Wenger's social learning systems and the community of practice comprised the conceptual framework that guided this study. The research questions pertained to nursing students' …

Patient Self-Assessment For Older Adult Fall Prevention, Deborah Brennan

Walden Dissertations and Doctoral Studies

Falls and falls with injury are a leading contributor to decreased quality of life for adults aged 65 and older. Complications associated with fall occurrences include death, long term disability, decreased mobility, decreased quality of life, and psychological effects.

The practice focused question addressed in the project asked if the use of a standardized publicly available assessment for falls risk will assist registered nurses in learning more about the patient's fall risk. To address the question, the Stay Independent Check Your Risk for Falling Questionnaire (SICRFQ), obtained from the CDC website, was used as the basis for an education program …

Evaluation Of An Opioid Risk-Assessment Screening Tool, Jacquelyne Guerra

Walden Dissertations and Doctoral Studies

According to the Centers for Disease Control and Prevention, prescribers should evaluate risk factors related to opioid use prior to initiation of opioid medication. The practice problem in this DNP project was that providers failed to consistently assess patients with complaints of pain for risk of opioid misuse and/or abuse prior to initiating opioid medication. An opioid risk-assessment screening tool (ORAST) has the potential to identify patients at high risk for opioid misuse and/or abuse. The purpose of this Doctor of Nursing Practice project was to identify and introduce an ORAST and then develop a policy to guide providers in …

An Evidence-Based Approach To Percutaneous Coronary Intervention Access, Kemi Funlayo Sanni

Walden Dissertations and Doctoral Studies

Coronary heart disease is a significant cause of mortality and morbidity in the United States; Healthy People 2020 set an objective to reduce the rate of the disease by 20% to the baseline rate of 126 deaths per 100,000 population per year. In the local healthcare setting, heart disease was responsible for a high percentage of mortality and morbidity. To address this, the local site developed a plan to improve outcomes for patients seeking care at the facility. Because the femoral approach to percutaneous coronary intervention (PCI) was used to treat coronary heart conditions at the site and complications were …

Educating Oncology Nurses About The Emotional Impact Of Cancer Diagnosis, Jonnell Ortiz Zayas

Walden Dissertations and Doctoral Studies

Anxiety and depression are common mood disorders in cancer patients, regardless of mental state prior to diagnosis. A gap in the education of oncology nurses in an eastern Caribbean island was discovered regarding their ability to identify anxiety and depression symptoms and to help patients who suffered from these disorders. The purpose of this project was to improve oncology nurses' assessment skills by reviewing appropriate use of the Hospital Anxiety and Depression Scale (HADS) tool and familiarizing nurses with resources to help patients who score high on the HADS. The Levine conservation model was the theoretical framework for this project. …

Type 2 Diabetes Management For Geriatric Veterans, Fachecia L. Fort

Walden Dissertations and Doctoral Studies

Managing diabetes in the geriatric long-term care population can be challenging, yet important because diabetes is a chronic, progressive disease. The purpose of this project was to identify clinical practice guidelines for managing Type 2 diabetes in geriatric veterans and to develop a class to educate providers on diabetes management in the geriatric long-term care population at a community living and rehabilitation center. The practice focused question asked if providing education to providers about the clinical practice guidelines for managing Type 2 diabetes in geriatric long-term care veterans would improve knowledge as measured by a pre- and posttest. The project …

Improving Glycemic Control In Adult With Type 2 Diabetes, Basirat Romoke Triplett

Walden Dissertations and Doctoral Studies

Ninety percent of people with diabetes have Type 2 diabetes mellitus (T2DM). T2DM is a complex disease that affects every organ in the body, which makes effective management of the disease imperative. The American Association of Clinical Endocrinologist (AACE) and American College of Endocrinology (ACE) strongly recommended early treatment initiation among the target population to delay disease progression and complications. The purpose of this evidence-based project was to examine the impact of using the T2DM management algorithm for effective management of adults with T2DM over a 3-month period. The shared experience decision-making model and the chronic care model were used …