Nursing Commons^™

Improving Human Papillomavirus Vaccination Rates Through Evidence-Based Interventions, Deidra Thompson

Walden Dissertations and Doctoral Studies

Cervical cancer is the most common human papilloma virus (HPV) -associated cancer and is the second leading cause of death in the world. Vaccination against HPV is essential to reduce the incidence of HPV and subsequent morbidity and mortality. According to the Centers for Disease Control and Prevention (CDC), approximately 79 million Americans are currently infected with HPV. The site for this DNP project was a 163-bed facility with inpatient and outpatient services in the southern United States. The vaccination rate at the site was 48%. The facility lacked educational interventions to prepare and remind providers to offer HPV vaccine. …

Self-Care Management Of African American Men With Type 2 Diabetes, Kevin Konstantinos

Walden Dissertations and Doctoral Studies

African American men are disproportionately affected by type 2 diabetes and have a 3 times higher rate of 3 serious complications of diabetes, including blindness, amputations, and end-stage renal disease, compared to other groups. The purpose of this project was to address the gap-in-practice disparity that exists in care of African American men with diabetes by providing one-on-one self-care management education in an outpatient clinic setting. The behavior change theories that supported the project intervention were Orem's self-care theory and Bandura's self-efficacy theory. Employing a quasi-experimental design, 33 participants between the ages of 40 and 65 were divided into an …

Workplace Violence Among Nurses And Nursing Assistants In Texas, Tamala Norris

Walden Dissertations and Doctoral Studies

Workplace violence (WPV) is ranked as one of the leading causes of occupational injury in the United States and is common in health settings. Nurses have the highest rate of violent victimization reported in the U.S., thus presenting a significant issue for healthcare leaders. Various researchers focus on prevalence rates of WPV among nurses discussing types of violence, location, and the setting where the WPV occurred. Less information exists regarding time taken off work and factors associated with WPV among nurses versus nursing assistants (NAs). This information is important due to the impact on safe work environments for nursing employees. …

Evidence-Based Practice Guideline For Peripheral Artery Disease, Jenny Ann Salve Managbanag

Walden Dissertations and Doctoral Studies

The absence of a practice guideline for peripheral artery disease (PAD) in the cardiology department creates differing practice preferences among providers, leading to deviations in practice among staff. Variations in practice can affect the quality of care that is provided to patients. This project was guided by research statements indicating that there was a difference in the screening approach for PAD among health practitioners at preimplementation and postimplementation and that an 85% compliance with the guideline would signify consistency in the provision of care. Rogers' theory of diffusion of innovations was used to facilitate the adoption of the guideline. This …

An Educational Program For Using The Distress Themometer, Mabel M. Che-Tuma

Walden Dissertations and Doctoral Studies

The distress thermometer (DT) is a screening tool designed to measure the level of stress in oncology patients. Clinical oncology nurses (CONs) at the local site lacked knowledge and training on how to administer and apply the DT. Because of this practice gap, patients were not receiving referrals to the necessary support services. The purpose of this project was to design and validate a CON staff education program on the use of the DT. The diffusion of innovation theory along with the theory of interpersonal relations served as the conceptual framework for the project. The project was organized into a …

Nonpharmacological Behavioral Interventions For Patients With Dementia: An Integrative Literature Review, Michelle Monique Spears

Walden Dissertations and Doctoral Studies

The use of antipsychotic medications in older adults with dementia increases risk of

mortality; therefore, it is critical that nurses use nonpharmacological interventions in dementia care. The nurses' role is integral to implementation of treatment strategies to dementia patients and efforts to improve care in patients with dementia using a nonpharmacological approach are necessary. Therefore, guidelines outlining nonpharmacologic dementia care management will enable nurses to provide a wider spectrum of care to dementia patients. The purpose of this project was to make recommendations for the development and implementation of interdisciplinary practice guidelines to standardize care in the organizational setting. An …

Development Of A Sexual Assault Support Group For Female Rape Victims, Ann Marie Nichole Willoughby

Walden Dissertations and Doctoral Studies

Survivors of sexual assault struggle to cope with subsequent psychological disturbances. The project facility was a rural hospital in the southwestern United States in which postasault care was initially provided, but survivors later returned to the emergency department. Support groups can be a powerful tool to alleviate long-term consequences of assault by helping individuals cope and improving socialization. This project used the social-ecological theory to explore whether a sexual assault support group would impact the progress of survivors toward improved social interaction, improved socialization, and decreased psychological disturbance. The purpose of the quality improvement (QI) project was the development of …

Emotional Self-Management Experiences Of Practical Nursing Students, Cindy Ko

Walden Dissertations and Doctoral Studies

In Ontario, Canada, practical nurses (PN) are educated through a 2-year diploma program. A review of PN program curricula in Ontario suggested that emotional intelligence (EI) and the core concept of emotional self-management are not specified in curriculum outcomes or courses. The study explored PN students' lived experiences with emotional self-management in the clinical settings where they are exposed to stress related situations using van Manen's orientation to hermeneutic phenomenology. The original four-branch ability model of EI by Mayer and Salovey was used as the theoretical framework to guide the explorative and interpretative processes of the study. Face-to-face interviews were …

Effectiveness Of Guardrails At Reducing Medication Errors Indrug Administration, Teresa Mosley

Walden Dissertations and Doctoral Studies

Medication errors during drug administration are an issue in the nursing profession. The errors that occur due to intravenous vein infusions pose threats to patients due to the mode of administration and the risk of occurrence. Strategies such as guardrails have been implemented to reduce the rate of such errors. Despite these guardrails, facilities record mixed results on the effectiveness of infusion pumps in reducing medication errors. The project was designed as a quantitative study to evaluate the effectiveness of guardrails in reducing medication errors at the facility. Data analysis included error reports from the facility before and after the …

Depression Management In Outpatient Settings: A Systematic Review Of The Literature, Modupe Mary Okonofua

Walden Dissertations and Doctoral Studies

Depression is a mental illness that requires prompt identification and treatment due to grave consequences if untreated. Depression can affect a person's level of functioning, lead to worsening health conditions, comorbid substance abuse, and suicide. Despite these facts, the current state of nursing practice includes an inadequate diagnosis of patients with depression, lack of guidelines for the use of assessment tools and diagnostic tests to identify depression, and insufficient information concerning the accuracy of depression assessment tools. This systematic literature review examined 6 depression assessment tools in regard to their accuracy as identified by specificity, sensitivity, reliability, and validity. This …

Bleach-It-Away Clostridium Difficile, Kim Ione Hecker

Walden Dissertations and Doctoral Studies

Hospital-associated infections (HAIs) are infections patients contract as a result of being hospitalized. HAI rates decreased for almost all pathogens in the past few years, with the exception of Clostridium difficile infections (CDIs), which have been steadily climbing, placing hospital-acquired CDI at the top of the HAI list. The Center for Disease Control and Prevention reported in 2010 almost a half a million people were infected with CDIs yearly in the United States, and CDIs claimed the lives of approximately 29,000 people, representing a 4-fold increase from 1993. To address the problem in the local hospital, a quality improvement initiative …

Chronic Low Back Pain- A Needs Assessment For Practice Change, Chukwudi Oduah

Walden Dissertations and Doctoral Studies

There is a practice gap in the self-management education of patients with chronic low back pain. Insufficient self-management leads to increased frequency of flare-ups of low back pain, disability, loss of productivity, and increased cost of health care. The guiding practice-focused question was focused on the unmet self-management support needs of the chronic low back pain patients in a Midwestern state local pain clinic. The purpose of this descriptive cross-sectional study was to ascertain the unmet needs of patients' self-management support by analyzing the results of a patient study performed by this clinic. The theoretical principles of the model for …

Educational Program For Parents Of Neonates On Nasal Continuous Positive Airway Pressure, Irina Sher

Walden Dissertations and Doctoral Studies

Parents in the neonatal intensive care unit (NICU) whose term or preterm infants are receiving nasal continuous positive airway pressure (NCPAP) experience stress. They often worry about being able to hold their child and possible complications of NCPAP, such as nasal deformities and compromised organ function. Lacking standard educational programming to provide parents information that they need to understand the care their infant is receiving, parents experience unnecessary stress that affects their capacity to care for their infants. A review of the literature suggested family-centered educational programs are able to decrease stress and increase parental confidence. The purpose of this …

A Nutrition Education Program For Advanced Practice Registered Nurses Caring For Obese Patients, Kathy Lynn Wilson

Walden Dissertations and Doctoral Studies

Obesity is a major U.S. public health epidemic. A review of the current literature identified a lack of obesity counseling with individuals. The gap in practice was a lack of understanding of nutrition, nutrition labeling, and how foods affect health. The objective of this project was to identify the community assessment need related to obesity and then educate APRNs on ways to better communicate with obese patients. This project focused on an education program for advanced practice registered nurses (APRNs) on using the 5 A's framework for obesity counseling to improve their knowledge and skill in counseling their overweight and …

Implications Of An All Bsn Workforce Policy, Mary Clifford

Walden Dissertations and Doctoral Studies

Discussion continues about requiring a Bachelor of Science in Nursing (BSN) as the minimum requirement for entry into registered nursing practice. A Magnet-® recognized hospital located in the Northeast United States is requiring all registered nurses without a BSN (n=284 or 28%) to obtain their BSN by 2022 as a condition for employment. The purpose of this project was to quantify the potential number and rationale of nurses who are not planning to return to school. The 2 practice focused questions are (a) What is the rationale for nurses who do not plan to pursue their BSN degree and (b) …

Stroke Risk Factor Knowledge, Attitude, Prevention Practices, And Stroke, Adaku Ngozika Madubuko

Walden Dissertations and Doctoral Studies

Regardless of the advances that have been made in stroke research and treatment and the overall decrease in stroke mortality, the stroke mortality rate for African Americans is still high at 45.2/100,000 and is still the leading cause of adult disability. Knowledge of the risk factors of stroke is paramount to reducing the morbidity and mortality of stroke, but knowledge of stroke risk factors has been found to be suboptimal in the African American population. The purpose of this study was to examine if there is a relationship between the knowledge, perception, and sources of stroke information of risk factors …

Development Of Patient-Centered Team-Based Care Certification, Stephanie Lynn Stewart

Walden Dissertations and Doctoral Studies

Accountable care units (ACU-?¢) provide a new model for integrated patient care. The ACU-?¢ promotes patient centeredness in nursing units as team members work collaboratively with physicians to improve patient outcomes and reduce unwarranted variations. A health system in the southeastern United States incorporated the ACU-?¢ as part of their care model. These units were held accountable for their clinical, service, and cost outcomes but lacked a validation process to demonstrate the effective utilization of their data. The purpose of this DNP project was to create a patient centered care (PCC) certification process, guided by the Donabedian model, that would …

A Staff Educational Initiative To Improve The Use Of Childhood Obesity Guideline Recommendations, Kris Kuhlmann Louque

Walden Dissertations and Doctoral Studies

Obesity affects one out every six children in the United States, which places them at risk for other chronic conditions such as cardiovascular disease, diabetes, and continued obesity into adulthood. Considering military children are more likely to enter the Armed Forces than their civilian counterparts, an increase in obesity among military families decreases the number of potential future military recruits who are physically eligible to serve. Despite this growing epidemic, providers report a lack of education and a low self-efficacy in the treatment of this condition. This doctorate of nursing practice study addresses this educational gap by attempting to improve …

Workplace Bullying From A Nurses Perspective, Dawn Reid White

Walden Dissertations and Doctoral Studies

Bullying has long been associated with school children. In recent years, however, more attention has been paid to the bullying that has reached beyond the playground and into the workforce. One population facing this problem is staff nurses. To date, no one has found an effective way to address workplace bullying in the healthcare field, nor have effective methods been found for retaining trained nurses affected by this problem. The focus of this dissertation was on understanding nurses' lived experiences and how nurses decided to remain in their current working position despite these problems. Taking a phenomenological approach and using …

Use Of Simulation For Tracheostomy Care, A Low Volume, High Risk Nursing Procedure, Vijaya Ramakrishnan

Walden Dissertations and Doctoral Studies

Often, education regarding low volume and high-risk procedures, like tracheostomy, are ignored. Lack of experience, skills, and human resources can lead to decreases in confidence levels, diminished quality of care, and potentially an adverse event. The purpose of this DNP project was to prepare simulation-based education on the tracheostomy procedure and provide hands-on education to bedside nurses. The project answered the question: To what extent will a simulation-based teaching method adequately prepare staff nurses in a post-acute surgical unit to perform this high risk low volume procedure? The Johns Hopkins evidence-based model method was used to assist in translation of …

The Effectiveness Of Screening For Comorbid Depression Among Outpatients With Chronic Diseases In Maryland, Linda Hasssan Allibalogun

Walden Dissertations and Doctoral Studies

Depression is a pervasive mental health disorder worldwide. Although being diagnosed with chronic illness exacerbates susceptibility to depression, detection and subsequent treatment of comorbid depression in primary care settings remain suboptimal because patients with chronic medical disorders are not commonly screened for depression. There is a need to initiate proactive measures by implementing routine screening in primary care settings. The plan-do-study-act (PDSA) model guided an intervention to establish a depression screening practice. This study aimed to determine if the implementation of evidence-based screening for depression using the Patient Health Questionnaire-9 (PHQ-9) tool could increase diagnosis of comorbid depression among patients …

Using Calcaneal Heel Ultrasounds To Screen For Osteoporosis At Alaska Health Fairs, Heather Guess

Walden Dissertations and Doctoral Studies

Osteoporosis is a major health problem. The Alaska Department of Health and Social Services reports national rates of osteoporosis at 13-18% of women and 3-6% of men over age 50, but current evidence suggests that osteoporosis rates in Alaska are more equal between sexes. Known risk factors for osteoporosis that are very common among Alaskans include arthritis and low vitamin D and calcium levels. The U.S. Preventive Services Task Force (USPSTF) recommends dual-energy x-ray absorptiometry (DXA) scans of the hip and lumbar spine as the gold standard of screening for osteoporosis; however, DXA scans are expensive, not portable, and not …

A Nursing In-Service For Diabetes Education, Heidi Steiner

Walden Dissertations and Doctoral Studies

Nurses play a central role in preparing patients for discharge. Diabetes affects one-third of all hospitalized patients, with readmission rates 20% higher for patients with diabetes. Low health literacy affects patients' ability to understand education provided during a hospitalization, especially in diabetic patients who are required to perform complex self-care activities. The rehabilitation nurses within the practicum site struggled to provide adequate diabetes education, leading to patients' readmissions and frequent calls to the nursing unit post discharge. The purpose of this project was to educate nurses on an inpatient unit about survival skills and teach-back approaches to improve inpatient diabetes …

Increasing The Value Of Medicare Annual Wellness Visits For Patients And Providers, Stephanie Hope Turner

Walden Dissertations and Doctoral Studies

The Medicare Annual Wellness Visit (AWV) has been available to Medicare beneficiaries since 2005; however, most eligible individuals have not taken advantage of this benefit. The literature supports that patients are willing to schedule and complete an AWV if urged to do so by their primary care provider; however, providers are reluctant to advise patients to pursue the AWV due to the lack of perceived value and overall health benefit. The integrative theory of health behavior change was used as the theoretical framework for the project. By increasing patient self-management skills through education, engagement, and support, the project was designed …

Emergency Room Nurse Perceptions Of Emotional Intelligence, Ingrid Astralaga

Walden Dissertations and Doctoral Studies

The delivery of quality care has been a priority for the health care industry in the United States. Researchers have established positive correlations between the levels of emotional intelligence of registered nurses and their clinical performances. However, new evidence suggests the need to enhance the use of emotional intelligence (EI) in high-risk clinical units. With the intent to understand the use of EI, a phenomenological research approach was used to identify the emergency room nurse's understanding of EI. The Four-branch Model of Emotional Intelligence was used as the theoretical framework, while the research question identified the emergency room nurse's perception …

Korean Immigrant Women's Perceptions Of Cervical Cancer Screening In Hawaii, Eurina Yujin Cha

Walden Dissertations and Doctoral Studies

Minority immigrant women are more likely to be diagnosed with and suffer from cervical cancer compared to other minority women in the United States. The purpose of this qualitative ethnographic study was to explore cultural health perceptions, behaviors, and barriers to cervical cancer prevention among Korean immigrant women (KIW) in Hawaii. The health belief model and the social-ecological model were used to guide the study. Data were collected using individual structured interviews with 20 KIW ages 21 to 65 who are first-generation KIW immigrant to Hawaii. Data were coded and analyzed to identify themes. Findings revealed that participants (a) prefer …

Preparing Novice Nurses For Early Recognition Acute Deterioration, Norma Patricia Harris

Walden Dissertations and Doctoral Studies

Hospitalized patients increasingly present with complex health issues that place them at risk for acute patient deterioration (APD). Novice nurses are ill-equipped with the critical clinical skills to function competently in recognizing APD, placing patients at risk for negative health outcomes. This project addressed the need to educate novice nurses to recognize APD and answered the project focused questions that asked if an educational intervention with high-fidelity simulation (HFS) would improve nurse knowledge and clinical confidence in recognizing APD. Benner's novice-to-expert and the constructivism theory were used to guide the project. Based upon a review of the literature, the HFS …

Staff Educational Program To Prevent Medication Errors, Rita Chinyere Hawthorne-Kanife

Walden Dissertations and Doctoral Studies

Medication administration errors (MAEs) may lead to adverse drug events, patient morbidity, prolonged hospital stays, and increased readmission rates, and may contribute to major financial losses for the health system. MAEs are the most common type of error occurring within the health care setting leading to an estimated 7,000 patient deaths every year. Interventions have been designed to prevent MAEs including education for nurses who administer medications; however, little effort has been made to design systematic educational programs that are based on local needs and contexts. The purpose of this project was to identify internal and external factors related to …

Achieving Glycemic Control In Rural Clinics, Gayla Diane Mclaughlin

Walden Dissertations and Doctoral Studies

Diabetes is the 7th leading cause of death in the United States and is the main cause of chronic kidney failure, nontraumatic limb amputations, blindness, myocardial infarction, and stroke. Many patients with diabetes do not meet goals for at least 1 control measure of blood sugar, blood pressure, or cholesterol. The purpose of the project was to implement a template for documentation--a toolkit for patient care management-to improve blood glucose and blood pressure levels in a rural health clinic in central Texas for 33 patients with diabetes during a 6- to 8-week timeframe. The practice-focused question asked whether management of …

An Evidence-Based Clinical Practice Guideline For Childhood Obesity, George Peterson

Walden Dissertations and Doctoral Studies

Childhood obesity is a national problem in the United States and has known implications as a potential cause of chronic illnesses as the child transitions into adulthood. A primary care clinic in the southwestern United States had a high percentage of obese Hispanic children within its population; therefore, the nurses and the pediatrician needed an evidence-based clinical practice guideline (CPG) to manage Hispanic children with a body mass index greater than the 95th percentile for their age. The purpose of the project was to develop a culturally competent CPG to manage childhood obesity in this primary care practice. The social …