Nursing Commons^™

Perioperative Orientation, Education, And Mentoring (Poem) Program, Esther M. Johnstone

Walden Dissertations and Doctoral Studies

Perioperative registered nurses (RNs) are vital to the provision of safe patient care for those undergoing invasive and surgical procedures within acute care settings. Unrealistic transition-to-practice (T2P) expectations for novice RNs (newly licensed and experienced RNs new to perioperative nursing) have resulted in significant turnover and attrition rates as high as 45%. A T2P program, known as the Perioperative Orientation, Education, and Mentoring (POEM) program, was developed to address attrition and turnover through mentoring and professional development. The POEM program was a pilot program implemented at a large academic medical center. An evaluation tool known as the Surgical Skill Assessment …

Developing Policies And Guidelines To Prevent Medication Errors And Ades In Nursing Homes, Marion Johnson

Walden Dissertations and Doctoral Studies

According to the National Patient Safety Foundation, more than 1.5 million Americans are affected by medication errors because of varied factors including miscommunication, bad handwriting, name confusion, poor packaging, and metric or other dosing unit errors. This project addressed medication errors and adverse drug events by developing policy and practice guidelines to support and aid the utilization of health information technology (HIT) systems in addressing medication errors and adverse drug events at a local nursing home in Cincinnati, Ohio. The National Quality Strategy Framework was used by a team of interdisciplinary stakeholders as a guide for the development of policies …

Infant-Driven Feeding Vs. Scheduled Feeding: The Effect On Hospital Length Of Stay, Lori L. Messer

Walden Dissertations and Doctoral Studies

Developmental delays related to feeding dysfunction in premature infants can lead to lengthy hospitalizations and increased healthcare costs initially and throughout the first year of the child's life. The purpose of this project was to use readiness-to-feed assessments to evaluate the impact of an infant-driven feeding protocol on length of stay. The project compared the length of stay of 2 groups of infants: a demand fed according to a readiness-to-feed protocol (protocol group, n = 14) and a traditionally fed according to scheduled, volume-driven feedings (traditional group, n = 15). The logic model served as the change management framework and …

A Curriculum On Culturally Competent Practices To Prevent Retraumatization In Diverse Survivors, Luana Rodriguez

Walden Dissertations and Doctoral Studies

This DNP project addresses the healthcare issue of intimate partner, domestic, and sexual violence (IPDSV), its impact on survivors, and reducing the potential for retraumatization by those who care for them in the clinical, behavioral, and social settings. Trauma-informed care interventions are designed to address the sequelae of trauma, promote recovery, and support resilience. Since IPDSV is a global health issue, supporting cultural needs of all clients is an essential aspect of trauma-informed care. This project was guided by a central research question that examined if trauma-informed, culturally competent curriculum be viewed by community stakeholders as an appropriate intervention for …

Improving Perinatal Team Communication To Decrease Patient Harm With Team Strategies And Tools To Enhance Performance And Patient Safety Training, Raquel Maria Walker

Walden Dissertations and Doctoral Studies

During childbirth, multiple providers deliver care at the bedside that requires optimal teamwork and communication to prevent patient harm. The complexity of caring for obstetrical patient demands a well-coordinated team to relay information and respond to conditions that can change quickly during childbirth. A patient safety strategy to prevent perinatal harm is Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) training. TeamSTEPPS is an evidence-based program based on crew resource management (CRM) principles developed in the aviation and military industries. This process improvement project used the Plan-Do-Study-Act framework and Kotter's change theory to implement TeamSTEPPS training after …

U. S. Nursing Students' Perceptions Of Safe Medication Administration, Kathy F. Johnson

Walden Dissertations and Doctoral Studies

Medication errors are a global concern that may affect patients' hospital stays, patients' lives after discharge, treatment costs, and mortality rates. Understanding medication errors among nursing students may help in preventing these errors as nurses are responsible for safe medication administration. The purpose of this descriptive phenomenological study was to examine upper-level nursing students' understanding of and experiences with medication administration and patient safety. Benner's nursing theory of novice to expert and Dreyfus's model of skill acquisition comprised the conceptual framework. Research questions focused on students' perceptions of safe medication administration. Face-to-face interviews were conducted with 7 upper-level nursing students …

An Evidence-Based Educational Intervention To Improve Nursing Staff's Critical Thinking And Decision-Making Skills, Rene Norene Barron-Kagan

Walden Dissertations and Doctoral Studies

An Evidence-Based Educational Intervention to Improve Nursing Staff's Critical Thinking and Decision-Making Skills

by

Rene N. Kagan

MSN, University of New Mexico, 2009

BS, University of Phoenix, 2000

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

September 2016

Hospitalized patients in acute care settings are at a high risk of developing health complications that can eventually lead to failure to rescue (FTR) situations. The aim of this project was to deliver a structured comprehensive medical-surgical competency plan for acute care nurses to detect deterioration in a patient's condition through the …

Student Perceptions Of Factors Affecting Retention In A Rural Associate Degree Nursing Program, Jodi Garcia

Walden Dissertations and Doctoral Studies

High nursing student attrition rates at a community college in a southwestern state were noted as a significant problem by nursing faculty and college administration because of a nursing shortage and subsequent health care issues in the surrounding community. The purpose of this project study was to explore the perceptions of nursing graduates regarding the influences that led to or impeded their success in completion of the associate degree nursing program. Additionally, perspectives of the usefulness of remediation sessions provided for students failing a course were investigated. This qualitative case study, guided by transformative learning theory, included a sample of …

Self-Efficacy And Self-Management Assessments On Hispanic Patients With Diabetes, Yesenia Dejesus

Walden Dissertations and Doctoral Studies

Hispanics are at increased risk for diabetes and are 40% more likely to die from the condition than are non-Hispanic Caucasians. The purpose of this project was to determine the effects of diabetes education conducted in Spanish by bilingual staff on the self-management and self-efficacy of a sample of 50 volunteer adult Hispanic clinic patients with diabetes. The education intervention incorporated the American Diabetes Association's Diabetes Self-Management Education program materials. Bandura's self-efficacy theory was selected as the theoretical support for the project that relied on self-management education of the patients to improve their self-efficacy to undertake the interventions necessary to …

Dementia Caregive Module And Pamphlet, Shawen Denise Ransby

Walden Dissertations and Doctoral Studies

Dementia care is an immediate and growing issue that affects everyone. People are living longer increasing the likelihood that they may be diagnosed with dementia. Friends and family are become caregivers but are often unprepared for the role. The purpose of this project was to develop a 15-minute dementia care module to assist caregivers with the home care of dementia patients. A pamphlet was created to reinforce the module information and to provide a quick reference for dementia support. The self-efficacy theory, along with the review of best practice guidelines and evidence from literature, informed the development of the module. …

Culturally-Based Diabetes Self-Management Education And Diabetes Knowledge In The Hispanic Population, Leslie Weldon Grunden

Walden Dissertations and Doctoral Studies

The Hispanic population has an elevated prevalence of diabetes, resulting in large part from a lack of self-management skills required to obtain glycemic control. The purpose of this project was to determine whether diabetes self-management knowledge was improved through the use of a culturally-based diabetes self-management program for Hispanic adults with diabetes using elements of the Hispanic culture. The research question asked whether a researcher-developed diabetes self-management education program that incorporated elements of the Hispanic culture improved diabetes knowledge in the Hispanic population when compared to a non-culturally based diabetes self-management program. The project was conducted using a quasi-experimental control …

Effect Of Healthy Food Demonstration On Minority Women's Dietary Habits In San Antonio, Texas, Staria Hudson Black

Walden Dissertations and Doctoral Studies

Obesity has become a global epidemic. Healthcare cost continues to increase due to co-morbidities such as diabetes, hypertension, and coronary artery disease associated with obesity. The purpose of this project was to examine whether teaching nutritious food choices to obese African American and Hispanic females in healthy cooking demonstrations would have an effect on their dietary behavior. The holistic self-care model was used to develop healthy strategies for weight loss. The model guided the development of nutritional support, exercise, and spiritual strategies for weight reduction. African American and Hispanic females between the ages of 25 to 64 were solicited from …

Workplace Violence Prevention Program To Improve Nurses' Perception Of Safety In The Emergency Department, April Hough Brown

Walden Dissertations and Doctoral Studies

The literature claims that workplace violence (WPV) in the health care setting is among the highest, with the majority of that violence taking place in the Emergency Department (ED). The significance of WPV in reference to nursing is that it leads to burnout, absenteeism, and the risk of nurses leaving their job all together. Leaving the nursing profession intensifies the present critical shortage. With the success of an evidence-based WPV prevention program (WPVPP), hospitals could improve the quality of work for nurses, which consequently will improve retention rates, as well as provide an environment that will be more conducive to …

Providing Optimal Nutrition In Critical Care, Jo Anne Foley

Walden Dissertations and Doctoral Studies

Malnutrition among hospitalized patients is prevalent and associated with adverse outcomes. At the health care facility for which this quality improvement (QI) initiative was developed, patients were not consistently fed within the nationally recommended 48 hours. The purpose of this project was to facilitate the early initiation of enteral feedings to prevent malnutrition in a vulnerable patient group by development of an evidence-based enteral feeding policy, algorithm, and nursing education module. The find, organize, clarify, understand, select, plan, do, check, and act model provided a systematic approach for development of the project. Validation of the QI initiative was through the …

Nurses' Occupational Trauma Exposure, Resilience, And Coping Education, Sherry Lynn Jones

Walden Dissertations and Doctoral Studies

Nursing education courses and professional development (PD) do not include coping and resilience training for registered nurses (RNs) who work in emergency departments (EDs). Exposure to traumatic events, death, and dying may lead to health issues, substance abuse, stress symptoms, nursing staff turnover, and compassion fatigue among ED RNs. Without training, the pattern of adverse outcomes may continue. The purpose of this study was to explore ED RNs' experiences with occupational traumatic stress (OTS), and their recommendations for change to nursing PD programs, using a qualitative bounded intrinsic case study. The conceptual framework for this study included social learning and …

Improving Pain Management For Hospitalized Patients, Ronda Sweet

Walden Dissertations and Doctoral Studies

Uncontrolled pain has proven effects on both physiological and psychological responses of hospitalized patients. These incapacitating sequelae most often negatively impact patient outcomes resulting in unnecessary suffering and prolong hospitalizations. First line nurses often have preconceived notions about a patient's pain without developing an individualized patient context that considers appropriate pain management knowledge translated from best practice standards. Guided by Bandura's social learning theory and Lippitt's change theory, the purpose of this quality improvement project was to determine if use of the Curriculum Outline on Pain for Nursing from the International Association for the Study of Pain (IASP) improved nursing …

Assessing Nurse Manager Competencies In A Military Hospital, Ruby O. Anderson

Walden Dissertations and Doctoral Studies

Military health care organizations need competent frontline managers with knowledge and skills to manage health care complexity and ensure evidence-based practice. With systematic, planned turn over of military managers, more civilian managers are needed to fill permanent positions in military hospitals. The purpose of this project was to provide a better understanding of the competencies perceived by nurse managers at a military medical center and whether they differed by military or civilian status. The American Organization of Nurse Executives competency model and framework provided the theoretical framework for the project. The design was nonexperimental, with an observational, descriptive, cross-sectional approach. …

Improving Health Literacy With Clear Communication, Carol Barbara Wilson

Walden Dissertations and Doctoral Studies

Health literacy is demonstrated when individuals can obtain, process, and understand basic health information and services needed to make appropriate health decisions. Veteran health literacy is believed to be lower than the general population due to the aging and culturally diverse population. Veterans require adequate health literacy to manage their diverse high acuity physical injuries, psychological conditions, and chronic diseases. Clear communication between the clinician and veteran patient is essential to provide high quality health services. The objective of this quality-improvement project was to evaluate the ability of nurses in the ambulatory environment to identify low health literacy patients and …

The Move From Recorded To Bedside Shift Report: Evaluating Barriers To Full Implementation, Elizabeth Jackson Cipra

Walden Dissertations and Doctoral Studies

Many sentinel events in acute care centers can be attributed to miscommunication of patient information at shift change. A growing body of evidence supports the implementation of bedside shift report as the standardized approach to ensure effective communication by staff. The purpose of this study was to identify the barriers that impede nurses from fully participating in bedside shift report in order to create an educational initiative to develop the nursing staff's proficiency in performing bedside report. Lewin's change theory served as the framework for the project. Data for the staff development project were collected using a focus group approach …

The Relationship Of General Science Grades To Program Completion In An Associate Degree Nursing Program, Catherine Edlebeck

Walden Dissertations and Doctoral Studies

High attrition of nursing students in the United States may contribute to a shortage of registered nurses and inefficient use of scarce resources. The purpose of this study was to explore the relationship between nursing student grades in 3 science prerequisites and length of time to program completion on each of the study college's 4 campuses. Ausubel's theory of subsumption, wherein a learner's ability to meaningfully learn new data depends on the existing cognitive structure within which the new material is assimilated, was used as a theoretical framework. Prerequisite science course grades for 575 nursing students attending a Midwestern technical …

Using The Power Of 3 With Total Joint Surgery Patients, Lynda M. Sanchez

Walden Dissertations and Doctoral Studies

The purpose of patient education is to provide patients and their families with the tools needed to care for themselves after discharge from the hospital, but shortened hospital stays, limited health literacy, language, and age can impede the patient's comprehension of the information provided. Researchers have found that the lack of effective patient education is related to 30-day hospital readmissions. The Power of 3 educational tool, designed by Sanchez and Cooknell, addressed the factors that impeded effective patient teaching by using the adult learning theory and low health literacy concepts. The Power of 3 was implemented as a quality improvement …

Development Of Evidence-Based Scenario With High Fidelity Simulation To Improve Nursing Care Of Chest Pain Patients, Ma Zolaica Paragas

Walden Dissertations and Doctoral Studies

Cardiovascular disease remains the leading cause of mortality in the United States, and a primary educational objective is to develop professional competency among nurses to ensure the provision of safe and effective care to the cardiac patient. Benner's theory of novice-to-expert led to the development of an evidence-based scenario for the care of the patient with chest pain using risk-free high-fidelity simulation environments that focused on assessment, history taking, and communication, while evaluating improvements in the competency of nurses providing care to chest pain patients. Thirty-six nurses volunteered in the study. Feedback from nurse educators, which led to modifications to …

Identifying The Beliefs And Barriers To Mammography In Rural African Women, Linda Harper Mangum

Walden Dissertations and Doctoral Studies

Breast cancer is the most commonly diagnosed cancer in African-American (AA) women and is the second leading cause of cancer-related deaths in the United States among AA women ages 40 to 55 years of age. The 5-year breast cancer survival rates for AA women (78%) are lower than are those of Caucasian women (90%). The purpose of this project was to describe the benefits and barriers toward screening mammograms for breast cancer in AA women living in the Southside Health District in Virginia. The subscales of The Champion's Mammography Beliefs and Attitudes Questionnaire (MBAQ, 1999), which is based on the …

Nurses' Knowledge Of Pain Assessments And Reassessments Impacts Hospitalized Patients' Reporting Of Pain, M. Michele Potter Williams Williams

Walden Dissertations and Doctoral Studies

Ineffective pain management can prolong a patient's length of stay and increase cost of care. Inadequate pain control decreases the patient's quality of life and contributes to poor health outcomes. A recent record audit showed that documentation of pain reassessments occurred only 20% of the time within an hour after administering pain medication. Furthermore, nurses may have insufficient knowledge regarding pain assessments and reassessments or hold irrational fears about addiction leading to inadequate treatment of pain. The purpose of this quality improvement project was to evaluate the effectiveness of an educational program for acute care nurses for the assessment and …

Moving Evidence Into Practice: Early Sepsis Identification And Timely Intervention In The Emergency Department (Project Code Sepsis), Jonjon Macalintal

Walden Dissertations and Doctoral Studies

Sepsis is the leading cause of death among hospitalized patients in the United States, is responsible for more than 200,000 deaths annually, and has as high as a 50% mortality rate. Sepsis requires prompt identification so that early goal-directed therapy can be instituted to lead to better outcomes. The purpose of this quality improvement project was to determine if implementing an evidence-based identification and intervention program, Project Code Sepsis, in the emergency department can increase the number of patients who receive antibiotics within the first hour of triage and decrease the length of hospital stay. Specifically, the primary project goals …

Development Of A Program Proposal For A Nitrous Oxide Program In Pediatrics, Sarah Oleson

Walden Dissertations and Doctoral Studies

When pediatric patients are admitted to the inpatient or outpatient hospital setting they potentially have to endure procedures that cause pain, fear, and anxiety which can have a lifelong impact on the child's response to future healthcare needs. The purpose of this project was to create a comprehensive program proposal for a nitrous oxide sedation program to minimize those perceptions towards medical procedures. The project utilized a systematic review of literature and secondary data to address the most important indicators for developing a comprehensive program proposal to present to the pediatric leadership team. Multiple studies have shown nitrous oxide having …

Increased Risk Factors For Substance Abuse And Attitudes Regarding Substance Use Among Nursing And Non-Nursing Students, Carolyn Sue Britt

Walden Dissertations and Doctoral Studies

Nonmedical prescription drug (NMPD) use is a well-documented problem among college students, but few studies have examined nursing students' attitudes regarding NMPD. The purpose of this study was to compare nursing and non-nursing students' attitudes, risk factors, and current substance use. This descriptive, comparative design utilized a convenience sampling and social media to reach students over 18 years of age and enrolled in a Midwestern university. Twenty-nine students, 14 non-nursing and 15 nursing students, participated in this online survey. Substance use attitudes were measured using the Drug Attitude Scale (DAS). Risk factors for substance use were used as demographic questions …

Telehealth: Improving Quality Of Life In Veterans With Congestive Heart Failure, Marcia Callender Callender

Walden Dissertations and Doctoral Studies

Congestive heart failure (CHF) affects an estimated 5.1 million Americans over the age of 20. The purpose of this quantitative study was to determine whether there is a difference in the Quality of Life (QOL) for Congestive heart failure patients receiving care through telehealth compared to patients receiving face-to-face care (usual care). Guiding this project was the Self-Care Model of Chronic Illness because the primary outcome of the self-care model is illness stability, well-being, and quality of life. Seventy-seven veterans with Heart Failure (HF) from the Washington D.C. Veterans Affairs Medical Center (VAMC) participated in the project. Forty reported they …

The Watson Room: Managing Compassion Fatigue In Clinical Nurses On The Front Line, Crystal Denise Crewe

Walden Dissertations and Doctoral Studies

The concept of compassion fatigue (CF) emerged in the early 1990s in North America to explain a phenomenon observed in nurses employed in emergency departments. A precursor to burnout, CF is a well-known phenomenon associated with emotional exhaustion, depersonalization, and an inability to work effectively. In nurses, CF has been shown to reduce productivity, increase staff turnover and sick days, and lead to patient dissatisfaction and risks to patient safety. The aim of this study was to determine if the use of a Watson Room designated as a 'quiet zone' with warm colors on the wall, massage chair, and soothing …

Nursing Distance Learning Course Comparison Of Assignments And Examination Scores, Jennifer Mundine

Walden Dissertations and Doctoral Studies

Nursing programs have embraced distance learning in their curricula, but discussion is ongoing about course assignments and grading criteria to increase examination scores in nursing distance learning courses. Because course examinations are a predictor of success on the postgraduate licensing examination (NCLEX-RN), the purpose of this study was to determine whether differences existed in student examination scores between nursing distance learning courses with and without points aligned to assignments. The theoretical framework was Knowles's theory of andragogy, which highlights adults' motivation and self-direction to succeed. The quantitative causal comparative study included a convenience sample of 164 students to compare archival …