Nursing Commons^™

Reducing Maternal And Child Morbidity And Mortality Through Project Recommendations, Dominique Valentin

Walden Dissertations and Doctoral Studies

Haiti is a Caribbean island with a humanitarian medical center providing healthcare services to 90,000 residents. Pregnant women visiting the medical clinic for prenatal care often do not return for delivery; instead, they return home to deliver alone or with the assistance of a traditional matron. Home-birth practices increase maternal-child health morbidity and mortality in an already fragile country. The purpose of this project was to gain a deeper understanding of Haitian pregnant women's preferences to deliver at home or at the healthcare clinic. The transtheoretical model for behavior change and the Johns Hopkins nursing evidence-based practice model guided the …

Effect Of Home Telehealth On Vterans With Chronic Heart Failure, Yolanda Major

Walden Dissertations and Doctoral Studies

More than 5 million Americans have heart failure, with approximately 5% of those affected being veterans. As the number of patients with CHF continues to rise, new treatment options are needed to improve the quality of care. Current studies show Telehealth is one treatment option. The purpose of this scholarly project was to determine if veterans diagnosed with CHF were able to maintain optimal weight and blood pressure following participation in Care Coordination Home Telehealth (CCHT) program. The CCHT program provides care to veterans, through the use of monitoring devices placed in their home. Bandura's self-efficacy theory was used as …

Advanced Practitioner Provided Pre-Hospital Discharge Asthma Education, Lyndsay E. Gardner

Walden Dissertations and Doctoral Studies

Asthma is a leading cause of pediatric hospital admissions. Parents of children under the age of 18 with asthma require education to recognize and manage the signs and symptoms of the disease. Parent education has shown to decrease their children's hospital admission and readmission rates. The purpose of this pilot project was to develop an asthma educational module for the parents of children with asthma and obtain parent feedback on the content. Families with children under the age of 18 who had been admitted to the hospital with a diagnosis of asthma, an asthma exacerbation, or status asthmaticus were invited …

Effectiveness Of Cognitive Screening For Heart Failure Patients, Comfort Nkengla

Walden Dissertations and Doctoral Studies

Cognitive impairment is commonly seen in the elderly population. It is unclear if cognitive deficit in heart failure (HF) patients is a primary factor for higher hospital readmission rates in this population. The Centers for Medicare and Medicaid Services have established strict guidelines for reimbursement on readmissions that occur within 30 days. It is imperative that organizations identify and rectify issues that impact readmissions. The aim of this project was to determine if there is a reduction in HF readmission after patients are screened for cognitive impairment. Orem's self-care model guided the project by providing a framework of inquiry regarding …

Impact Of An Innovative Classroom On Bsn Students' Self-Efficacy And Academic Performance, Laurie Jo Singel

Walden Dissertations and Doctoral Studies

The critical shortage of registered nurses (RNs) in the United States has led to increased enrollment in nursing schools, but the number of graduates is still decreasing, as nursing students struggle and fail in upper division courses. There is a significant gap in knowledge concerning students' self-efficacy (SE) as a factor directly influencing students' academic performance. The problem examined in this correlational study was the impact of collaborative learning in an innovative classroom setting on Bachelor of Science in Nursing (BSN) students' SE and academic performance. Framed by Bandura's theory of SE, the research questions examined the relationship between students' …

Nurses' Perceptions Of Supports And Barriers In Transitioning To The Nurse Faculty Role, Kelly Flanigan

Walden Dissertations and Doctoral Studies

This project study addressed nurses' perceptions of supports and barriers in transitioning from a clinician to a faculty role in a 3-year diploma nursing program located in Eastern Pennsylvania. This problem is significant at both the local and national level due to the shortage of qualified nursing faculty members. A qualitative case study design using in-depth interviews was used. The framework to guide the study was Schoening's Nurse Educator Transition (NET) Model. The guiding question addressed perceptions of new nursing faculty members regarding supports and barriers of transitioning to the faculty role. Interview questions focused on participants' identification of their …

Evidence-Based Alternative Therapy To Reduce Anxiety In Ambulatory Mental Health Patients, Renee Ann Denobrega

Walden Dissertations and Doctoral Studies

Evidence-Based Alternative Therapy to Reduce Anxiety in Ambulatory Mental Health Patients

by

Renee Denobrega

MS, Widener University, 2013

BS, Alvernia University, 2007

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

January 2016

Transforming Care Of The Behavioral Health Patient In An Emergency Department Setting, Theresa J. Kubiel

Walden Dissertations and Doctoral Studies

Behavioral and mental health issues contribute to the needs of many patients presenting to emergency departments, and yet these needs often go unrecognized. Patient processing procedures in emergency departments may not include mechanisms to consistently identify and triage patients whose care is complicated by behavioral illness. The purpose of this project was to plan a program to improve early identification and management of behavioral health patients presenting to the emergency department. The objective of this project was to develop a rapid mental health screening tool and policies guiding use of the tool in the emergency department. A multi-disciplinary team of …

Assessing Knowledge Of Evidence-Basedpractice Among Nurses, Suja Merin John

Walden Dissertations and Doctoral Studies

Evidence-based practice (EBP) is used worldwide to improve the quality of patient care to provide cost-effective care. EBP is a mandate for nursing practice combining individual clinical judgment with available expertise to generate a positive outcome for the patient. Investigators have documented that nurses have varying degrees of confidence and knowledge about EBP. The purpose of this project was to improve knowledge of EBP among registered nurses (RNs). The ACE Star Model of Knowledge transformation was used as the conceptual model. The key project question was to assess the level of knowledge and confidence about EBP among RNs in a …

Development Of A Practice Guideline For Dnp Prepared Nurse Practitoners Working In Long-Term Care Facilities, Ashley M. Marshall

Walden Dissertations and Doctoral Studies

Clinical evidence-based practice guidelines providing recommendations for health care decision making have become vital components of long-term health care practice in the United States. Frequently changing guidelines have complicated nurse practitioners' (NPs) efforts to implement evidence-based practice into the daily care that they provide to patients. The purpose of this project was to develop an evidence-based practice guideline for doctoral-prepared NPs working in long-term care facilities. This project is important because practitioners use practice guidelines to provide patients with the most appropriate, evidence-based care. Kolcaba's comfort theory was used to guide this project. Kolcaba's theory holds that comfort exists in …

An Evaluation Of Service Learning For Associate Degree Nursing Students, Valerie Marie Pauli

Walden Dissertations and Doctoral Studies

The purpose of this study was to evaluate outcomes of the service-learning requirement in the Associate of Science in Nursing (ASN) curriculum at the local college. The problem addressed in this study was that the local ASN program lacked formal evaluation of the service-learning requirement. Guided by Kolb's model of experiential learning, a goal-based, summative evaluation employed as a qualitative case study explored the perceptions of 20 stakeholders including graduates, faculty members, and key community informants. The research questions focused on how service learning influenced a student's learning of cultural competence and the impact service learning had on the community. …

Analysis Of How Newly-Hired Nurses Are Educated To Provide Customer Service, Patricia Mcafee

Walden Dissertations and Doctoral Studies

As part of healthcare reform through the Affordable Care Act of 2010,

hospitals across the United States are being held accountable for

providing a positive patient experience and will lose up to 2% of

their reimbursement by 2017 if they fail to reach targeted scores.

The purpose of this quality improvement project was to review the

process used by a Georgia hospital to educate newly-hired nurses

about customer service expectations and to provide recommendations

for process improvement. Theoretical foundations supporting

customer service included the caring philosophy of Mayeroff; the

caring theories of Watson, Leininger, Boykin, and Nyberg; and

Roy's adaptation …

The Underuse Of Hospice Care In The African American Military Beneficiary Population, Wanda Castleberry Richards

Walden Dissertations and Doctoral Studies

Hospice services provide a holistic approach to end-of-life care to terminally ill patients though there is some evidence to suggest that African American military beneficiary populations may not access hospice care as often as expected. The purpose of this nonexperimental study was to evaluate reasons for the low use of hospice care among the terminally diagnosed members of this population, between the ages of 18 and 64. Kolcaba's comfort theory provided the theoretical framework for this study. The research explored whether a statistically significant difference exist among African Americans military beneficiaries population as compared to non-Hispanic Whites pertaining to their …

Evaluation Of Intervention To Increase Exercise Among A Group Of Hispanic Patients In South Florida, Rene Beltran Rodriguez Elias

Walden Dissertations and Doctoral Studies

Despite knowledge regarding the need for regular physical exercise, little is known about the most effective ways to encourage and maintain regular physical activity among primary care patients. New approaches to education about and support of physical activity are needed for everyone, but especially for groups susceptible to diseases related to sedentary lifestyles. This project evaluated a web-based educational intervention guided by the health belief model to address the lack of regular physical activity among 25 Hispanic patients in a South Florida clinical practice. The physically inactive patients were identified through the clinic's electronic medical records and consented to participate. …

Improving Bedside Swallow Screening In Acute Stroke Patients: An Evaluation Plan, Juliette Segree

Walden Dissertations and Doctoral Studies

A stroke is a life-changing event for a patient and his or her family. The acute stroke patient is at risk for developing aspiration pneumonia, whether silent or overt. Prevention of pneumonia in this population requires timely completion and documentation of the bedside swallow screen to identify those patients at risk for aspiration pneumonia; however, anecdotal data from the emergency department at the site of this project suggested that completion and documentation of the screening were inconsistent. Guided by the quality caring model adopted by the project site as well as the logic model, the aim of this project was …

Development Of A Church-Based Educational Program To Increase Prostate Cancer Screening For Black Men 40 And Older, Dawn Marie Silvera-Ndure

Walden Dissertations and Doctoral Studies

Prostate cancer is the most common cancer among men in the United States and is one of the leading causes of cancer death among men of all races. However, African-American men are at particularly high risk. These men are diagnosed more often with prostate cancer, are diagnosed later, and are more than twice as likely to die from prostate cancer than are Caucasian men. A strategy to address this inequity was to develop a community based program that would reach this at risk population. The goal of the project was to develop an evidence-based, theory-supported education and referral program to …

Case Study Of Stakeholders' Views On Retention And Self-Efficacy In Texas Nursing Programs, Durcilla Kay Williams

Walden Dissertations and Doctoral Studies

Retention of students through the completion of the nursing degree is a problem that exists at local Texas nursing programs, adding to the nursing shortage at local Texas hospitals. The purpose of this qualitative research study was to identify the best practices used by a local Texas college with graduation rates above the benchmark of 85% set by the Texas Higher Education Coordinating Board. The study framework was based on Bandura's theory of self-efficacy and Tinto's theory of student retention. The research questions for the study focused on reasons the college maintained a high retention rate, best practices currently used, …

Reducing The Use Of Indwelling Urinary Catheters During Cesarean Deliveries, Michelle Renee Borland

Walden Dissertations and Doctoral Studies

One concern for medical professionals and women experiencing cesarean deliveries is the use of indwelling urinary catheters, which is associated with a delay in first void time, slower ambulation time, increased discomfort, longer hospital stays, and an increased risk for urinary tract infections. The purpose of this project was to determine if a practice change regarding the use of urinary catheters among pregnant women decreases the number of women receiving a catheter prior to having a cesarean section in a small community hospital. The knowledge to action and Rosswurm and Larabee's models were used to guide this project, which was …

Creating A Safe Newborn Environment Education Program For Postpartum Registered Nurses, Melanie Myers

Walden Dissertations and Doctoral Studies

In the United States, sudden infant death syndrome (SIDS) is the 3rd leading cause of death for infants; other unintentional sleep injuries are the 5th. In addition, the estimated newborn fall rate in the United States is 1.6 to 6.6 falls/10,000 live births. At the project facility, postpartum registered nurses observed parents engaging in behavior that did not contribute to a safe newborn environment such as placing the infant at risk for injury from a fall or from a sleep injury. This observation led to this current project, which examined the development of an educational program for post-partum nurses to …

An Effective Succession Planning Educational Program For Operating Room Nurses, Sherly Bejoy Alexander

Walden Dissertations and Doctoral Studies

The current nationwide shortage of registered nurses is a growing problem impacting patient care and hospital operations. The operating room is the area most affected by the nursing shortage. Reasons cited for this shortage include ineffective nursing orientation programs and a decline in job satisfaction. The purpose of this project was to develop a best practice succession planning educational program to provide novice operating room nurses with an introduction to the operating room. The Dreyfus model of skills acquisition and Benner's novice to expert theory guided this project. A 2-step process was used to assess and validate the content and …

The Use Of The Illness Perception Questionnaire: Enhancing Clinical Staff Understanding, Typhanie Beasley

Walden Dissertations and Doctoral Studies

Women with Type II diabetes face unique challenges coping with the physiologic complications of the disease, which can be enhanced or hindered by their perception of their ability to effectively manage their diabetes. The Illness Perception Questionnaire (IPQ-R) is a tool that evaluates factors influencing patient-provider communication and assesses patient's perception of their health. Guided by the common sense model of self-regulation, this quality improvement project focused on familiarizing health care providers with the IPQ-R and evaluating their receptiveness to implement it with women with Type II diabetes. Seven Primary Care providers participated in an educational in-service that included information …

Compassion Fatigue In Emergency Department Nurses, Dionne Hutson Hendy

Walden Dissertations and Doctoral Studies

Compassion fatigue (CF) is a problem seen within healthcare institutions worldwide, especially critical care units and emergency departments (EDs). The problem identified in this quality improvement (QI) project was CF, experienced by nurses in the ED. The effects of CF cross nurse-patient boundaries and negatively impact a patient's expectations of having a quality care experience. The Iowa model's evidence-based team approach was used to guide the development of the education initiative for nurses on recognizing, preventing, and identifying methods of coping with CF in the ED. The outcome products for the project included an extensive review of the literature, a …

Effects Of Education On Pressure Ulcer Prevention In Developmentally Disabled Individuals, Jasneth M. James

Walden Dissertations and Doctoral Studies

Pressure ulcers were a continuing concern among the nonverbal developmentally disabled population of a state institution. The lengthy use of wheelchairs, the inability to body shift, and physical and mental impairment were attributes of the target population that have been cited in the literature as contributing to pressure ulcer. The purpose of this quasi-experimental pretest/posttest project was to evaluate the effectiveness of an education intervention for direct care staff on the prevention treatment, and eradication of pressure ulcers among patients with developmental disabilities. Orem's self-care deficit theory, particularly the emphasis on the need for nursing staff to perform self-care activities …

The Influence Of Nursing Academic Leadership On Faculty Retention, Carol Turrin Turrin

Walden Dissertations and Doctoral Studies

The critical nursing faculty shortage in the United States affects the ability of nursing schools to train an adequate number of nurses to meet increasing health care demands. Researchers have focused on the nursing faculty shortage; however, insufficient information exists on the relational influence leadership has on faculty retention. The research problem addressed in this study was the lack of information identifying how and in what ways leadership influences retention and intent to stay in academia. The purpose of this phenomenological study was to explore the perceptual views of current faculty, using the leader-member exchange theory. Focusing on baccalaureate nursing …

Nurse Education And The Reduction Of Nosocomial Infections In Acute Care Settings, Charmaine Amoy Byrd

Walden Dissertations and Doctoral Studies

Nosocomial infections are acquired in health care settings and they can lead to catastrophic health care consequences for patients. These infections can also pose significant financial burdens on society and health care systems. Educating nurses on hand hygiene is essential to reducing infection rates. The research question for the study examined the effectiveness of hand hygiene among nurses in reduction of nosocomial infections and how can health care organizations develop educational strategies to reduce nosocomial infections to improve public confidence in health care systems. The purpose of this study was to educate nurses on how to reduce the incidence of …

Managing Acute Pain In Postoperative Surgical Patients, Sabrina Gregory

Walden Dissertations and Doctoral Studies

Every year, millions of Americans suffer from either chronic or acute pain that results in tremendous healthcare cost, rehabilitation, and loss of work productivity. Pain is an unpleasant sensation associated with sensory and emotional experiences that can cause potential or actual tissue damage. One plausible solution to managing pain is the use of nonpharmacological modalities such as guided imagery. The purpose of this project was to determine if there was a difference in pain scores following pharmacological interventions and the use of guided imagery among postoperative same day surgical patients. Guided imagery is a nonpharmacological modality that uses pictures, music, …

Development Of A Policy And Procedure To Decrease Alarm Fatigue, Samantha Deck

Walden Dissertations and Doctoral Studies

According to The Joint Commission (TJC), 98 unexpected and unacceptable events related to alarm fatigue were reported in United States hospitals between January 2009 and June 2012. There were 80 deaths, 13 permanent loss of function, and 5 extended care stays that occurred during this time period. The problem identified in this quality improvement (QI) initiative was the TJC report that nursing staff in the US was experiencing alarm fatigue due to the overstimulation of senses from continuous beeping from alarms on the unit. Framed within the Iowa model of evidence-based practice to promote quality care, the purpose of the …

Improving The Charge Nurse's Leadership Role: A Collaborative Learning Forum, Felicia Katherine Pryby

Walden Dissertations and Doctoral Studies

Staff nurses are frequently placed in charge nurse positions without the necessary formal training. The long-term goal of this project was to develop a curriculum for a formal institutional leadership workshop for the charge nurses at the practicum site. The Johns Hopkins Nursing Evidence-Based Practice model and Lewin's change theory were used to guide the development and implementation of the workshop. Data were collected using a focus group approach with 4 novice and 5 expert medical-surgical charge nurses. The short-term goal of the project was to understand the charge nurses' perceptions of leadership and the challenges as a front-line leader. …

Transformational Leadership As A Means Of Improving Patient Care And Nursing Retention, Carla D. Thomas

Walden Dissertations and Doctoral Studies

The Joint Commission (TJC) sets standards to assist healthcare organizations in improving performance. The hospital for which this project was developed did not meet national TJC benchmarks for patient satisfaction and nurse retention. Based on direct observation, discussion with staff, and results of the Multifactorial Leadership Questionnaire given to 39 staff nurses before this project was chosen, evidence suggested that the leadership style of the charge nurses was transactional, which is less effective than transformational leadership (TFL). Framed within the Plan, Do, Study, Act model, the purpose of this quality improvement project was to design an educational curriculum including didactic …

A Needs Assessment Of African American Women's Risk For Cardiovascular Disease, Chikaodi Priscilla Eziaha Banor

Walden Dissertations and Doctoral Studies

Suboptimal cardiovascular health among African American (AA) women contributes to high costs of care related to acute illness, chronic illness, and disability. Using the health promotion model, this needs assessment project examined risk factors that predispose adult AA women between the ages of 21 to 64 years of age to higher incidence of cardiovascular disease (CVD). Seventy of the 300 charts that met the inclusion criteria (female AA patients, 21 to 64 years of age, receiving care in a community clinic in an urban city of Texas) were audited for this project. Descriptive analysis showed that 66% of the women …