Nursing Commons^™

Development Of A Teach-Back Educational Module For Heart Failure Discharge Teaching, Marissa Blair Jamarik

Walden Dissertations and Doctoral Studies

Heart failure (HF) readmissions create a financial burden for healthcare nationwide and speak to the lack of effective discharge preparation for patients to be successful with self-care at home. The 183-bed hospital where this DNP quality initiative will take place currently reports an observed-over-expected (O/E) readmission rate for HF patients (Centers for Medicare and Medicaid [CMS]). Core measures on HF developed by the Joint Commission and the Centers for Medicare and Medicaid Services do not appear to be enough to ensure successful transitions of care from hospital to home. Guided by the LOGIC model, the purpose of this quality improvement …

Strategies To Mitigate Nurse Turnover In Eastern And Northern Virginia, Fred E. Echoles

Walden Dissertations and Doctoral Studies

Registered nurses leaving the workplace are estimated to cost healthcare organizations and society between $1.4 and $2.1 billion annually. The purpose of this multiple case study was to explore what strategies leaders of healthcare organizations from the Eastern and Northern regions of Virginia can use to mitigate the effects of nurse turnover and its cost to the organization. The target population consisted of 8 RNs who experienced turnover during their nursing careers. The conceptual framework for this study was Herzberg's dual-factor theory. Face-to-face semistructured interviews were conducted and publically available documents were garnered. Thematic reduction of participants' interviews, coupled with …

Impact Of Simulation Training On Novice Nurses, Sheila Marjean Moore

Walden Dissertations and Doctoral Studies

In 1999, the Institute of Medicine released its report on building a safer health system. Since then, safety in patient care has become a paramount interest. Given the growing support for increasing patient safety, simulation training has become a common part of novice nurses' orientation program. This simulation training is designed to mimic situations in the acute care setting where novice nurses can practice in a patient safe environment. In this DNP project, a stroke simulation scenario and supporting patient chart was developed as an addition to a novice nurses' orientation program. The National League for Nursing simulation template was …

Creating And Establishing Content Validity Of A Tool Kit To Educate Mothers Of Premature Babies, Lilian Chinyere Ofoegbu

Walden Dissertations and Doctoral Studies

Abstract

Delivering a preterm baby who is admitted to a neonatal intensive care unit can be an enormous hardship for parents and families, and especially for mothers. The consequences of prematurity alter the parental role, affect their confidence in caring for the baby, and subsequently may impact infant outcomes. Adequately educating mothers of premature babies using an evidence-based practice approach may help them gain the confidence and skills needed to care for their infants. The purpose of this project was to create a tool kit to educate mothers of premature babies about the essential components of caring for their babies, …

Breastfeeding Education For Women With Diabetes, Pregnancy-Induced Hypertension And Multiple Gestations, Oluwapelumi Adefunmike Adeboyejo

Walden Dissertations and Doctoral Studies

Breastfeeding is considered a public health concern due to increased maternal/infant mortality and morbidity rates associated with persistent low rates in breastfeeding. Providing early breastfeeding education for women with diabetic, pregnancy-induced hypertension and multiple gestations can result in higher persistence rates and a decrease in maternal and infant mortality and morbidity rates. This quality improvement project provided early prenatal breastfeeding education for women with diabetes, pregnancy-induce hypertension and multiple gestations at a private clinic in Long Beach, Southern California. Evidence-based literature reviews were conducted through CINAHL and Medline (2009-2014). The descriptive study used for the project was made up questionnaires …

The Transition-To-Practice Gap And Graduate Nurse Proficiency, Maxine Coleman

Walden Dissertations and Doctoral Studies

After nursing school, graduate nurses complete a licensure examination to demonstrate possession of the minimal knowledge necessary to practice nursing. Even with the successful completion of the examination, many new graduate nurses still lack the competencies required for safe practice. This discrepancy between demonstrated knowledge and competent practice, which is termed a transition-to-practice gap, is a safety issue especially for persons with chronic illnesses. The purpose of this study was to identify and clarify this transition gap to determine possible solutions in the local setting of a large health care system. The theoretical model framing this investigation was Benner's novice …

Effectiveness Of A Critical Care Nurse Residency Program, Pam Redman

Walden Dissertations and Doctoral Studies

The importance of nurse residency programs is addressed in the literature; however, a review of residency program outcomes and effectiveness is needed. Guided by Roy's adaptation model and Deming's plan-do-check-act model, the purpose of this quality improvement project was to assess the current state of a longstanding critical care nurse residency program in meeting organizational goals and objectives and to recommend modifications to the program related to external factors, internal challenges, and educational deficits of nurses entering the program. A review of the evidence-based literature and feedback from focus groups of leadership stakeholders were used to develop recommendations for residency …

Healthy Work Environment: Essentials For Outcome Improvement, Lisa Cuff

Walden Dissertations and Doctoral Studies

The purpose of this project was to identify the standards for the American Association of Critical Care Nurses (AACN). The employees of a 39-bed medical surgical unit within a 697-bed metropolitan medical center were selected through collaboration with the practicum site. Out of 68 allocated positions for this unit, only permanent employees were selected to participate. An employee presented the purpose of the project, the survey process, and inferred consent represented by online login to complete the survey. Following the online assessment, the employee explained the AACN healthy work environment standards in a subsequent presentation. The online healthy work environment …

Barriers To Exclusive Breastfeeding Among Mothers During The First Four Weeks Postpartum, Jessy V. Thomas

Walden Dissertations and Doctoral Studies

According to the World Health Organization, breastfeeding is natural and the most effective way of nourishment to feed infants and young children to ensure child health and survival. Currently, the World Health Organization, the American Academy of Pediatrics, and other health organizations recommend exclusive breastfeeding during the first 6 months of life. Although exclusive breastfeeding has been shown to reduce the occurrence of adverse health outcomes to the infant and mother, the duration of exclusive breastfeeding remains relatively low in the United States. The theory of planned behavior was used as a theoretical framework for this study. The purpose of …

Nurses' Experiences Transitioning From Staff Nurse To Management In A Community Hospital, Jennifer Sylvia Buffenbarger

Walden Dissertations and Doctoral Studies

This project study addressed the problem of frequent turnover of nurse managers at a Northeastern community hospital. The lack of retention of nurse managers has led to attenuated support for the nursing staff who continued to hold the front line in patient care. The purpose of this qualitative bounded case study was to explore nurse managers' experiences with turnover in order to identify strategies for enhancing retention. Work empowerment and servant leadership theories served as the frameworks for the study. Research questions focused on nurse managers' perceptions of empowerment and servant leadership characteristics that were important in decisions to assume …

Practice Preparedness In New Graduates: Exploring The Education-Practice Gap, Wendy L. Batch-Wilson

Walden Dissertations and Doctoral Studies

As newly licensed registered nurses enter their first nursing role, their perceived preparation for practice may vary. This descriptive study addressed the education-practice gap that exists as nurses transition into nursing practice. The use of Benner's skill acquisition model offers a structure for connecting theory to practice. New graduate nurses responded to the Casey-Fink Graduate Nurse Experience Survey-© to identify gaps in preparedness for novice practice. A convenience sample of nurses within the first 12 months of hire (n = 35) was sent the survey link by educators from the chosen sites. Anonymity was maintained with 18 total responses and …

Diabetes Self-Management Education For Adults With Type 2 Diabetes Mellitus, Rondalyn Dennis-Bradshaw

Walden Dissertations and Doctoral Studies

Diabetes, a major public health challenge in St. Kitts, has been a focus of international public health community research. Although researchers have demonstrated that diabetes self-management education is a cost-effective strategy for the prevention of diabetes-related complications, they have yet to establish whether there is adequate education occurring in treatment settings with diabetic patients. The purpose of the study was to implement and evaluate the short-term effectiveness of a diabetes self-management education intervention on diabetes-related knowledge and accepted behavioral changes to decrease risk for complications. Based on a self-care approach, this education intervention was designed to improve diabetes-related knowledge and …

Reducing The Surgical Patient's Family Member's Anxiety Using An Electronic Patient Tracking Board, Pamela M. Barberi

Walden Dissertations and Doctoral Studies

Family members of surgical patients experience anxiety due to lack of consistent communication during the surgical process. Attending to the needs of the surgical patient's family members is an important factor easily forgotten in a busy clinical arena. The purpose of this project was to decrease the surgical patient's family member's anxiety by providing family members with timely and consistent information regarding the patient's progress through surgery. The theoretical foundation used was general systems theory showing that a change in one part of a system leads to change in the whole system with the use of improved communication and feedback. …

The Effect Of A Culture Of Safety On Patient Throughput, Laurie Lee Dawn Dillon

Walden Dissertations and Doctoral Studies

There is a national movement to create improvements in patient safety and outcomes due to evolutionary changes in the healthcare. Many health care organizations are using the framework of a culture of safety in order to create a reliable and stable work environment that emphasizes safety and improves patient outcomes. Patient throughput, defined as the active management of the supply of patient beds (rooms for occupation) to the demand of patients to beds and the length of time it takes for this action to occur, has been identified as one of the areas in need of improvement. This study considered …

Promotion Of The Hospital's Patient Portal, Courtnie Jones Burrell

Walden Dissertations and Doctoral Studies

The Centers for Medicare and Medicaid Services wanted to ensure that electronic health records were used in a meaningful manner to improve coordination and quality of patient care. In 2011, the federal government began offering monetary incentives to help healthcare facilities and providers adopt technology that supported patient access and increased their ability to manage their own health. The hospital where this project took place encouraged patients’ involvement in their health by providing a patient portal, yet the public has underutilized it. The purpose of this project was to develop an evidence-based strategy for future implementation at the hospital that …

The Effects Of The Night Shift On Nursing Staff Of An Inpatient Hospice Facility, Carolyn Dopson Horton

Walden Dissertations and Doctoral Studies

The night shift environment in an inpatient hospice facility is unique in care and relegates challenging situations for the nursing staff. Using the Parse methodology, the purpose of this project was to explore the challenges faced by inpatient hospice facility night shift nursing staff in providing a continuum of care for dying patients and their families. Nine night shift hospice nurses participated in 45-60 minute interviews. The interviews were conducted in a hospice quiet room or a designated place of comfort for the participant, which allowed for dialogical engagement. The interviews were unstructured with open-ended questions about lived experiences. The …

Using Appreciative Inquiry To Improve Rn Retention In A Clinical Float Pool, Janet Buck

Walden Dissertations and Doctoral Studies

In an Idaho-based hospital, the registered nurse (RN) turnover rate in the float pool was excessively high. The purpose of this project was to examine the effect of Appreciative Inquiry (AI) on a RN's sense of community (SOC) in a float pool and an RN's intent to stay employed after attending an AI event. Although much had been written about nursing retention, AI, and SOC separately, there was nothing on how AI could be used to increase a RN's SOC or intent to stay employed. AI is a change management framework that has been used to engage employees in a …

Diabetes Education Tailored Towards English Speaking Caribbean Immigrants, Joanna A. Dunk

Walden Dissertations and Doctoral Studies

The prevalence of diabetes is increasing among persons of Caribbean ancestry in the United States, yet there is little research on the differences in the health and nutrition patterns of diabetics from this population. This study created a culturally-sensitive diabetes education program for the staff of an internal medicine practice that treated patients from the English-speaking Caribbean. The project was guided by the health belief model, as well as Leininger's theory of transcultural nursing. Methodology of project had a quality improvement focus. The comprehensive curriculum included diabetes medications, physical activity, culturally-tailored medical nutrition therapy, complications, self-care behavior, problem solving, and …

Faculty Perspectives On Factors Impacting Work As Nurse Educators, Sharon Shockness

Walden Dissertations and Doctoral Studies

Job dissatisfaction among nursing faculty could have a significant impact on nursing faculty retention and student enrollment in nursing programs. The purpose of this qualitative instrumental case study was to gain insight into the perspectives of faculty members who teach nursing education in a university program. This study used Herzberg, Mausner, and Snyderman's motivation-hygiene theory to explore employee satisfaction and dissatisfaction in the workplace. The research question focused on the perspectives of nursing educators and challenges they face. Data were collected through individualized interviews with 15 nurse educators, using open-ended questions and reviewing relevant documents. The data were analyzed by …

Planning For A Community Supported Farmers Market In A Rural Usda Food Desert, Carrie Lynn Engelbright

Walden Dissertations and Doctoral Studies

A community initiative to develop and sustain a farmer's market can address insufficient access to fresh and affordable fruits and vegetables for individuals working and residing in a United States Department of Agriculture (USDA) designated food desert. This project addressed a particular USDA food desert in South Wood County, Wisconsin. The purpose of this project was to develop and plan for implementation and evaluation of a community-supported farmers market in South Wood County, with the goal to increase access to fruits and vegetables. Project objectives included development of a sustainable community infrastructure to support the market, development of policies and …

An Outcome Evaluation Of An Evidenced-Based Leadership Framework On Nursing Retention In A Tertiary Medical Center, Robbie Gail Robbie

Walden Dissertations and Doctoral Studies

An evidence-based leadership (EBL) framework is an intervention designed to facilitate organizational changes such as the reduction of nursing turnover and the improvement of nursing job enjoyment. This project provides an overview of the effect of nursing turnover on an organization, presents the components of the EBL framework, and provides an evaluation of the influence of EBL on nursing turnover and job enjoyment. The EBL framework provided a method for reducing variance in leadership skill and behavior by outlining specific methods necessary to reduce inconsistency. The project objective was to determine if the implementation of an EBL framework for 820 …

Development Of An Evidence-Based Influenza Vaccination Program For Nurses, Marlene Reid

Walden Dissertations and Doctoral Studies

The purpose of this educational influenza vaccination project was to increase nurses' influenza vaccination rates. Nationally, 41% of nurses were vaccinated, which is far below the Healthy People 2020 goal of an influenza vaccination rate of 90%. Literature suggests that the low nurses' vaccination rate is responsible for inpatient healthcare associated influenza, mortality, and influenza-like illness. Healthcare facilities will not be reimbursed for treatment of healthcare associated infection. Despite recommendations from the Centers for Disease Control and Prevention for nurses to become vaccinated, only 20% of the 800 nurses at a healthcare facility in Baltimore were vaccinated for the past …

Needs Assessment For A Nurse Practitioner-Led Transitional Care Program, Maria Victoria Trinidad Salcedo

Walden Dissertations and Doctoral Studies

The rising cost of health care and changes in healthcare delivery have prompted a need to improve continuity from the hospital to home. This scholarly project was initiated to assess the impact on patient outcomes related to initiation of a nurse practitioner-led transitional care program (TCP). Using the Diffusion of Innovations and Health Belief Models, the purpose of this study was to identify the impact of a TCP on improving the health of patients with congestive heart failure (CHF), diabetes mellitus Type II (DM II), and chronic obstructive pulmonary disorder (COPD). The impact of the TCP was evaluated by a …

Nursing Care Of Terminal Patients In Intensive Care Units, Pervell Velethia Dunbar

Walden Dissertations and Doctoral Studies

Nursing Care for Terminal Patients in Intensive Care Units

by

Pervell Dunbar

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

August 2015

Although the goal of the ICU has always been to save lives, ICU now additionally provides end-of life (EOL) care. The objective of this project was to provide ICU nurses with a comprehensive awareness of physical, emotional, and spiritual EOL care issues of patients and their families in order to be better equipped to handle EOL care. The framework used was Jean Watson's Caring model (10 Caritas). A …

Challenges Of A Novice Nurse Educator's Transition From Practice To Classroom, Tori Brown

Walden Dissertations and Doctoral Studies

This project study addressed the lack of formal preparation encountered by novice nurse educators within a nursing program located in the southeastern region of North Carolina. This problem is significant at both the local and national levels because expert clinicians are needed to fill nurse educator vacancies that have led to qualified students being denied admission to nursing programs. A qualitative case study research design was employed to explore the perceptions of novice nurse educators in one nursing program transitioning from clinical nursing practice to the nurse educator role. The theoretical framework to guide this study was Benner's novice to …

Nurse Educators' Perspectives Of Supplemental Computer-Assisted Formative Assessment In An Associate Degree Nursing Program, Jennifer Buehler Sugg

Walden Dissertations and Doctoral Studies

Despite the implementation of various strategies to improve outcomes, the pass rates for the National Council Licensure Exam for Registered Nurses (NCLEX-RN) for an associate degree nursing (ADN) program continue to decrease. This study examined the use of a supplemental computer-assisted formative assessment (SCAFA) as a strategy for NCLEX-RN success. A qualitative case study with a theoretical framework based on constructivism was designed to investigate nurse educators' perspectives of this particular strategy for successful outcomes. To explore these perspectives, data were collected from face-to-face interviews with nurse educators and from program documents from 1 ADN program in the southeastern United …

Cultural Competence Education For Care Coordinators, Wendy Janet Renault

Walden Dissertations and Doctoral Studies

Aboriginal people bear a burden of health disparities when compared to non-Aboriginal people in Canada. To date, traditional health-related programs to address these disparities have not been effective. Compounding this problem, the Aboriginal people have also reported dissatisfaction with the healthcare system and the relationships they experience with healthcare providers. However, the literature supports that when providers employ cultural competence in their practice, there is a possibility for improved relationships with patients. Using critical social theory as a framework, the purpose of this project was to conduct a 1-hour class on cultural competence for care coordinators and nurses in a …

A Proposal For The Development And Validation Of A Diabetic Self-Management Education (Dsme) Program, Melissa Sue Garrison

Walden Dissertations and Doctoral Studies

The World Health Organization has estimated that by 2030, approximately 350 million people will be diagnosed with Type 2 diabetes mellitus (T2DM). Currently, 18.8 million people are diagnosed with T2DM. An additional 7 million people have high blood sugar but have yet to have an official diagnosis of diabetes. The literature supports early identification and prevention are key to reducing the severity of T2DM its complications. The Health Belief Model, the Chronic Care Model and Orem's Theory of Self-Care guided the current proposal, whose purpose was to develop and validate a new T2DM DSME module. A validation of the DSME …

Correctional Nurses' Knowledge And Perceptions Of Methicillin-Resistant Staphylococcus Aureus, Deborah Winbush

Walden Dissertations and Doctoral Studies

Since 1999, Methicillin-resistant Staphylococcus aureus (MRSA) outbreaks have occurred in many correctional facilities. Even after the Federal Bureau of Prisons developed clinical practice guidelines on the management of MRSA within correctional facilities, the prevalence of MRSA decreased only insignificantly. Other researchers suggested infection control compliance was equally as important as developing clinical practice guidelines in reducing the incidence of MRSA. Several studies identified the healthcare professionals' nonadherence and inconsistencies to clinical practice guidelines as contributors to MRSA transmission. Accordingly, this project was designed to develop evidence-based recommendations for improving nurse professionals' adherence to MRSA practice guidelines in correctional settings. Using …

Oral Care Practice Guidelines For The Care-Dependent Hospitalized Adult Outside Of The Intensive Care Unit Setting, Cynthia Susan Drapal

Walden Dissertations and Doctoral Studies

Many nurses lack evidence-based knowledge to deliver appropriate oral care, view oral care in the care-dependent patient as a comfort measure, and give it a low clinical priority. An estimated 44%-65% of hospitalized care-dependent patients do not receive adequate oral care, an intervention that can prevent aspiration pneumonia or pneumonitis. The purpose of this project was to develop a policy for use of an oral assessment tool and evidence-based guidelines for oral care in hospitalized care-dependent adults outside of the intensive care unit setting at a regional health system in the Southeast United States. The project used the theoretical foundations …