Nursing Commons^™

Assessment Practices At An Associate Degree Nursing Program, Tracey Jane Siegel

Walden Dissertations and Doctoral Studies

Nursing programs have traditionally used teacher-developed multiple-choice (MCQ) examinations to prepare students for licensure. Researchers have determined that poorly constructed MCQ tests used as formative and summative evaluations may penalize nursing students and impact progression and retention in nursing programs. The purpose of this exploratory case study was to examine issues related to the use of teacher-developed MCQ examinations as the only method of student assessment in the theory component of nursing courses. The National League for Nursing Core Competencies for Nurse Educators and the revised Bloom's Taxonomy were used as the conceptual frameworks for this study. The Director of …

Critical Care Nurses' Perceptions Of Their Knowledge And Self-Efficacy About Providing End-Of-Life Care, Mary Kathryn Gaffney

Walden Dissertations and Doctoral Studies

Most nurses receive limited formal education regarding end-of-life (EOL) care, which affects their ability to meet dying patients' needs. Guided by Bandura's social learning theory, this explanatory correlational study examined the relationships between critical care nurses' personal and professional characteristics and their perceived knowledge and self-efficacy when providing EOL care at an academic medical center. Convenience sampling was used to recruit participants from the eligible adult, pediatric, and neonatal critical care nurses for this study. The 67 participants completed the End-of-Life Professional Caregiver Survey (EPCS) to assess EOL care knowledge and self-confidence. Total EPCS scores revealed only moderate levels of …

Nursing Students' And Novice Clinical Instructors' Experiences With Clinical Instruction And Assessment, Bridgett Alveta Jackson

Walden Dissertations and Doctoral Studies

Adjunct faculty members make up a growing proportion of nursing school clinical faculty in the United States due to a nurse educator shortage in higher education. Many of the nurses hired as clinical faculty members have years of experience providing patient care, but they lack experience in clinical instruction and assessment. At a state community college in the southeastern United States, nursing students have expressed dissatisfaction in their course evaluations with inexperienced faculty in clinical programs. The experiences of both nursing students under the guidance of novice clinical instructors and clinical faculty were examined in this case study. The National …

The Effect Of The Implementation Of Relationship-Based Care On Patient Satisfaction, Laura Ellen Field

Walden Dissertations and Doctoral Studies

The purpose of this project was to evaluate the effects of relationship-based care (RBC) on patient satisfaction. RBC is a caring model that promotes a caring and healing environment by establishing and maintaining therapeutic relationships between patient, self, and coworker. The Centers for Medicare & Medicaid Services links Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores with reimbursement to hospitals. It is essential to not only achieve high patient satisfaction scores in order to ensure full financial reimbursement, but also to ensure high quality, patient-centered care. The current project assessed samples from 2 medical surgical groups, one system-wide …

Factors That Influence Empowerment In Adjunct Faculty Members, Lisa Murthy

Walden Dissertations and Doctoral Studies

To offset the cost and meet the demand for high quality nursing graduates, adjunct faculty members are hired to educate students in the practice settings. Adjunct faculty may not have access to the resources allocated to full-time faculty and may not feel empowered to provide the most effective educational experiences for the students. The purpose of this quantitative study was to measure factors that influence empowerment in adjunct faculty members teaching in an associate degree nursing program at a community college located in the Midwestern United States. The study also examined whether there is a difference in the empowerment of …

A Staff Development Program: Diabetes And Tb Education And Screening, Relyndo Manalo Salcedo

Walden Dissertations and Doctoral Studies

There is a growing body of evidence on the positive association between diabetes and tuberculosis (TB), especially in populations with low socioeconomic status. According to the CDC and the WHO, diabetes is increasingly seen as a global epidemic, one that poses a threat to global TB control. The goal of this DNP project was to develop a program to educate clinical staff on the importance of early identification of diabetic and TB patients. The logic model was chosen as the framework for this project because it allows the planner to rationally observe each stage of a project's development. The program …

Self Esteem, Locus Of Control, And The Relationship With Registered Nurses' Experience With Workplace Incivility, Elizabeth Anne Berry

Walden Dissertations and Doctoral Studies

The study's purpose is evaluating the relationship between locus of control and selfesteem

in relation to the registered nurse's experience and perception with lateral and

vertical incivility. There is a lack of research concerning nurse-to-nurse incivility within

the nursing profession. The hypothesis examined whether dynamics of locus of control

and self-esteem could provide insight into the personality dynamics influencing incivility

in the workplace. This non-experimental quantitative study used 2 self-evaluation tools

and 1 demographic survey tool to collect data via Survey Monkey, a commercial data

collection company. Participants were 65 randomly selected faculty (n = 36) and

graduate students (n …

Student Perceptions Of Effective Learning Strategies For National Council Licensure Examination Preparation, Lori Jean Johnson

Walden Dissertations and Doctoral Studies

The purpose of this study was to examine efficacious instructional strategies that the New England Community College (NECC) nursing program could implement in the curricula to improve National Council Licensure Examination Registered Nurse (NCLEX-RN) first-time pass rates. Effective strategies from students and nursing program faculty had used were investigated. Such strategies support student nurses in their efforts to succeed on the first administration of the exit examination. The rationale for this study and resulting project was that they could improve NCLEX-RN first-time pass rates and positively impact the local hiring of qualified nurses. Guided by Knowles's adult learning theory, key …

Nurse-Physician Communication Tools To Enhance Use Of Nursing Evidence-Based Protocols, Tochi Onyenwe Ubani

Walden Dissertations and Doctoral Studies

Nurse-Physician Communication Tools to Enhance use of Nursing Evidence-Based Protocols

by

Tochi Onyenwe Ubani

MSN, Walden University, 2011

BSN, Chamberlain College of Nursing, 2009

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

February 2015

In the current health care environment, consumers are demanding collaboration among clinicians even when traditional attitudes minimize nurses' input on the direction of clinical care. Compounding this problem is that nursing practices have not always been derived from randomized clinical trials, but instead from personal experiences. The purpose of this study was to explore the perceptions …

Implementing Bedside Shift Report: An Evaluation Of Change In Practice, Jessica Palumbo

Walden Dissertations and Doctoral Studies

Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) survey results from 2013 revealed a need for improvement in nurse-patient communication at the unit level. In response, nursing administrators at an acute-care hospital asked bedside nurses to develop a protocol for bedside shift report according to best practices. The protocol was implemented in May 2014. Three months later, a postimplementation survey was distributed. Work from Lewin and Kotter theoretical concepts were used to evaluate this organizational change. The purpose of this study was to determine whether re-educating staff nurses on the bedside shift report protocol increased compliance with evidence-based practice …

The Use Of Mock Code Training In Improving Resuscitation Response, Maureen Anne O'Brien

Walden Dissertations and Doctoral Studies

The American Heart Association's Get With the Guidelines (GWTG) has established measures for how quickly a resuscitation team is to respond in a cardiac arrest with performance of cardiopulmonary resuscitation (CPR) and defibrillation. Two of the core measures for GWTG require initiation of CPR within 1 minute of cardiac arrest and defibrillation within 2 minutes in at least 85% of cases. The problem of interest in this Doctor of Nursing Practice (DNP) project was that the facility had not been able to reach 85% on these 2 measures. The purpose of this project was to achieve nursing response times for …

Effects Of Telemedicine In The Intensive Care Unit On Quality Of Care, Amanda Wallace

Walden Dissertations and Doctoral Studies

The growing concern over the nursing shortage has affected the intensive care unit (ICU) and how these units provide quality care, adhere to best practices, and maintain high satisfaction scores. Implementing telemedicine technology allows the ICU to have additional staff available, via cameras at an offsite location, to assist with patient care. The purpose of this project was to evaluate the potential benefits of telemedicine application used within an ICU on quality of care, adherence to best practices, and satisfaction, as evidenced by data from the hospital's telemedicine dashboard. The goals of this project were to reduce length of stay, …

Identifying Risk Factors For High Incidence Of Peripheral Intravenous Catheters Complications: Reducing Infiltration Rate Within The Hospital, Janise Marrisette Banks

Walden Dissertations and Doctoral Studies

This study addressed an increasing number of peripheral intravenous catheter infiltrations within hospitals, leading to problems such as phlebitis and cellulitis, which may result in a longer length of hospital stay. The purpose of this project was to determine how to reduce infiltrations in order to increase the longevity of the catheter. A quantitative, description design was used, guided by Abdellah's classification framework for identifying nursing problems. The target population was 50 patients experiencing incidents of peripheral intravenous catheter infiltration, identified in a patient safety event log used across a 252-bed hospital. Each incident was assessed for several risk factors, …

Provider-Initiated Condom Education, Hiv, And Stds Among Older African American Women, Natasha Hall

Walden Dissertations and Doctoral Studies

Older African American (AA) women are at increased risk for HIV and STDs. The purpose of this quantitative study was to examine the influence of provider-initiated condom use education on condom use among unmarried, heterosexually active AA women aged 50 and over using the constructs of self-efficacy and attitudes of the health belief theoretical model. The relationships between provider education on condom use, condom use self-efficacy, condom use attitudes, and actual condom use were tested individually, and provider education on actual condom use was tested after controlling for condom use self-efficacy and attitudes among 95 study participants recruited primarily from …

Visual Arts And Chronic Pain: Thematic Analysis To The Artistic Statements Of Visual Artists, Susan Beth Janicke

Walden Dissertations and Doctoral Studies

The relief of pain is an essential element of nursing practice. Nursing has begun to successfully use art to assess and reduce pain among hospitalized children, surgical patients, and oncology patients. Structured art projects have been used to provide distraction from pain and patient drawings have allowed nurses to assess pain. This project employed grounded theory and thematic analysis to uncover significant concepts in the artists' statements. The Roy adaptation model and Saunders' total pain theory provided the project theoretical framework. The artistic statements and the art of chronic pain patients were examined using thematic analysis to identify recurrent themes. …

Health Education To Decrease Obesity In Adolescents With Asthma, Mitzie Eumarie Thomas

Walden Dissertations and Doctoral Studies

Obesity increases asthma severity and is costing the health care industry a significant amount of money. Decreasing adolescents' obesity will decrease the risk for chronic health problems, which can have a significant impact in adulthood. Implementing a school-based health education program can decrease the prevalence of obesity amongst adolescents. This program will be implemented by school nurses in the after-school program at Public School 59 (P.S) in New York City. The purpose of this project is to develop adolescents' school-based obesity prevention policies and documentation which will focus on increasing their nutrition education, increasing physical activities, and providing skills to …

Chronic Care Model Staff Education And Adherence With End-Stage Renal Disease Patients, Emilia K. Addo

Walden Dissertations and Doctoral Studies

The management and treatment of chronic diseases, such as end-stage renal disease, is often unproductive because of patients' poor adherence to treatment. The chronic care model toolkit is an Agency for Healthcare Research and Quality supported framework, associated with improved outcomes in patients living with chronic disease. The purpose of this project was to develop and plan an educational program using the chronic care model toolkit for the interdisciplinary clinical staff of a renal hemodialysis center. The goal of this project was to adapt team building between patients and their clinicians through the use of the chronic care model in …

A Proposal For The Development Of An Exercise Program To Treat Post Thrombotic Syndrome, Christy Jean Hansen

Walden Dissertations and Doctoral Studies

Healthcare costs continue to escalate and hospitals need to use programs that encourage cost effectiveness, reduce resources and staffing, and increase patient accountability for their own healthcare risk factors, comorbidities, and participation in their healthcare decisions. Post Thrombotic Syndrome (PTS) is a debilitating disease with few treatment options. Allowing patients to have shared decision making in a care plan for this disease process that involves an exercise program may be a significant factor in the success or failure of their own healthcare goals and outcomes. The development of a proposal for an exercise program for PTS should provide patients with …

The Association Between Core Science Course Timing And Completion Of An Associate Degree Nursing Program, Patricia Ann Pfeiffer

Walden Dissertations and Doctoral Studies

The aging population in the United States has led to an increased demand for registered nurses. Nursing program administrators must examine ways to increase nursing program completion, which will increase the supply registered nurses. The purpose of this study was to determine the associations among length of time between core science course completion and nursing program admission, on-time completion, and National Council Licensure Examination for Registered Nurses (NCLEX-RN) success for students at a southeastern community college. A convenience sample of 288 community students admitted to an associate degree level nursing (ADN) program between 2007 and 2012 was selected. The guiding …

Reducing Emergency Department Length Of Stay By System Change, Brian Dale Haybarker

Walden Dissertations and Doctoral Studies

Emergency departments (ED) are exceeding the Centers for Medicare and Medicaid Services and The Joint Commission's recommended 4-hour door-to-admission and 2-hour door-to-discharge for patients. The purpose of this project was to look for factors that decrease door-to-admission and door-to-discharge times and offer recommendations to the Patient Flow Committee (PFC) at the health care facility that may reduce overcrowding, diversion, and patient boarding. The 7-step Iowa model of evidence-based practice (EBP) was used to concentrate on problem-focused triggers that initiate the need for change. The project focused on decreasing door-to-admission and door-to discharge times: by opening an observation unit run by …

Assessing Spirituality Among Hospice Patients: A Phenomenological Study Of Hospice Nurses, Isabel Esther Kaufman

Walden Dissertations and Doctoral Studies

The shift in health care and nursing philosophy and practice from a holistic approach to a highly technological, cure-oriented approach has been attributed to effective pharmaceuticals made to prolong life. Recently medical professionals have shifted their focus to a combination of spiritual healing and medicine. Hospice care in particular have taken a key interest in integrating spirituality within their health care. The problem is that due to the complications in defining spirituality and appropriate training and education of spirituality within nursing curriculum, assessing patients' spiritual distress may be difficult for many hospice nurses which may be at a loss when …

Fall Prevention Quality Initiative: Implementation Of A Unit Safety Champion (Usc), Susan Lynn Rednak

Walden Dissertations and Doctoral Studies

The literature supports that a Unit Safety Champion (USC) may reduce falls among hospitalized patients. The purpose of this project was to determine if the implementation of a USC would assist in reducing falls on an acute unit in an urban hospital environment. The frequency of patient falls on the unit was collected from the hospital's quality department 3 months before and 3 months after the implementation of the USC. The average number of falls for 3 months before implementation was 5.0 per month (SD = 2.65) and involved a total of 15 individual patients. The average number of falls …

Evidence-Based Mentorship Program: Overview, Review Of Evidence, And Approach, Elizabeth Villanueva

Walden Dissertations and Doctoral Studies

Nurses comprise the largest segment of the healthcare workforce. Adequate numbers of

nurses help to ensure sufficient and safe nursing care in all settings. The current nursing shortage poses a barrier to optimum nursing care, and the nature of recruitment and retention of nurses has generated research interest because of its association with the labor shortage. The purpose of the project was to develop a nurse mentorship program for possible adoption by a northern state correctional facility. Goals are to aid recruitment and improve retention of nurses in the facility. This quality improvement project was informed by Jean Watson's theory …

Evaluation Of Chlorhexidine Bathing Practices In Trauma/ Surgical Intensive Care Units, Kara Willett

DNP Projects

Central venous catheters (CVC) are vital in present-day medical practice, particularly in the intensive care unit (ICU). However, their use puts patients at risk for developing central line-associated bloodstream infections (CLABSIs) which are a major concern in today’s health care system. CLABSIs are a significant source of patient mortality, increased length of stay, and healthcare spending. The heightened awareness of these infections along with their escalating cost has amplified implementation of preventative protocols.This practice inquiry project includes three manuscripts, each of which discusses relevant aspects of CLABSIs prevention utilizing daily whole body chlorhexidine gluconate bathing inlcuding a review of literautre …

Treatment Outcomes For Opiate Addicted Pregnant Women, Jennifer L. Roth Parr

DNP Projects

The problem of opiate addiction is complex enough but compounded when the patient is pregnant. Substance use during pregnancy produces harmful and costly effects to both the mother and the fetus (Veilleux, Colvin, Anderson, York & Hines, 2010). The rate of opiate addiction among pregnant women in the U.S. has been increasing in epidemic numbers since the beginning of the 21st century. This paper looks at research on the origin of the problem, the demographics of the average pregnant opiate addicted patient, the effects on the woman and her unborn child, and available treatment options.

Self-Management Education In Hispanic Women With Gestational Diabetes Mellitus (Gdm), Laura B. Hieronymus

DNP Projects

The purpose of this Practice Inquiry Project was to develop, implement, and evaluate the effectiveness of a diabetes self-management education intervention in a population of Hispanic women at risk for gestational diabetes mellitus within a CenteringPregnancy(R) model of care.

Prenatal Anxiety And Cesarean Delivery In A Clinic Population, Carol A. Kirby

DNP Projects

Although there is an abundance of literature on the topics of prenatal anxiety, stress, depression, etc. during pregnancy, very little research has been conducted on the impact of prenatal anxiety on cesarean delivery and the studies which have been conducted have resulted in conflicting results. This study focused on prenatal anxiety in a clinical population, the characteristics of participants with reported high anxiety, and its association with cesarean deliveries. Prenatal anxiety was defined as Spielberger’s state anxiety and measured with the STAI. Data was collected over all three trimesters of pregnancy and post-delivery. The characteristics of participants who reported high …

Assessment Of Patient Barriers To And Facilitators Of Screening Colonoscopy: Utilizing Patient Perspectives To Formulate Recommendations To Improve Colorectal Cancer Screening Rates, Heather N. Cox

DNP Projects

A pilot study was conducted that utilized focused patient interviews to determine patient barriers to and facilitators of screening colonoscopy. The interviews were transcribed and systematically analyzed to detect recurring patterns and themes related to screening colonoscopy completion or lack thereof. Descriptive statistics were used to summarize additional sample characteristics such as gender, education level, and income level. Among those who had received a screening colonoscopy (44%, 11 of 25), provider recommendation was the most influential factor for procedure completion, followed by the combination of provider plus family member recommendation. Additional findings revealed that due to medical necessity, several patients …

Improving Depression Care For Older Home Health Patients, Sarah R. Schirmer

DNP Projects

Rates of depression in older home healthcare (HH) patients are highly prevalent. Although depression in this population is associated with increased rates of re-hospitalization, falls, and suicides, it is frequently under diagnosed and under treated. This Capstone Report examined this problem through three interrelated manuscripts. The first manuscript explored the problem through a review of the literature. This review determined that while there are many barriers to adequate depression care, programs that train clinicians to screen for depression and connect patients to depression care encourage adequate evaluation and treatment and can result in clinically significant changes in depression scores. This …

Assessment Of Organizational Readiness: Parent Advisory Councils In A Children's Hospital Within A Hospital, Suzanne R. Springate

DNP Projects

Background: A children’s hospital within a hospital (CHWH) in the Midwest region of the United States established a strategic goal to become the preferred provider for children in the region. Outcomes in patient and family experience had fallen short of established organizational expectations. Recognizing that parent advisors are an essential component of patient and family centered care, the strategic plan called for integrating parents into formal, advisory roles.

Purpose: The purpose of this practice improvement project was to perform an assessment of organizational readiness to incorporate parents into formal advisory roles at this CHWH.

Methods: A cross-sectional survey design was …