Nursing Commons^™

Improving Foot Care And Kidney Disease Screening Through Implementation Of American Diabetes Association Standards–2016 In The Primary Care Setting, Maricela Hernandez

Doctor of Nursing Practice

The purpose of this quality improvement project was to increase adherence to the American Diabetes Association Standards of Medical Care in Diabetes—2016 recommendations for foot care and kidney disease screening for patients with diabetes mellitus type II in a primary care setting. Diabetes mellitus type II affects approximately 18.9-19.9 million, or 90-95%, of all diagnosed cases in the United States. Early detection and management decrease the risk of developing microvascular complications that may lead to neuropathy and nephropathy. Adults with diabetes mellitus type II, 20 years of age and older, accounted for approximately 73,000 non-traumatic lower-extremity amputations in 2011. Diabetes …

An Initiative To Improve Primary Prevention Of Heart Disease In Adults With Type Ii Diabetes Based On The Acc/Aha (2013) And Ada (2016) Guidelines, Litzie Garza

Doctor of Nursing Practice

Heart disease is the leading cause of death in the United States and in Texas. Hyperlipidemia is a precursor to cardiovascular disease and is a highly manageable and treatable acute and chronic disease in the outpatient primary care setting. This project is designed to increase clinicians’ adherence to the American College of Cardiology/American Heart Association (2013) and American Diabetes Association (2016) clinical practice guidelines for the prevention of heart disease in 40 to 75 year old adults with type II diabetes through interactive education, an electronic alert, and quality improvement sessions on the treatment and management of cholesterol in a …

Implementation Of Quality Improvement Interventions To Increase Provider Adherence To Standards Of Medical Care In Diabetes, Elizabeth A. Betz

Doctor of Nursing Practice

Purpose: To improve a South Texas primary care clinic’s diabetes management system by implementation of a quality improvement intervention to help staff and medical providers increase adherence to the American Diabetes Association standards of care related to screening referrals and orders for urine microalbumin, in order to improve self-care and health outcomes for adult patients with diabetes. Background and Problem: Diabetes is the 7th leading cause of death in the United States and the cause of vision loss, amputations, and end-stage renal disease. The patients at the Wellness Center do not consistently receive routine screenings for neuropathy, retinopathy, nephropathy, microalbumin, …

Does Empowerment Matter? Perceptions Of Nursing Leaders In Pakistan Through Qualitative Approach, Saleema A. Gulzar, Rozina Karmaliani Professor, Kausar S. Khan Ms, Rubina Barolia, Shirin Rahim, Aneeta Pasha

School of Nursing & Midwifery

Background: In a patriarchal society like Pakistan, where women are oppressed, women dominating professions like nursing is mostly seen as disempowered and requires considerable struggle to achieve its due recognition and respect.
Aim: This study aims to explore the experiences of empowerment among the nursing leaders of Pakistan. Methods: This study uses a qualitative descriptive design. Total of twelve Pakistani Nursing leaders were interviewed using semi-structured interview guideline to explore their experiences of empowerment.
Results: The study findings revealed five major categories which include: status of a nurse, nursing profession, power relationships, value-belief system, and leadership and management.
Conclusions: Nurses’ …

Shining A Light On Nursing Art In Pakistan, Shirin Rahim, Rafat Jan Ruknuddin, Kathryn L. Gramling

School of Nursing & Midwifery

Nursing is considered both science and art. Artful nursing has been essential for holistic nursing practice since the time of Nightingale, but it is getting neglected and has been lately limited to nursing literature (Gramling, 2004). This qualitative study seeks to gain an understanding of the perceptions of active nurses in Pakistan about nursing art and yields four major themes: artful nursing is embedded in humane responsiveness, artful nursing has healing power, artful nursing is a satisfying experience, and artful nursing is invisible in nursing practice. Study participants valued nursing art, and their perceptions illuminate Watson's Theory of Human Caring …

Associations Between Weight Status And Post-Tonsillectomy Pain Experiences In Children: A Retrospective Study, Shirley Smith Martin

Nursing Dissertations - Archive

There has been little research on pain outcomes in obese and overweight (OB/OW) children undergoing surgery. Tonsillectomy or adenotonsillectomy (T&A) is one of the most common painful surgeries performed in children. The estimated number of OB/OW children undergoing T&A each year approaches 200,000. Post-tonsillectomy pain (PTP) management after surgery is complicated by potential for airway obstruction or altered drug metabolism in OB/OW children. The purpose of this study was to examine associations between weight status and PTP outcomes in the PACU. A retrospective correlational cohort design was used. Data were obtained from 180 electronic health records of children who had …

A Retrospective Descriptive Study Of Chemically Impaired Nurses In Texas, Mercy Ngosa Mumba

Nursing Dissertations - Archive

There are approximately 3.1 million nurses in the Unites States (US Census Bureau, 2016) and approximately 8% of them suffer from chemical dependency and substance use disorders (Kunyk, 2015). In Texas, nurses with impaired practice are referred to peer assistance programs such as the Texas Peer Assistance Program for nurses (TPAPN), a monitoring program for nurses as they seek rehabilitation and recovery. Nurses are referred for various reasons including diversion of medications from patients and impairment at work. Currently, 348 nurses in TPAPN are actively participating in the program for substance abuse related offenses. Many nurses are also referred to …

Women's Experiences During An Acute Myocardial Infarction, Dena R. Allen

Nursing Dissertations - Archive

Objective: The objective was to describe the lived experience of women having a myocardial infarction and seeking health care, using the framework of the stress and coping theory (Lazarus & Folkman, 1984). Setting: Three acute care hospitals in a major metropolitan area in the North Texas region were the settings for the study. Method: A total of 20 English speaking women were interviewed about their experience when having an acute myocardial infarction from the onset of their symptoms through their hospital stay. The interview questions and findings were aligned with the stress and coping theory concepts. Results: The women realized …

Noise: Its Impact In The Operating Room, Brennon Wesley Sloan

Doctoral Projects

Orthopedic and neurologic cases routinely reach noise levels exceeding 120 decibels (Katz, 2014). Modern equipment and monitors used by anesthesia personnel only reach 85 decibels (Katz, 2014). These monitors can go undetected during peak noise levels creating a serious safety concern for patients that could lead to patient injury or death (Gawande, Zinner, Studdert, & Brennan, 2003). A clinical question was developed to determine if the education of noise levels in the operating room affects change in practice. For operating room managers and staff, does education of noise levels in the operating room compared to no education initiate a change …

Reducing Hypotension In Elective Cesarean Section Patients With Administration Of Ondansetron Prior To Spinal Anesthesia: A Retrospective Chart Analysis, Linsey Erin Phipps

Doctoral Projects

The birth of a child is one of the most memorable moments in a woman’s life, and many women undergo an elective cesarean section, requiring spinal anesthesia. At this time, the patient and the unborn child’s well-being become the anesthetist’s main focus. The ultimate goal of anesthesia providers is to provide the safest care to the patient. Spinal anesthesia has many benefits, but has a common side effect of hypotension, which can also result in nausea. Hypotension, dangerous to mother and child, is often treated with vasopressors, but can also cause nausea, which is treated by the administration of ondansetron. …

Oral Carbohydrate Administration Prior To Colorectal Surgery: Practice Change Outcomes And Economic Analysis, Joshua Kendrick Ezelle

Doctoral Projects

Difference in recovery times has been an interest of mine for many years. I observed that an open heart surgery routinely recovered and discharged on the third post-op day, while a colorectal patient often required a hospital stay of five to ten days. I began researching recovery methods of colorectal patients. I found enhanced recovery techniques like decreased narcotic, use of NSAID’s, early ambulation, and the use of medications that assist with bowel peristalsis are being employed nationally. Other techniques are now starting to be used with positive results. One of these is Carb-loading. Carb-loading is the oral intake of …

Decisional Involvement And Professional Practice: Relation And Outcomes, Carolyn L. Davidson Rn, Phd, Kim S. Hitchings Msn, Rn, Nea-Bc, John W. Nilson Phd, Msn, Rn, Debra Peter Msn, Rn-Bc, Cathy Schwartz Ms, Rn

Patient Care Services / Nursing

No abstract provided.

The Uptake Of Skilled Birth Attendants’ Services In Rural Nepal: A Qualitative Study, Yuba Raj Baral, Jo Skinner, Edwin Van Teijlingen, Karen Lyons

Journal of Asian Midwives (JAM)

Aim and objective: The general aim of this research was to explore why women do or do not want to uptake Skilled Birth Attendants’ (SBAs) services during childbirth. The objective was to explore the factors affecting the uptake of SBAs’ services during childbirth in rural Nepal.
Methods: Semi-structured interviews were conducted. The data were analysed using thematic analysis.
Setting: The fieldwork was conducted in a rural area, in a western hill district of Nepal.
Participants: Interviews were conducted with 24 married women aged 18-49, who had given birth during the three years prior to the time of interview. Sixteen women …

Strengthening The Knowledge And Skills Of Community Midwives In Pakistan Through Clinical Practice Internships, Arusa Lakhani, Rafat Jan, Kiran Mubeen, Sadia Karimi, Shahnaz Shahid, Rozina Sewani, Marina Baig, Farzana Adnan

Journal of Asian Midwives (JAM)

Objective: On the-job training of Community Midwives (CMWs) is of critical importance in enabling midwives to provide services that meet standards of quality care. The objective of this study was to assess the intervention of an internship for CMWs that would increase their ability to provide quality maternal, newborn, and child health services.
Method: A pre and post-intervention design was used to evaluate the effectiveness of an internship of 32 working days. Validated questionnaire was used to assess the CMWs’ knowledge and skills before and after the intervention. Overall, 252 CMWs from 14 districts of the Sindh and …

Adolescent Pregnancies: The Case Of Pakistan, Kiran Mubeen, Marina Baig

Journal of Asian Midwives (JAM)

Early motherhood not only causes poor health outcomes, but often also deprives adolescent girls of educational, social, and economic development opportunities for the rest of their lives. Evidence suggests that although the burden of adolescent pregnancies is less in Pakistan than in Bangladesh, Afghanistan and Nepal, the pregnancy outcomes continue to be devastating in this country. This paper discusses the social barriers in addressing this issue in Pakistan and proposes recommendations for targeted interventions to reduce the high birth rate amongst adolescents in the country. The role of midwives asfrontlinegatekeepers can be pivotal for prevention ofteenagedpregnancies in Pakistan. Unfortunately, the …

News & Events

Journal of Asian Midwives (JAM)

No abstract provided.

Intergenerational Hispanic Perceptions Of Childhood Obesity, Janelle Weiss

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Background: Childhood obesity is on the rise in the United States especially among minority families. This study investigates how Hispanic parents perceive their child's weight based on years of acculturation, education level, age, child’s gender and 1^st or 2^nd generation status.

Objective: To assess if there are differences in perception between more acculturated Hispanic immigrants and their less acculturated counterparts.

Methods: Data were collected using the Child's Body Image Scale. Participants were asked to arrange the images based on a series of questions inquiring about their perception of their child and health in general. BMI's were then …

Incidence Of Student Registered Nurse Anesthetists In The United States Who Own And Use Smartphone As Supplemental Learning Tools, Ruoyu Zhao

Doctoral Projects

Background: Smartphones have a great potential for students to learn more efficiently. Students now have the ability to download applications with pertinent information in the palm of their hand for both educational and clinical duties. This descriptive correlational quantitative research examines whether student registered nurse anesthetists own and use smartphones as supplementary learning tools.

Methods: An online survey was sent through AANA to Masters and DNP student registered nurse anesthetists (SRNAs) in the United States. Respondents were asked if they owned smartphones and how often they used smartphones for educational and clinical duties. Data Analysis was conducted using a Chi-square …

Utilizing Culturally Congruent Educational Interventions To Improve Native American Diabetic Outcomes, Laurie Ann Hamilton

Doctoral Projects

Native Americans suffer from diabetes type II at a proportionately higher rate than other populations. Management of diabetes in this population is problematic and compounded by multiple influences such as socioeconomic, cultural and linguistic variables. The purpose of this DNP project was to investigate cultural influences on Native American diabetic outcomes.

Do cultural influences act as barriers to diabetic medication, diet and education understanding? Would a Native American nurse applied education on medication, diet and exercise improve diabetic outcomes in a 3 month period?

A convenience sample of 6 Native American participants obtained at a primary care clinic were given …

Optimizing Anesthesia Providers’ Timing Of Administration Of Dexamethasone For The Prevention Of Post-Operative Nausea And Vomiting: Translating Clinical Guidelines Into Practice, Tanner Young Mixon

Doctoral Projects

Research has shown that post-operative nausea and vomiting (PONV) is a significant contributing factor to extended recovery times and unwanted hospital admissions following ambulatory surgery. The purpose of this DNP project was to assess current practice regarding administration of dexamethasone for the prevention of PONV, provide information based on best practice guidelines, and assess willingness to change practice based on the guidelines set forth by the Society for Ambulatory Anesthesia (SAMBA). Administration of dexamethasone is aimed at decreasing the incidence of PONV, optimizing PACU times, and increasing patient satisfaction regarding perioperative care.

An electronic presentation and survey were emailed to …

Evaluating The Likelihood Of Use Of Bispectral Index Guided Anesthesia As A Strategy To Reduce Postoperative Delirium In Surgical Patients 65 Years Of Age Or Older, Simon Jack Gibson

Doctoral Projects

Postoperative delirium (POD) is the most common postoperative complication in the elderly, accounting for approximately $164 billion in costs per year in the United States (Inouye, Westendorp, & Saczynski, 2014, p. 911). This complication occurs in as many as 50% of elderly patients, but can be prevented as much as 40% of the time (Inouye et al., 2014). The use of processed encephalographic monitoring, such as Bispectral Index (BIS) monitoring, to guide anesthetic dosage is the single intraoperative intervention with enough evidence to support it as a recommendation for use to reduce POD (American Geriatrics Society, 2015). There were two …

Efficacy Of Intravenous Ondansetron In Relieving Nausea/Vomiting And Pruritus Post Epidural Administered Opioids In The Obstetric Patient, Benjamin Stephen Butler

Doctoral Projects

One prominent side effect in the use of a neuraxial anesthesia is pruritus, with an incidence in the obstetric patient of 60-100% (Kumar & Singh, 2013). Another side effect of an epidural placement is nausea and vomiting. Nausea and vomiting occurs frequently during the progress of labor and is difficult to determine an incidence that is related to epidural opioid administration (Chestnut, Wong, Tsen, Ngan Kee, Beilin, & Mhyre, 2014). A review of literature was performed and established evidence that ondansetron is effective in reducing incidence of pruritus in intrathecal administered opioids for cesarean sections in the obstetric patient. No …

Opioid Use In The Cesarean Section Patient With The Preoperative Administration Of Intravenous Acetaminophen, Dana Edwards Bernardo

Doctoral Projects

Cesarean sections are one of the most common surgical procedures and there are no current guidelines for the management of postoperative pain control (Darvish, Ardestani, Shali, & Tajik, 2013). Unresolved pain in this population can lead to long lasting problems, such as chronic pain and depression (Booth, Harris, Eisenach, & Pan, 2015). The goal of multimodal therapy with IV acetaminophen for CS mothers was to ensure a rapid and safe recovery process with reduced adverse complications and shortened hospital length of stay. The independent t-test was used to compare the mean time for length of stay, first request of pain …

Looking Forward To More And Better Midwifery In Asia In 2017, Rafat Jan, Edwin Van Teijlingen

Journal of Asian Midwives (JAM)

No abstract provided.

Sbar, Communication, And Patient Safety: An Integrated Literature Review, Kathryn R. Stewart

Honors Theses

Communication errors are a common cause of adverse patient safety events in the healthcare field. The Situation-Background-Assessment-Recommendation (SBAR) communication tool was introduced in 2002 to guide the communication of critical patient-care information. The purpose of this integrated literature review was to determine how the use of the SBAR tool during handoff of critical information affects communication between healthcare providers and patient safety. An integrated literature review approach was chosen due to the varying methodologies and multiple variables that have been used in the study of SBAR. The combined search terms of “SBAR”, “Communication”, and “Patient Safety” were entered into PubMed, …

An Analysis Of Moral Distress Experienced Among Nursing Students, Katherine Merchent Johnson

Honors Theses

The purpose of this senior honors thesis was to obtain descriptive data about the moral distress experienced by nursing students during clinical rotations in nursing school. This senior honors thesis is significant to nursing because, although moral distress is a well-researched topic, little to no information has been gathered regarding moral distress among the nursing student sub-culture. Nursing students are likely one of the most important groups in which moral distress needs to be explored, because experiencing it could lead to fewer people wanting to become a part of the nursing profession. The research design used quantitative methodology. The approach …

Faculty-To-Faculty Incivility As Perceived By Nursing Faculty, Melinda Lofton Sills

Dissertations

The purpose of this research was to determine the perceived presence of workplace incivility among nursing faculty in associate, baccalaureate, and graduate nursing programs and whether there was a significant difference between workplace incivility behaviors, occurrence of incivility, extent of incivility, and engagement of incivility among the three groups. A convenience sample of faculty from nursing programs accredited by Accreditation Commission for Education in Nursing and Commission of Collegiate Nursing Education in Alabama, Arkansas, Florida, Louisiana, and Tennessee completed the Incivility in Nursing Education-Revised (INE-R) survey. The final sample included 169 nursing faculty.

Based on the results of the study …

Directly Comparing Handoff Protocols For Pediatric Hospitalists, Elizabeth H. Lazzara, Robert Riss, Brady Patzer, Dustin C. Smith, Y. Raymond Chan, Joseph R. Keebler, Sarah D. Fouquet, Evan M. Palmer

Publications

BACKGROUND AND OBJECTIVES: Handoff protocols are often developed by brainstorming and consensus, and few are directly compared. We hypothesized that a handoff protocol (Flex 11) developed using a rigorous methodology would be more favorable in terms of clinicians’ attitudes, behaviors, cognitions, or time-on-task when performing handoffs compared with a prevalent protocol (Situation Background Assessment Recommendation [SBAR]).

METHODS: Using a between-groups, randomized control trial design (Flex 11 versus SBAR) during a pilot study in a simulated environment, 20 clinicians (13 attending physicians and 7 residents) received 3 patient handoffs from a standardized physician, managed the patients, and handed off the patients …

Leadership Practices Of Supervisory Employees: An Exploration Of Current Practices At A Southeastern Veterans Affairs Medical Center, Melissa M. Zimmerman

Electronic Theses and Dissertations

As the nation’s healthcare system moves through the 21^st century, unprecedented changes are occurring on both a local and global stage. Healthcare organizations are faced with creating and implementing leadership strategies to enhance the overall patient experience. When coupled with the need to ensure increased nurse job satisfaction, improved cost-effectiveness and healthy organizational cultures with fiscally sound budgets, improvement work has led efforts to ensure effective leadership techniques are used across an agency.

This task may be viewed as commonplace for some organizations, while others may perceive this process as a complete paradigm shift from historical practices related to …

Examining The Associations Between Depressive Symptoms, Body Mass Index, And Physical Activity Self-Efficacy In African American Mother-Child Dyads, Y'Esha Vonyae Williams

Theses and Dissertations (ETD)

In recent decades the prevalence of childhood and adult depression and obesity has increased worldwide. Multiple factors influence the onset of both depression and obesity. Individual manifestations of depressive symptomatology and health-related problems associated with obesity vary; however, genetics and environmental and psychological factors have been implicated as correlates. Consequently, both disorders can ultimately interfere with individuals’ activities of daily living and decrease their quality of life. African American women are known to have a higher prevalence of obesity and more severe depressive symptoms in comparison to Caucasian women. Likewise, African American children are more obese and experience many factors …