Nursing Commons^™

Fostering An Environment Of Magnet Recognition By Using Internet Technology, Shyneka Montgomery

Walden Dissertations and Doctoral Studies

Magnet Recognition, a nurse-driven certification, is an acknowledgement of nursing excellence within a hospital. Magnetic Recognition supports the highest quality of patient outcomes and is the standard for nursing care and professionalism in nursing practice. The site for this project has engaged in the process of seeking Magnet Recognition but lacked a method of communicating their progress to staff, prompting the need for the institutional intranet Magnet webpage. Guided by Roger's diffusion of innovation theory and Lewin's change management model, the purpose of this quality improvement project was to develop an evaluation plan for this webpage on the institutional intranet. …

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

Walden Dissertations and Doctoral Studies

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

Transition To The Professional Role For Graduate Nurses In A Hospital Orientation Program, Shirley Denise Richardson

Walden Dissertations and Doctoral Studies

This study focused on the transitioning of graduate nurses (GNs) employed by a teaching hospital in the eastern United States to the professional role of registered nurse after a 6-week orientation was the focus of this study. Benner's novice-to-expert theory served as the framework for this qualitative case study. Twelve participants were chosen from 3 specific populations: GNs, nursing preceptors, and nurse managers. Three research questions asked about the perceptions of newly licensed nurses after completion of the orientation process related to their ability to make critical decisions in the professional role of RN, how the preceptor educational training program …

Increasing Seasonal Influenza Vaccine Rates In A Black Inner City Population, Barbara E. Beckford

Walden Dissertations and Doctoral Studies

The seasonal influenza (flu) vaccine has been shown to prevent flu outbreaks that can cause debilitating effects on the body and even death. Underserved members of Black communities are more likely to refuse the flu vaccine than are persons of other ethnicities. The purpose of the project was to determine from a needs assessment the reasons for flu vaccine refusal in the Black population of an inner city clinic in order to develop tailored communication and nursing actions that promote awareness of the flu vaccine's importance and safety. The health belief model constructs (perceived susceptibility, perceived severity, perceived benefits, and …

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 …

Implementation Of A Nurse Practitioner Residency Program In Critical Access Hospitals, Anna Ngwisah Bolima

Walden Dissertations and Doctoral Studies

Access to health care in rural communities is challenged by workforce shortages. Nurse practitioners (NPs) have been filling the gap created by physician migration into specialty areas. Flex hospital legislation allows critical access hospitals (CAHs) to staff the emergency department with NPs without on-site physicians. NP education often lacks emergency and trauma curriculum, resulting in gaps in practice expectations and significant role transition stress and turnover. The purpose of this project was to construct from the scholarly literature a transition-to-practice residency program to support NP's in providing emergency department care in the CAH. The limbo to legitimacy theory guided the …

Co-Construction Of Consent And Counselling During Provider Initiated Counselling And Testing (Pitc) In Nairobi Kenya, Eunice Ndirangu, Evans Catrin, Kristian Pollock

School of Nursing & Midwifery, East Africa

Background: The global policy focus of today’s HIV efforts and strategies is to reverse the spread of HIV/AIDS and provide care, treatment and support. A key component of this strategy is to increase individual HIV status awareness through expansion of HIV testing and counselling (HTC). However, the numbers tested still remain and evidence suggests that there are significant missed opportunities for HIV testing in clinical settings. One key strategy to expand HTC in clinical settings has been to implement a policy of ‘provider initiated counselling and testing’ (PITC) in which all patients accessing health facilities for treatment are routinely offered …

Health Professionals In Kenya: Strategies To Expand Reach And Reduce Brain Drain Of Psychiatric Nurses And Psychiatrists, Sharon Brownie, Elizabeth Oywer

School of Nursing & Midwifery, East Africa

This paper highlights the extent of the brain drain in relation to human resources for health (HRH) that is currently challenging Kenya, and suggests strategies that have the potential to change current working environments and improve HRH retention rates. Governments in partnership with health professional bodies and regulators could improve the working conditions for psychiatrists and mental health nurses: by promoting career choices in mental health; by providing accessible professional development opportunities; and by easing workload pressures by expanding service reach through thoughtfully planned and delivered task-shifting to primary care. While these strategies have the potential to make a significant …

Experiences In Care Given During Child Birth At A Referral Hospital In Kenya, Jane Kabo, A. Karani, J. Oyieke, A. B. Wakoli, B. Cheruiyot

School of Nursing & Midwifery, East Africa

The fifth Millennium development Goal (MDG) calls for a reduction in the maternal mortality ratio (MMR) by 75% between 1990 and 2015, with a key indicator being the proportion of births attended to by skilled health personnel, (United Nations, 2007). In Kenya the MMR is 400 and has made insufficient progress towards improving maternal health, (UNICEF, WHO, World Bank, 2013). According to KDHS (2014), the proportion of skilled birth attendance is 46.5%, while in Kenya it is 62% against an MDG target of 90%. According to Zaers S., et al., (2008), prior experience in delivery care by skilled attendants affects …

Canadian Nurse Leaders' Experiences With And Perceptions Of Moral Distress: An Interpretive Descriptive Study, Jodi-Rae Kortje

Antioch University Dissertations & Theses

Moral distress in nursing has been studied across many care contexts, yet there is a paucity of research on the experience among health care leaders.The purpose of this study was to understand the experiences and perceptions of moral distress in nurse leaders.This study used an interpretive description approach interviewing 32 Canadian nurse leaders about their experiences and perceptions of moral distress within their role as a leader and nurse.A constant comparative and thematic analysis process revealed three thematic patterns:(a) leaders suffer moral distress in similar and different ways from their employees; (b) relationships matter in the midst of coping and …

Professional Learning And Knowledge Transfer To Practice In Unregulated Care Provider Training In Resident-Centred Care, Sarah Pottier

Theses and Dissertations (Comprehensive)

Ongoing training for unregulated care providers (UCPs) in Ontario is required to meet the care needs of the aging population. Inconsistencies in standards and options for formal training for UCPs as well as the evolving complex needs of the aging population are factors contributing to needing training programs for UCPs in the workforce. This thesis examined the delivery and transfer of professional learning for UCP training in resident centred care. Increasing resident-centred care behaviours and knowledge were the primary aims of the training. One 128-bed long-term care home in southwestern Ontario volunteered to participate in this study while providing the …

An Educational Initiative To Prevent Unnecessary Hospitalization For Hospice Patients, Alkeisha Hill Mims

Walden Dissertations and Doctoral Studies

Avoidable hospitalizations of hospice patients cost Medicare $3 billion a year. When hospice nurses are able to identify early signs and symptoms of acute illness and provide appropriate interventions to prevent such admissions, 20-60% of the hospitalizations are preventable. The practice problem addressed in this quality improvement doctor of nursing project was the 30% hospital admission rate of hospice patients as evidenced by chart review, admission data, and revocation data. The first purpose of the project was to identify evidence-based nursing care paths in the literature for the top 5 medical diagnoses related to avoidable hospital admissions. The second purpose …

Type 2 Diabetes Prevention And Management In A Primary Care Clinic Setting, Ada Nwachuku Nwachuku

Walden Dissertations and Doctoral Studies

Approximately 8.3% of the U. S. population has type 2 diabetes. Preventing the onset and improving the management type 2 diabetes are crucial for health care professionals. The purpose of this project was to develop and evaluate a type 2 diabetes prevention and management education program in a primary care setting using group medical appointments (GMAs). The chronic care model provided the framework for the study. The education program consisted of information from the Centers for Disease Control on the management of type 2 diabetes to be delivered by clinic staff using a GMA approach, a timeline for implementing the …

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, …

Evaluation Of Clinical Reasoning Of Nursing Students In The Clinical Setting, Stefanie Lynn Legrande

Walden Dissertations and Doctoral Studies

The primary focus of nursing education in the 21st century is to graduate students with well-developed critical thinking and clinical reasoning skills. This descriptive case study explored the perceptions of 6 faculty and 6 unit staff nurses concerning the assessment of critical thinking and clinical reasoning skills of nursing students in the clinical setting. Benner's novice to expert theory served as the conceptual framework for the research. The guiding research questions focused on faculty and staff perceptions concerning unit staff nurses' level of preparedness to assess the critical thinking and clinical reasoning ability of nursing students, and explored how faculty …

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. …

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, …

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 …

Improving Colorectal Cancer Screening In Primary Care, Jenerie Reniedo Navarrete-Pak

Walden Dissertations and Doctoral Studies

Despite indications that colorectal cancer (CRC) screening strategies can decrease mortality and morbidity, screening rates among veterans remains to be low. In the Veterans Affairs (VA), the performance measure for CRC screening is lower than the national standard. This quality improvement (QI) project evaluated the effect of a team-based approach, effective electronic information structures, and the provision of education to nurses and patients in increasing CRC screening rate in primary care from 77% to 85%. CRC screening data were retrospectively collected prior to the start of the project and then compared to screening data 3 months after project implementation. The …

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

Walden Dissertations and Doctoral Studies

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

by

Rene N. Kagan

MSN, University of New Mexico, 2009

BS, University of Phoenix, 2000

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

September 2016

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

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

Walden Dissertations and Doctoral Studies

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

A Nurse's Perception Of Hand-Off Communication Before And After Utilization Of The I-5 Verification Of Information Tool, Maryann Bowersox

Walden Dissertations and Doctoral Studies

Abstract

Miscommunication or omission of critical patient information contributes to preventable

medical errors that result in 98,000 patient deaths each year. The hand-off

communication process creates a critical time for the patient as necessary information for

the continuity of care must be communicated. The purpose of this practice project was to

evaluate the nurses' perception of the current hand-off communication process before and

after an educational intervention and implementation of the I-5 Verification of

Information Tool. Registered nurses were asked to complete a pre survey of their

perception of the current hand-off communication process, followed by an educational

power point …

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 …

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

Walden Dissertations and Doctoral Studies

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

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

Walden Dissertations and Doctoral Studies

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

Frontline And Middle-Level Nursing Leader Transition Within The Military Health System, Rudolph George Newman

Walden Dissertations and Doctoral Studies

Healthcare delivery within the military requires a multifaceted approach to achieve the desired outcomes of safe, effective, patient-centered, timely, efficient, and equitable health care. The prospect of maintaining a cycle of continuous process improvements within military clinical settings hinge on frontline leaders and middle-level managers who must be prepared to execute the mission and motivate, supervise, coach and mentor the staff. This project showcases a review of current literature translated into the development of an evidence-based Transformational Leadership Induction Program (TLIP) module that consisted of 4 subsections: the environment of care, clinical decision support systems, human resources management, and change …

Promoting Shared Decision Making Through Patient Education Of Labor Inductions, Lenora W.Y. Low

Walden Dissertations and Doctoral Studies

The induction of labor is medically indicated for many conditions in which delivering the baby outweighs the risk of continuing the pregnancy. Patients admitted for the induction of labor require adequate information to actively participate in decision making that affects their plan of care. The purpose of this quality improvement project was to improve the quality of healthcare delivery and promote patient engagement by providing consistent education using a teaching tool. The project question addressed the impact of a labor-induction teaching tool on improving patient education, participation, and overall satisfaction. The Plan-Do-Study-Act (PDSA) model was used to plan, implement, and …

Improving Health Literacy With Clear Communication, Carol Barbara Wilson

Walden Dissertations and Doctoral Studies

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

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

Walden Dissertations and Doctoral Studies

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