Nursing Commons^™

Predicting Burnout Among Psychiatric Technicians, Sarah E. Hernandez

Electronic Theses, Projects, and Dissertations

This thesis attempted to examine stressors associated with the psychiatric technician profession and levels of burnout amongst them. This was accomplished through the use of a survey which included demographic data, the Maslach Burnout Inventory Human Services Survey (MBI‑HSS), an adaptation of the Nursing Stress Scale (NSS) and a self‑care assessment tool. A total of three research questions were examined statistically including levels of burnout on subcategories (personal accomplishment, emotional exhaustion and depersonalization), most common stressors identified by psychiatric technicians and percentage of participants who utilized therapy to cope with work related stress. The survey was made available via survey …

Educating Family Caregivers For Older Adults About Delirium: A Systematic Review, Margaret J. Bull, Lesley Boaz, Martha G. Jermé

College of Nursing Faculty Research and Publications

Background

Delirium in older adults is considered a medical emergency; it contributes to a cascade of functional decline and to increased mortality. Early recognition of delirium symptoms is critical to prevent these negative consequences. Family caregivers who are educated about delirium could partner with nurses and other healthcare professionals in early recognition of delirium symptoms. Before implementing such partnership models, it is important to examine the effectiveness of educating family caregivers about delirium.

Aims

To examine whether providing education on delirium to family caregivers improved their knowledge, emotional state, or response in reducing the incidence of delirium in older adults. …

Improving Outcomes Through Performance Improvement, Evidence-Based Practice, Or Research: Choosing The Right Road, Eve Butler, Maria Ojeda, Andrea Prentiss

All Publications

No abstract provided.

Assessment Of Air Force Providers’ Adherence To Overweight And Obesity Guidelines, Dale Harrell

Doctor of Nursing Practice Scholarly Projects

Despite the existence of obesity treatment guidelines, Air Force healthcare providers may offer suboptimal weight management. The purpose of this quality improvement project is to assess adherence by healthcare practitioners with adult overweight and obesity guidelines before and after an educational session on the optimal management of the overweight or obese patient. Overweight or obese adults treated in Military Treatment Facilities (MTF) may not be properly identified and controlled, as providers may not be adhering to the American College of Cardiology (ACC) and the American Heart Association (AHA) guidelines for the management of obesity.

Describing The End Of Life Knowledge, Beliefs, And Preferences Of Alaska Native And American Indian Peoples, Colleen Marie Kelley

Theses and Dissertations

This dissertation is comprised of three manuscripts that will be submitted for publication, describing the end of life knowledge, beliefs, and preferences of Alaska Native and American Indian Peoples. The first manuscript is a literature review that examines what is known about the understanding about the end of life knowledge, beliefs, and preferences of Alaska Native and American Indian Peoples. The second manuscript offers results of an exploratory descriptive study designed to describe the end of life knowledge of hospice care services, beliefs about dying, and preferences for end of life care of Alaska Native and American Indian Peoples. Finally, …

Diabetes Self-Management Education (Dsme) Program For Glycemic Control, Jenilyn P. Peros

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose: The purpose of this quality improvement project was to implement and evaluate the impact of Diabetes Self-Management Education (DSME) program with type 2 diabetes mellitus (DM) patients. The goals were to improve glycosylated hemoglobin (A1C) and improve patient satisfaction.

Methods: A quality improvement project using the Iowa model was implemented in a primary care setting in Southern California to provide DSME program for adults with type 2 diabetes. A nurse practitioner conducted three DSME group sessions, which were done for 90 minutes per session in a 4-month period. The American Association of Diabetes Educators (AADE) 7 self-care behavior …

A Structured Telephonic Transition Program For Heart Failure Patients, Julia E. Robinson

Doctor of Nursing Practice Final Manuscripts

HF is a fatal condition affecting more than 5 million Americans leading to frequent hospitalizations, poor quality of life and death. The annual cost to the healthcare system is approximately $38 billion, ranking HF as one of the costliest conditions to manage. Significant evidence exists that HF self-care management programs improve patient self-care and decrease HF-related readmissions. Current guidelines recommend health professionals provide comprehensive HF education focused on knowledge, skills of management, and self-care behaviors.

The Iowa Model of Evidence Based Practice provided the foundation for the practice change. Structured telephonic support (STS) was based on Bandura’s Self- Efficacy behavior …

Appropriate Gestational Weight Gain, Eugelyn Opalec Santos

Doctor of Nursing Practice Final Manuscripts

Abstract

Over the past 30 years, excessive weight gain during pregnancy among American women has been a significant concern, resulting in serious health consequences to mothers and their newborns. During 2011, 48% of U.S. women gained more than the ideal amount of weight during pregnancy. Several international studies have also documented that excessive weight gain during pregnancy is associated with adverse maternal and neonatal outcomes. As a result, one in ten babies were born prematurely in the United States in 2014. Based on the Institute of Medicine's (IOM) guidelines (2009), the purpose of this project was to implement the Healthy …

Health Care Transition Program For Adolescents With Spina Bifida, Teresa M. Scavone

Doctor of Nursing Practice Final Manuscripts

The purpose of this evidence-based project was to evaluate the feasibility of implementing an NP facilitated formal transition program for adolescents with Spina Bifida. There is an increased awareness of the need for health care transition for youth with special health care needs (YSHCN) due to the 2009-2010 Maternal Child Health Branch National Survey findings that only 40% of YSHCN receive adequate support for transition that meets the core outcome measures. Recent studies have investigated transition in youth with chronic disease specific conditions such as diabetes, cystic fibrosis, and congenital heart defects, and provide valuable insight into possible strategies for …

Evaluation Of A Smoke And Tobacco-Free Initiative In A Student Wellness Center, Angelito Dela Cruz

Doctor of Nursing Practice Final Manuscripts

Background

Tobacco use remains a leading cause of preventable disease and death in the U.S. Nearly all tobacco users begin using tobacco by 26 years of age. In a Southwest university, 9% of students smoke tobacco. This project evaluated a university-wide tobacco-free initiative by reviewing students’ use of tobacco cessation services following a tobacco-free policy implementation. This project also reviewed students’ tobacco use following campus tobacco cessation counseling.

Methods

A smoke and tobacco-free campus policy was implemented in August 2015. The Student Wellness Center provided free tobacco cessation services to all students. Each tobacco cessation counseling session lasted a minimum …

Stress Management In A Corporate Setting, Erinn Gelakoska, Susan Instone

Doctor of Nursing Practice Final Manuscripts

Abstract

The purpose of this evidence-based project was to implement a sustainable stress management program in a corporate setting, utilizing company stress management resources. A three-step program was initiated to include a 30-minute stress education session, followed by a 30-minute one-on-one session with a nurse practitioner student utilizing aspects of motivational interviewing to develop a goal oriented stress management plan. An individual one-month follow up was also performed. Of the 30 employees who attended the educational session, 15 signed up for a one-on-one session. Eight out of the 15 employees completed the one-month follow up. Employees completed a pre and …

Improving Suicide Risk Management In Military Primary Care, John A. Hoyos

Doctor of Nursing Practice Final Manuscripts

Background: In the military, completed suicides and attempt rates have risen across the services since 2001 by 82% per 100,000 in spite of various intervention programs. The literature suggests that absent and inadequate suicide assessments may be part of the problem. Primary care providers are often not prepared for risk assessment and management of suicidal patients.

Aim/Purpose of Project: The project sought to improve the consistency of providers in conducting adequate risk assessments and providing crisis hotline information to patients who were cleared to return home after an encounter, as required by NPSG 15.01.01.

Project Plan Process: This evidenced-based project …

Improving Postexposure Hiv Follow-Up In Healthcare Workers, Linda Valles Gutierrez

Doctor of Nursing Practice Final Manuscripts

The purpose of this evidence-based practice (EBP) project is to improve the HIV postexposure follow-up (PEFU) rate in healthcare workers (HCWs) through implementation of a revised infection control policy and reminder system. Occupational exposure to HIV is a significant risk for all healthcare workers. In the United States every year, 1 out of 10 U.S. healthcare workers suffers a blood or body fluid exposure (BBFE). Transmission of one serious blood-borne infection can cost more than a million dollars for medications, follow-up laboratory testing, clinical evaluation, lost wages, and disability payments. Completion of HIV PEFU in HCWs is very low nationally. …

Obstructive Sleep Apnea: Emphasis On Discharge Education After Surgery, Arbert Almoite Nazareno, Cresilda Newsom, Esther Lee, Joseph Burkard

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based practice project is to evaluate the effectiveness of discharge education (DCE) on obstructive sleep apnea (OSA) for increasing continuous positive airway pressure (CPAP) compliance after surgery among adult surgical patients diagnosed with OSA, who use CPAP.

Background & Evidence for Problem: In the United States, the prevalence of OSA in the adult population is approximately 20%. Over half of the surgical patients with OSA are predisposed to increased incidence of perioperative complications. Based on recent evidence, obstructive events are at the highest on the third day after surgery, which predisposes them for postoperative complications. …

Early Mobilization To Enhance Patient Outcomes, Keelia N. Mailander Rn, Sarah F. Vito Rn, Susan Gross Bsn, Rn

Patient Care Services / Nursing

No abstract provided.

The Lived Experience Of Urban Plus-Sized Black Women In A Midwestern City, Jolene Johnson Lynn

Dissertations

ABSTRACT Obesity among adults in the United States is a significant problem of growing proportions. Black women have a higher rate of obesity than other women but there is a paucity of research about the experiences and perspectives of plus-sized Black women. The purpose of this phenomenological study was to explore the experience of plus-sized Black women living in an urban area. Ten participants were interviewed guided by open-ended interview questions. All interviews were audiotaped and transcribed verbatim. Colaizzi’s (1978) phenomenological method was used to identify themes within the data. Data analysis resulted in three themes: the meaning of plus-size, …

Increasing The Awareness Of Trauma Informed Care In The School Setting: Giving Practitioners The Tools To Actively Participate In Trauma Related Care, Rebekah L. Sypniewski

Doctor of Nursing Practice (DNP) Projects

Of the approximately 15 million children and adolescents who have a mental health disorders that are interfering with their functioning, a mere 25% seek medical advice or treatment (Melnyk, Kelly, & Lusk, 2014). Furthermore, two thirds of youth report experience at least one traumatic event by age 16 (Suarez, Belcher, Briggs, & Titus, 2012). School health practitioners have regular contact with children and adolescents as they typically attend school five days a week, nine months out of the year. The consistent presence of the relationship between the practitioner and student creates an ideal environment for discussing the sensitive topics necessary …

A Quality Improvement Project On Diagnosis And Management Of Asthma In A Private Pediatric Setting., Sosamma Ashley

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Although national guidelines exist for the diagnosis and management of asthma, general practice differs significantly from recommendations. Quality improvement methodology when implemented can narrow quality gaps.

Objective: The objective of the project was to create and implement a plan of action to address identified gaps in key clinical activities of asthma care among pediatric population in a private pediatric setting in Northern California

Methods: The project was centered on the use of Education in Quality Improvement for Pediatric Practice (EQIPP), a program of the American Academy of the Pediatrics. Both the pediatrician and the DNP student took this …

Development, Implementation And Evaluation Of A Screening Mammography Program, Christine Natan

Doctor of Nursing Practice (DNP) Projects

Breast cancer is a major public health concern in the United States and remains a priority for national women’s health centers, primary care practices and cancer control organizations such as the American Cancer Society (ACS). The cancer care continuum includes the spectrum of prevention/risk reduction, early detection, treatment, and living with the diagnosis. Currently there are no proven primary prevention options for women at average risk of developing breast cancer; therefore, secondary prevention interventions such as screening mammography and clinical breast examination (CBE) are required to reduce morbidity and mortality. This manuscript describes a Doctor of Nursing Practice (DNP) led …

Integrating Improved Geriatric Content Into A Nursing Curriculum: Enhancing The Competencies Of Nursing Students In Gerontological Care, Sylvia Andrade

Doctor of Nursing Practice (DNP) Projects

The United States is facing a critical shortage of health care professionals who are trained in geriatrics. Among the health care professions, nursing, with more than 3 million members, comprises the largest segment of the nation’s health care workforce. New nurses entering this workforce find themselves caring for an extraordinarily large number of older patients with complex health care needs, regardless of the care setting. Currently, 36 million Americans are aged 65 or older. By 2030, that number will double. Accordingly, the need is significantly greater for more gerontologically trained registered nurses to address the complex health care needs of …

Implementing The 5as Framework For Obesity Management, Jennifer C. Sassman

Doctor of Nursing Practice Final Manuscripts

This Doctor of Nursing Practice (DNP) pilot project strives to improve management of obesity by increasing provider knowledge and utilization of the 5As Framework which is an effective evidence-based intervention and a behavioral counseling tool. Pre-data including BMI and waist circumference were collected over one month. An educational in-service on the 5As was held for one primary care nurse practitioner. Post data was gathered over five months. Provider knowledge on the 5As was increased however, there was not an increase in identifying obesity. The 5As was used about 10% of time with obese patients. This pilot project can be expanded …

Utilizing Tiger Competencies To Improve Informatics Practice, Kwun Ying M. Fung

Doctor of Nursing Practice (DNP) Projects

Nursing Informatics (NI) is quickly becoming an essential part of nursing. From the classroom, to the bedside, and to the boardroom, nurses across the nursing continuum are expected to use NI in their practice with the hopes of delivering better quality care to their patients. However, the training and education of NI provided to all levels of nurses is unable to keep up with the pace of technology. This project seeks to improve the NI competency of the nursing workforce at a pediatric hospital through an educational course using NI competencies identified by the Technology Informatics Guiding Educational Reform (TIGER) …

Implementing Change To Decrease The Re-Admission Rate For Clients Of A Care Transition Program, Aileen Tran

Master's Projects and Capstones

The clinical nurse leader (CNL) internship project’s purpose is to implement a change to decrease readmission for clients in a care transition program, thereby improving quality of life. This care transition program aids with the transition from hospital to home for adults. The microsystem is composed of public health nurses, volunteers, student interns, supervisors, and an administrative assistant. The aim statement for this change project is to improve patient safety by decreasing readmission rates by implementing an initial follow-up phone call within one day of discharge in 75% of the care transition clients by April 30, 2016. This project was …

Discharge Improvement Process, Medeina O'Neal

Master's Projects and Capstones

Abstract

The focal point of the project takes account of the CNL educational program component of the Care Environment. The purpose of the CNL role would reflect the Team Managers functionality. “Care Environment identifies clinical and cost outcomes that improve safety, effectiveness, timeliness, efficiency, quality, and the degree to which they are client-centered“ (AACN, 2013). The unit provides care to patients who require constant cardiac monitoring for reasons that may include sepsis, pneumonia, recent surgeries, advanced congestive heart failure, renal failure and COPD. Having a standardized discharge process could hopefully reduce the number of delays, so that the desired goals …

Implementing Ways To Reduce Catheter-Associated Urinary Infections (Cautis), Maryam Keyhani

Master's Projects and Capstones

Abstract

Center for Control and Disease Prevention (CDC), estimates that 40% of all Urinary Tract Infections (UTIs) are related to Hospital-acquired Infections (HAIs) (CDC, 2013). The Facility where the project was done consists of oncology, orthopedic, medical-surgical, telemetry, incentive care, and step-down units. This hospital with 242 licensed beds has approximately 51,571 ER visits and a total of 10,606 admissions per year.The prevalence of Cather-associated Urinary Tract Infections (CAUTIs) on the 4th floor, the medical-surgical unit with 42 beds was significantly higher than other units. The hospital goal is to increase patient safety and satisfaction as well as reduce and …

Managing Postoperative Pain For Timely Discharge Of Total Hip Replacement Patients, Elmer De Leon

Master's Projects and Capstones

This project requires three competency area of Clinical Nurse Leader: 1) Essential 2:Organizational and Systems Leadership, good fiscal stewardship is a condition of quality care, 2) Essential 3: Quality Improvement and Safety, practice guidelines are based on evidence, and 3) Essential 4: Translating and Integrating Scholarship into practice, client-centered practice is intra- and interdisciplinary. The purpose of this study is to develop a nursing intervention that would result in enhanced comfort for total hip replacement patients so timely hospital discharge (i.e., within 2 days) can be achieved. The preceptor site for this project is a hospital located in northern California. …

Reducing Iv Infiltrates In The Neonatal Population, Stephanie L. Miller

Master's Projects and Capstones

Abstract

The objective of the CNL project is to improve the quality of care provided to our patients. The project focuses efforts to reduce IV infiltrates by auditing all running IV lines, IV management monitoring and auditing infiltrate grading and documentation to find commonalities that could be causing infiltrates.

The project is focusing on the neonatal population at a children’s hospital in the Neonatal Intensive Care Unit (NICU). This NICU is an 80 bed unit that houses both critical care patients and intermediate care neonates.

Auditing was a major component to the project and helped with identifying common causes so …

The Development Of Standardized Patient Controlled Analgesia Documentation To Improve Patient Care, Collyn West

Master's Projects and Capstones

On a 28 bed post-surgical unit, reviewing patient records revealed only 26% had thorough patient controlled analgesia (PCA) documentation. A pre-quiz no staff knew all of the required components for documentation or which policies to reference and, on average, the staff were only able to correctly answer 30% of the questions. Therefore, a project utilizing the clinical nurse leader improvement theme of clinical outcomes management was initiated to standardize the documentation of PCA medication administration to improve post-operative pain management, improve patient satisfaction, and improve patient safety.

The current process was determined using a fishbone diagram, a SWOT analysis was …

Obstetric Triage Improvement, Whitney Depaoli

Master's Projects and Capstones

The objective of the obstetric triage improvement project is to decrease the average length of stay for perinatal patients presenting to the obstetric triage. The setting is a university hospital in a large urban city. The population includes pregnant patients with obstetric complaints presenting to triage for further evaluation. Methods used include a root cause analysis, process mapping, lean transformation methodology, and standardization of workflow. The results of the project include reducing the average length of stay in obstetric triage from a baseline of 152 minutes to 120.58 minutes, which represents a 21% decrease. The creation of standard workflows, the …

An Interdisciplinary Approach To Reducing Falls: Utilizing Team Huddles And Visual Aids To Increase Nursing Staff And Patient Knowledge On T.E.A.M. Fall Risk Interventions, Jennifer A. Viernes

Master's Projects and Capstones

One of the most important aspects of patient safety is the prevention of patient falls (PFs). PFs are a never event and are preventable. The project addresses the ongoing increase in PFs on a medical-surgical oncology unit in an inpatient hospital setting. The increase in PFs created urgency to provide solutions to these preventable circumstances. This Clinical Nurse Leader (CNL) led the project and conducted a comprehensive microsystem assessment of the potential causes of PFs calling for further investigation of the unit’s current fall policy. After conducting two surveys of both the nursing staff (NS) and patients’ knowledge of fall …