Nursing Commons^™

Exploring Incivility Among Nursing And Health Science Students: A Descriptive Study, Diane Louise Smith

Student Theses, Dissertations and Capstones

Incivility has infiltrated our institutions of higher learning as well as the world of nursing. All too familiar in nursing is the phrase “eating their young,” which aptly describes how nurses treat other nurses, even though they should be nurturing and caring professionals.

The investigator explored nursing and health science students’ perceptions of student and faculty uncivil behaviors within the academic environment, seeking the levels and frequency of the problem. Bandura’s social learning theory presents a sound theoretical framework for this dissertation. The research methodology consisted of a quantitative descriptive approach. The Incivility in Higher Education-Revised (IHE-R) Survey was used …

The Applicability Of The Decisional Conflict Scale In Nursing Home Placement Decision Among Chinese Family Caregivers: A Mixed Methods Approach, Yu-Ping Chang, Loralee Sessanna, Joanne Kraenzle Schneider

Asian/Pacific Island Nursing Journal

This study aimed to 1) examine relationships between uncertainty, perceived information, personal values, social support, and filial obligation among Chinese family caregivers faced with nursing home placement of an older adult family member with dementia; and 2) describe the applicability of the Decisional Conflict Scale in nursing home placement decision making among Chinese family caregivers through the integration of quantitative and qualitative data.

We used a mixed-methods approach. Quantitative data analysis consisted of descriptive and correlational statistics. We utilized a thematic analysis for the qualitative data. Data transformation and data comparison techniques were used to combine qualitative and quantitative data. …

An Investigation Of Factors Predicting The Type Of Bladder Antimuscarinics Initiated In Medicare Nursing Homes Residents, Daniela C. Moga, Qishan Wu, Pratik Doshi, Amie J. Goodin

Pharmacy Practice and Science Faculty Publications

Background: To examine factors predicting type of bladder antimuscarinics (BAM) initiated in nursing home (NH) residents.

Methods: Incident BAM initiators following NH admission were identified by constructing a retrospective cohort from Medicare files and Minimum Data Set (MDS). Participants included all residents 65 years and older admitted in Medicare-certified NH between January 1, 2007 and December 31, 2008 who were prescribed BAM and had continuous Medicare (Part A, B, and D) enrollment. Patient characteristics, medications, and comorbidities were derived from Medicare enrollment and claims. NH characteristics and health status were derived from MDS assessments. The outcome was defined as type …

Lived Experience In Patients With Recurrent Glioblastoma In Japan: A Narrative Study, Ai Chikada, Asako Takekuma Katsumata, Mariko Asase, Sayaka Takenouchi, Yoshiki Arakawa, Kazuko Nin

Asian/Pacific Island Nursing Journal

Glioblastoma (GBM) is well known to have one of the poorest prognoses among all cancers. Patients with GBM in progression-free survival (PFS) may be relatively stable and can often maintain their quality of life. Thus, PFS is a desirable goal. In Japan, the median PFS is 11 months. It is difficult to grasp a patient's thoughts and hopes when, after PFS, they are readmitted due to recurrence or acute deterioration. Therefore, this study aimed to describe the lived experience of illness in patients with recurrent GBM, focusing on PFS. We enrolled five patients into the study; however, only four patients …

The Horns Of Dilemma: Life Or Sovereignty, Farida Bibi Mughal, Bibi Hajira Irshad Ali

School of Nursing & Midwifery

Death and dying are the bitter truth that is faced by every person inevitably. Paying respect to the decision of a patient in a hospital setting is always a challenging task. In eastern countries, family plays an important role in decision making. But it always overrides the preferences and wishes of the patient and this leads to violation of ethical principles such as autonomy, informed consent and veracity. Looking a situation from different paradigms and deciding the best solution on the ground of ethical principles should be the utmost priority of the healthcare provider.

Effects Of An Alcohol Education Program On Improving Knowledge, Attitudes And Satisfaction Of Registered Nurses Caring For Patients Undergoing Alcohol Withdrawal, Luis Medina

Seton Hall University DNP Final Projects

Managing and caring for patients who are undergoing alcohol withdrawal presents challenges for nurses in an inpatient setting. These challenges are influenced by factors such as negative attitudes, lack of knowledge and poor satisfaction. The purpose of this quality improvement initiative was to determine whether the effects of implementing an alcohol educational program would improve knowledge and satisfaction while reducing negative attitudes. This program implemented education on alcoholism, alcohol withdrawal and the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) monitoring tool which would be incorporated into the everyday practice of nurses caring for patients undergoing alcohol withdrawal. The …

Implementation Of An Opioid Risk Assessment Tool, Stacey Cuomo

Seton Hall University DNP Final Projects

The increased prevalence of opioid use in society has led to an increase in surgical patients with a history of such use. Patients who use or are addicted to opioids have different tolerances and responses to anesthesia than non-opioid users, and will require different care than non-users both pre- and post-operatively. The means to identify this population prior to a surgical procedure is needed as a way to organize, plan and manage patient care during the perioperative period. An Opioid Risk Assessment Tool (ORAT) was used as a way to streamline the process of identifying these patients. This paper addresses …

The Effectiveness Of Nurse-Driven Early Mobility Protocol, Viktoriya Fridman

Seton Hall University DNP Final Projects

Purpose: The purpose of this quality initiative is to introduce the nurse driven evidence-based practice change related to patient mobility in the hospital setting with the aim to improve nurse knowledge, attitude, and behavior on a medical-surgical unit.

Significance of Project: The proposed DNP quality project is devised from the American Academy of Nursing (AAN) Choosing Wisely campaign unique to the elements of “don’t let older adults lay in bed or only get up to a chair during their hospital stay” to achieve a practice change. A significant aspect of patient care in a hospital setting is patient …

Debriefing With Reflection: Best Practice For Learning In Simulation In Pre-Licensure Nursing Education, Mary Mcdermott

Seton Hall University DNP Final Projects

Purpose: The purpose of this project was intended to transform the outdated method of conducting debrief after simulation by implementing a good judgment model and integrating the concept of “advocacy-inquiry.” This implementation was expected to reduce demoralizing and anxiety producing debrief experiences and improve student reflection and learning in order for students to more deliberately link theory with practice.

Significance: The debrief is often recognized as the component of simulation in which the most effective learning occurs. It is the time when students are provided opportunity to reflect on thoughts, actions and behaviors. Unfortunately, many nursing students often experience undue …

Psychometric Testing Of The Healthy Eating And Physical Activity Self-Efficacy Questionnaire And The Healthy Eating And Physical Activity Behavior Recall Questionnaire For Children, Jane Lassetter Phd, Rn, Christopher I. Macintosh, Mary Williams, Martha Driessnack, Gaye Ray, Jonathan Wisco

Faculty Publications

Purpose: The purpose of this study was to develop and assess the psychometric properties for two related questionnaires: the Healthy Eating and Physical Activity Self-Efficacy Questionnaire for Children (HEPASEQ-C) and theHealthy Eating and PhysicalActivity Behavior RecallQuestionnaire for Children (HEPABRQ-C). Design andMethods: HEPASEQ-C and HEPABRQ-C were administered to 517 participating children with 492 completing. Data were analyzed to evaluate for reliability and validity of the questionnaires. Results: Content validity was established through a 10-person expert panel. For the HEPASEQC, item content validity index (CVI) ranged from 0.80 to 1.00. The CVI for the total questionnaire was 1.0. AllHEPASEQ-C items loaded on …

Reducing Rehospitalizations From One Skilled Nursing Facility: A Quality Improvement Project, Victoria Ann Phillips

Doctoral Dissertations and Scholarly Projects

The purpose of this quality improvement project initiated by a core project team in a large medical center was to investigate possible causes for increased hospital readmissions from one specific skilled nursing facility. The conceptual framework utilized was the Define, Measure, Analyze, Improve, Control (DMAIC) model from the Lean Six Sigma methodology. Data collection from chart audits, a staff survey, a system probe, and a process mapping project assisted to narrow the focus of the plan to improve communication among facilities by standardizing documentation and coordination of care as patients transitioned from the skilled nursing facility to the medical center’s …

Using Social Narratives To Improve The Healthcare Experiences Of Children Diagnosed With Autism Spectrum Disorder, Margaret Spindel

Senior Honors Projects, 2010-2019

Children with Autism Spectrum Disorder (ASD) often experience significant emotional stress when they visit a healthcare provider. The focus of this research project was to explore the use of social narratives to help reduce stress associated with this environment. Social narratives are short stories designed to walk a child through a potential situation that they will encounter, that they may not be familiar with, or that they are not currently handling properly. As part of an initial literature review, evidence for the need for additional intervention in the healthcare setting for children with ASD was established. Continuing literature review then …

Out Of The Darkness And Into The Limelight: How Nurse Jackie Betters The Nursing Image, Shayla M. Holloway

Senior Honors Projects, 2010-2019

Due to the media’s portrayal of nurses, the nursing image has been

misconstrued over the past few years. Although nurses tend to be overlooked in the

media, there are television series out there that help promote the profession. This

essay considers how the television series Nurse Jackie is positively changing

society’s view of the modern day nurse. By analyzing some of the main protagonists

in season one of this controversial late night drama, one can see how Nurse Jackie

dispels popular nursing stereotypes and enhances the nursing image. Although

viewers may not grasp this shows impact on nursing, this show …

An Informatics Solution For Operating Room Efficiency, Richard A. Barrow

Doctor of Nursing Practice (DNP) Projects

Problem: For most hospitals, a major cost is the operating room. Inefficiency increases costs and risks for adverse events. An efficient operating room can also be a major revenue generator.

Context: This evidence-based performance improvement project was conducted in a small rural Veteran’s Hospital, which belongs to an integrated health network in Central California. The facility has four operating rooms and is expanding services provided to their patients.

Intervention: The intervention was the use of analytics and evaluations to improve the operating room efficiency by five percent. The use of 3 separate queries which were combined to generate reports and …

Assessing The Impact Of Simulation Role On Anxiety And Perceived Outcomes In Undergraduate Nursing Students, Teresa A. Bates

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Background: Due to large class sizes and limited resources, students participating in high-fidelity simulation experiences may be assigned to an observer role as opposed to an active, nursing role. It is important for educators to determine if anxiety levels and student learning outcomes are comparable regardless of role.

Methods: A quasi-experimental correlational study composed of 132 prelicensure baccalaureate students was conducted.

Results: There were no significant differences between simulation roles for anxiety levels and perceived outcomes for satisfaction, self-confidence in learning, clinical ability, problem solving, confidence in clinical practice, and collaboration.

Conclusions: These findings suggest that either role is an …

“These Classes Have Been My Happy Place”: Feasibility Study Of A Self-Care Program In Native Hawaiian Custodial Grandparents, Loriena Yancura, Heather Greenwood-Junkermeier, Christine A. Fruhauf

Asian/Pacific Island Nursing Journal

Native Hawaiian custodial grandparents have a distinctive set of strengths and challenges that may lead them to benefit from a structured self-care program. The purpose of this paper is to describe a feasibility study with nine Native Hawaiian custodial grandparents who participated in a 6-week self-care intervention. Based on open-ended questions during the post-questionnaire and at the 6-month follow-up focus group, grandparent participants noted that their grandchildren needed education and clothing. Most grandparents did not endorse statements that their grandchildren had any mental or physical health conditions. Grandparents reflected that the intervention provided them with skills to help cope with …

Improving Obesity Management In Primary Care, Jeffrey M. Waddell

Doctor of Nursing Practice Scholarly Project

This project examined how advanced practice nurses (APNs) manage overweight and obesity in primary care. Not only were their general attitudes and beliefs toward overweight and obesity explored, but their beliefs about the treatment and management of obesity were also examined. The APNs’ knowledge and current practice with managing obesity in the primary care setting were evaluated. This project went on to examine the APNs’ awareness and utilization of clinical practice guidelines in managing overweight and obesity. Finally, the study asked about the perceived impact of a website designed to provide guidance managing obesity based on the American Association of …

Improving Nursing Adherence To Pediatric Pain Management Bundle Using The Pdsa Cycle, Stephen W. Lovern

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Given the current standards, pediatric post-operative pain management can be a distressing outcome to the patient and family. Adequate management of post-op pain in this population is a challenge despite the availability of evidence-based interventions combined to form care bundles. Tonsillectomies are common procedures in the pediatric population and often include moderate to severe pain with ineffective pain relief. Inadequate pain management leads to unplanned admissions, longer post anesthesia care unit (PACU) stays, slower oral intake, and longer recovery periods. In this project, two interventions were tested using the plan-do-study-act (PDSA) model for rapid cycle improvements. The first intervention was …

Quality Improvement In Provider Attitudes Towards Adherence To Comprehensive Diabetic Care Hedis Standards, Samantha Taylor

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Healthcare Effectiveness Data and Information Set (HEDIS) is a quality measurement for standard of care used to rate a health plan or provider's ability to demonstrate clinical effectiveness. Medicare Advantage healthcare plan utilizes HEDIS as a guide for standard of care. Adherence to HEDIS is useful in decreasing chronic disease burden through preventative measures. Diabetes, a disease with high burden, has Comprehensive Diabetes Care HEDIS standards that specifically target providers. Increasing adherence to HEDIS measures is shown to significantly improve health outcomes when used with evidence-based guidelines. The literature shows having high HEDIS scores are not an incentive to adhere …

The Effectiveness Of Education And Cognitive Rehearsal In Managing Nurse-To-Nurse Incivility, Deborah B. Kile

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

This project was designed to evaluate the effectiveness of education on nurse-to-nurse incivility and use of cognitive rehearsal techniques on registered nurses' perception of their ability to recognize and confront incivility, along with resulting job satisfaction. Nurse-to-nurse incivility negatively affects nurses, organizations and patients. The Tri-Council for Nursing's proclamation calls nurses to recognize incivility and take steps to eliminate this in practice ("Tri-Council" 2017). A mixed method, quality improvement pilot study was conducted. Participants, (registered nurses employed in a Post-Anesthesia Care Unit in a community hospital in Virginia), received education on incivility and cognitive rehearsal techniques. Data was collected through …

Identifying Ways That Institutional Staffing And Scheduling Committees Engage Nursing Staff In Resource Allocation At The Unit And Institutional Levels, Kevin M. Shimp

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

The American Nurses Association (ANA) recommends that at least fifty percent direct care providers are involved in staffing and scheduling decisions at the institutional level (ANA Staffing, 2015). This recommendation coincides with Magnet recommendations for the staff most impacted by staffing levels. Magnet organizations are recognized for superior nursing processes and quality patient care, which lead to the highest levels of safety, quality, and patient satisfaction (ANCC, 2015). Existing research, largely at the unit level, shows that registered nurses in acute care environments have higher general work satisfaction and morale when they are engaged in decision making around staffing (Ellerbe …

Pilot Of A Randomized Trial Comparing Outcomes Of Three Types Of Peripheral Intravenous Catheters (Pivc): Utilizing The Plan, Do, Study, Act Cycle, Heather Galang

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Peripheral intravenous catheters (PIVC) are used in high volume in acute and ambulatory settings. Due to high volume of use in patient care, complications from a PIVC can significantly impact patient experience. Literature indicates complications such as blood exposure, phlebitis, unplanned removal, infiltration, occlusion, dwell time, pain, and cost have serious consequences in patient care, leading to potential delays in treatment, patient discomfort, patient dissatisfaction, safety concerns, nursing interruptions, increased length of stay, and added costs. Gap analysis indicates additional research can prove beneficial for evidence-based care improvement. The authors propose using the plan, do, study, act to conduct a …

Improve Readmissions And Patient Satisfaction Scores With A Revised Discharge Education Plan, Michele M. Hughes

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Problem: Payers of health insurance are tracking key performance measures and are limiting payments to hospitals. With this threat to financial reimbursement hospital systems have increased emphasis on tracking and improving outcomes. The purpose of this project is to reduce all-cause 30-day readmissions and improve patient satisfaction scores in the care transitions domain after a total hip or total knee replacement by revising the discharge materials and education.

Method: The total joint replacement discharge education materials were revised to address the common causes of readmissions. The documents were reformatted to improve literacy level, readability, and patient learning. Nurses were educated …

New Nurse Huddle Pilot To Improve New Graduate Nurse Retention, Timothy Craddock

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Purpose: With the continued nursing shortage, it has become increasingly important for healthcare organizations to focus on nurse retention to maintain quality of care standards and maintain fiscal responsibility. The purpose of this project was to pilot a new graduate nurse huddle to improve retention of new graduate nurses.

Method: A new graduate nurse huddle was developed using past nurse residency cohort Casey-Fink Graduate Nurse Experience Survey data to focus on areas of poor performance. Mixed methods surveys were administered pre-huddle and post-huddle to measure participant intent to stay and perception of huddle value. Descriptive statistics were used to evaluate …

Improving Adherence To Mental Health Treatment In A Low-Income Clinic, Janice G. Gandy

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

The increasing prevalence of mental illness in the United States presents significant challenges for primary care providers in low-income settings. Integrated Behavioral Health (IBH) programs have resulted in improved general health for low-income participants; however, managing appointment adherence, in which the patient attends appointment as scheduled, is particularly challenging. The purpose of this pilot project was to implement bundled interventions at a low-income primary care clinic to improve patient adherence to behavioral health treatment. The bundle of interventions included: 1) educational interventions emphasizing the benefits of IBH care 2) warm patient handoffs between the primary care provider to a behavioral …

Inpatient Hospice Home: A Needs Assessment And Business Plan, Stacey Middleton

Doctor of Nursing Practice Scholarly Project

An Abstract of the Scholarly Project by

Stacey Middleton

There are two constants that every person can count on in life, being born and dying. No amount of research is required, and there is no need to challenge the inevitable. When a child is born, people celebrate and congratulate the new parents and their family. When a person dies, people are saddened by the loss of a friend and loved one. Death comes to all and is either, fast and unexpected or a slow drawn out process. Every dying patient deserves to die with dignity, be free from pain, and …

Leadership Development, Succession Planning And Simulation: A Succession Plan For Organizational Success, Beth Eichenberger

Doctor of Nursing Practice (DNP) Projects

Future executive nurse leaders must be identified and prepared for the challenges of 21st century health care. The literature suggests a lack of existing standardized succession plans for these leaders. Senior leaders are often faced with the complex issue of how to develop and validate the competencies required for these leadership roles (Dyess, Sherman, Pratt, & Chiang- Hanisko, 2016). Therefore, in the absence of a succession plan, creating a leadership development program, which provides a pipeline of new executive leaders, would alleviate this gap. The motivating force is an effort to promote current talent and provide a higher level of …

Development Of A Nurse Practitioner First Assistant Orientation Program, Romoanetia Lofton

Doctor of Nursing Practice (DNP) Projects

The demand for surgical services continues to increase, creating a strain in our healthcare system and causing increasing backlog hours for the operating room. Allowing nurse practitioners (NP) to function in an expanded role in the perioperative environment requires additional training beyond the generic NP program. With this additional training, the NP can function as a first assistant, providing delegated medical functions in the perioperative environment. An in-house NP registered nurse first assistant orientation program was developed based on the adult learning theory as a conceptual framework combined with the AORN perioperative standards as a foundation. The cost of using …

Float Rns: Unit Specific Tools To Promote A More Positive Float Experience, Tarra Abdullah-Grayson

Doctor of Nursing Practice (DNP) Projects

Despite efforts to transition large portions of primary health care services to more community-based outpatient settings, federal projections say the rising complexity of acute care will increase demand for RNs in hospital settings by 36% in 2020 (American Association of Colleges of Nursing [AACN], 2017). Other projections indicate that by 2025, the U.S. registered nursing shortage will expand to more than 260,000 (Buerhaus, Auerbach, & Staiger, 2009). In an effort to address the ongoing challenges of nursing staff shortages, many hospitals have established a core of internal float pool RNs as a practical and cost effective solution to address the …

Increasing Faculty Knowledge And Empathy Related To Nursing Students With Learning Disabilities, Jodi Kushner

Doctor of Nursing Practice (DNP) Projects

The purpose of this paper is to provide a project overview for the implementation of a disability training module and simulation experience offered to university school of nursing faculty to increase faculty knowledge and empathy related to nursing students with learning disabilities. The number of students with learning disabilities in the postsecondary education setting has tripled in the past decade (Orr & Hammig, 2009). This growing student population makes faculty preparation essential in order to effectively meet the needs of these students. The literature indicated that best practices include disability training, faculty support, student support, inclusive strategies such as Universal …