Nursing Commons^™

Recovery-Oriented Care In A Psychiatric Health Setting, Renita Denise Hargrow

Walden Dissertations and Doctoral Studies

Psychiatric recovery-oriented care is aimed at improving patients' quality of care while increasing the efficiency of health care providers. Despite the benefits of recovery-oriented care, this approach is often lacking in health care settings. The purpose of this project was to implement a recovery-oriented training on psychoeducational groups on a 26-bed psychiatric unit. The Iowa model of evidence-based practice and adult learning theory provided the framework for the project. The objectives were to (a) assess training needs, (b) evaluate barriers for recovery-oriented psychiatric nursing, (c) develop strategies to address barriers, (d) train staff in psychoeducational approaches, and (e) evaluate the …

Implementation Of A Standardized Multifactorial Fall Prevention Program In A Rehabilitation Facility, Shanetta Monique Ancrum-Lee

Walden Dissertations and Doctoral Studies

One and a half million people are currently living in residential care facilities; as the baby boomer generation ages, this number will increase to 3 million. Approximately 3 out of 4 residents of these facilities fall each year, and 10% to 20% of those falls result in serious injuries such as fractures, disability, and a decreased quality of living. The BOUNCE Back fall initiative is a multifactorial program that uses a systematic approach starting on admission and to re-evaluate a resident following a fall. Nursing and therapy uses the Morse Fall Scale and the Elderly Mobility Scale to assess and …

Quality Improvement Through Evidence-Based Education: Advancing Obesity Awareness And Clinical Management Strategies For People Living With Mental Disorders, Ellis Ehizele Opusunju

Walden Dissertations and Doctoral Studies

People living with mental disorders (PLWMDs) are at an increased risk for developing obesity due to poor diet, physical inactivity, and antipsychotic medications. In the United States, the general-population obesity rate is 36% compared to more than 50% for PLWMDs. Mental health professionals (MHPs), focused on addressing psychiatric conditions, seldom recognize and clinically manage obesity. Furthermore, this population is socioeconomically disadvantaged with poor dietary habits while consuming psychiatric medications that stimulate hunger, further exacerbating the risk for obesity. The Promoting Action on Research Implementation in Healthcare Services (PARISHS) framework guided this quality improvement project to improve obesity awareness and management …

An Evidenced-Based Pain Management Module To Improve Clinicians' Knowledge, Mark A. Wells

Walden Dissertations and Doctoral Studies

Chronic pain syndrome continues to be a national health concern among all medical specialties. It has an impact on the entire health care system and if current trends continue, the economic impact alone will exceed 100 billion dollars. In 2014, 254 million prescription opioids were written in the United States. During this time, an increase in prescription opioid related deaths was seen, with approximately 20,101 deaths occurring in 2015. Properly trained clinicians across the health care system are needed to achieve successful patient outcomes, while reducing cost, morbidity, and mortality. The purpose of the scholarly project was to develop a …

Performance Improvement Data And Staff Responsibility, Tabitha Anne Bentley

Walden Dissertations and Doctoral Studies

Improving the role the nurse plays in health care delivery should be embodied in the performance improvement initiatives to successfully improve the quality of care that is delivered. The purpose of this evidence-based practice project was to collect performance improvement data and present it to staff who, in turn, used the information to improve practice and influence patient safety outcomes. The practice-focused question addressed what would occur if a tool that allowed frequent data trending was used to measure effectiveness of care and thereby influence key outcome measures. Duffy's quality caring model provided a framework for the study to support …

Improving Seasonal Influenza Vaccine Uptake Among Health Care Workers, Debra Gray

Walden Dissertations and Doctoral Studies

Yearly influenza (flu) immunization rates for hospital healthcare workers (HCW) continue to be lower than those suggested by the Centers for Disease Control and the World Health Organization. Vaccination is considered a valuable step in the process to protect patients against influenza infection. The goal of Healthy People 2020, and most hospital administrators, is that 90% of HCWs are being immunized. The objectives for this systematic literature review were to identify best practice recommendations for improving the vaccine rate among HCWs. The Cochrane methodology framed this systematic review, and Fineout-Overholt's and Melnyk's levels of evidence were used to evaluate the …

The Impact Of Nursing Staff Ratios On Falls Rates In Skilled Nursing Facilities, Akudo Okeorji

Walden Dissertations and Doctoral Studies

Falls and complications from falls are a common problem among adults aged 65 years and older. About 60% of older adults fall every year, causing injuries, hospitalization, nursing home placement, and even death. Most studies on falls among skilled nursing facility (SNF) residents focus on fall preventive measures that fail to include staffing variables such as nursing hours. Although researchers have examined the relationship between nursing staff and patient outcomes in hospital settings, similar studies have not occurred in long-term care facilities. The purpose of this retrospective longitudinal study was to determine whether a correlation exists between nursing staff hours …

The Development And Validation Of A Novice Nurse Decision-Making Skills Education Curriculum, Joanne Stephanie Simmons

Walden Dissertations and Doctoral Studies

Novice nurses (NNs) are entering critical care environments with limited knowledge, skills, and decision-making expertise. They are expected to care for complex patients in a dynamic healthcare setting. The research question for this project examined whether NNs improve their knowledge and skills by participating in a nursing decision-making skills curriculum. The purpose of the project was to develop and validate a nursing decision-making skills education curriculum working in an intermediate critical care unit. Taba's instructional theoretical model was used to guide the new curriculum development along with current evidence based practice found in the current literature. Scaffolding approach theory encouraged …

Appraisal Of Nonpharmacological Chronic Pain Management, Yvonne Larue Anthony

Walden Dissertations and Doctoral Studies

Chronic pain is a condition that impacts millions of men and women around the globe. It is a compelling disease that particularly impacts quality of life (QOL) for many veterans with undertreated or untreated pain. The focus of this systematic literature review was the appraisal of articles and clinical practice guidelines to better understand best-practice nonpharmacological strategies for management of chronic pain. Key words used in the literature search included chronic pain and veterans, complementary alternative medicine (yoga, tai chi, music therapy, acupuncture, and massage), and cognitive behavioral therapy (CBT). The articles included in the review were limited to those …

Sucrose Use In Children: A Systematic Review, Dorothy Luongo

Walden Dissertations and Doctoral Studies

Sucrose is a method of pain relief that can be used for children during minor painful procedures. Pain left unrelieved has been found to lead to long-term consequences such as distress, anxiety, needle fear, parental non-adherence with vaccination administration, and avoidance of medical care. Therefore, it is important to ensure pain management methods are provided to infant and toddlers. The purpose of this project was to present a systematic review on the use of sucrose in child in primary care. The comfort theory by Kolcaba served as the theoretical framework in exploring the use of sucrose in children in primary …

The Effect Of Referral Source On Patient Participation In Diabetes Education Programs, Karyn Marie Gallivan

Walden Dissertations and Doctoral Studies

The goal of diabetes education programs (DEPs) is to improve patients' pattern-management habits for those with type 2 diabetes (T2D), though participation in DEPs is lower than expected due to low physician referral rates. This retrospective study examined secondary data of 162 T2D patients who had been referred to a DEP in a community center in RI to determine whether the source of referral affected patient attendance, participation persistence, and outcomes. Self-referred (n = 62) and physician-referred (n = 100) groups were analyzed for possible associations among the aforementioned variables. Chi-square (p = .04) and logistic regression (p = .04) …

Effects Of Authentic Leadership Style And Nurse Engagement On Patient Satisfaction, Kimberly Dawn Washburn

Walden Dissertations and Doctoral Studies

Ineffective leadership and disengaged nurses reduce the quality of care and patient satisfaction in healthcare organizations. Healthcare leaders can benefit from understanding the factors that improve leadership ability and nurse engagement to improve healthcare outcomes. The purpose of this correlational study was to examine the relationship between the demonstration of authentic leadership characteristics and nurse engagement. The study's population comprised acute care registered nurses in a rural hospital in central Washington State. Authentic leadership theory and engagement theory constituted the theoretical framework. Independent variables were the 4 constructs of authentic leadership theory, self-awareness, balanced information processing, relational transparency, and internalized …

Caring For Patients With Delirium In The Intensive Care Unit, Susan Archer

Walden Dissertations and Doctoral Studies

Patients in hospital intensive care units are at increased risk to develop delirium, a condition which is characterized by a disturbance of consciousness and a change in cognition. Critical care nurses must have the knowledge to assess, recognize, and manage delirium. The purpose of this project was to develop an evidence-based policy for the assessment of delirium and a comprehensive nursing education plan which included an analysis and synthesis of the literature, a curriculum plan, and a pretest/posttest. The Johns Hopkins Evidence-Based Practice Model framed the project, which used a multidisciplinary team approach. Two nursing leaders, each with a doctor …

Decreasing Thirty Days Hospital Readmission Rates Of Adult Heart Failure Patients, Katherine Eyegue-Sandy

Walden Dissertations and Doctoral Studies

Heart failure is a complex heart disease that incapacitates more than 5 million people, is associated with increasing healthcare cost, and remains the leading cause of admission in the United States. As the United States faces increasing financial burden related to readmission of heart failure patients within 30 days of discharge, many healthcare institutions are evaluating interventions to determine the most effective opportunities to improve systems, including nursing practice. The purpose of this doctoral project was to improve readmission rates within 30 days of discharge from an acute care facility through the development and implementation of a standardized, evidence-based, patient-centered …

Relationship Between Student Characteristics And Attrition Among Associate Degree Nursing Students, Wendy Elizabeth Watson

Walden Dissertations and Doctoral Studies

High nursing student attrition has been a pervasive problem in the nursing program at the research site of this study. The purpose of this project study was to investigate the relationship between attrition and nursing student characteristics, including age, gender, ethnicity, English as Second Language (ESL) background, licensed practical nurse (LPN) licensure, grade point average (GPA), the number of preadmission college credits, and the Test of Essential Academic Skills (TEAS) scores. This correlational study of archival data was guided by Jeffreys's nursing undergraduate retention and success model and included a convenience sample of 240 students admitted to the program between …

Improving Nurse Mentor Retention Through The Use Of Nurse Residency Programs, Morgan Newman

Walden Dissertations and Doctoral Studies

Graduate nurses beginning their nursing career require a collaborative relationship with an expert nurse mentor to make this transition successful. However, high turnover among these experienced nurse mentors is causing a problematic gap in knowledge transfer, experience, and expertise in the nursing workforce. This project investigated whether nurse mentors who mentored in a Nurse Residency Program (NRP) remained with the organization longer and were more satisfied with their mentoring experience than nurse mentors who mentored outside of a NRP. The diffusion of innovations theory was used to support the project and process of dispersing information on the outcome of the …

Reducing Delirium In The Hospitalized Elderly With A Nursing Prevention Protocol, Mari L. Fraire

Walden Dissertations and Doctoral Studies

The aim of this project was to implement and evaluate the effectiveness of the Clear Minds protocol for early detection and prevention of delirium in hospitalized, elderly patients. The protocol was used to monitor for delirium and improve sleep quality by reducing sleep disturbances caused by environmental factors in hospital settings. Due to the risk of delirium for patients in late adulthood, implementation of a delirium-prevention protocol was needed. Upon admission, patients 60 years and older or patients that screened positive for the Brief Confusion Assessment Method (bCAM) were placed on the Clear Minds protocol. The protocol consisted of establishing …

Barriers To Transition Of Care For Heart Failure Patients, Catherine Mary Murray

Walden Dissertations and Doctoral Studies

Heart failure (HF) is an escalating chronic disorder that impacts patients, families, and society. HF necessitates efficient transition of care and complex self-care knowledge in a population often burdened with low health literacy and high readmission rates. The purpose of this project was to improve transition of discharged HF patients from a Level 1 trauma system in a mostly rural area of South Carolina to its affiliated nurse-led HF clinic. The no-show rate for initial visits to the health care system's outpatient HF clinic by postdischarge patients was 59%. Using Henderson's need theory and Stevens's knowledge transformation model for theoretical …

Needs Assessment For A Lifestyle Intervention Weight Loss Program For Hospital Employees, Karen Baumann

Walden Dissertations and Doctoral Studies

The rate of obesity is increasing in the United States. In Florida, almost 60% of the population will be obese by 2030. This increase is expected to contribute to millions of cases of preventable chronic diseases costing the state an estimated $34 billion dollars. Employer-sponsored health programs can positively influence employees' lifestyle choices and support weight loss programs to reduce health-related costs to the employee and the employer. Guided by the transtheoretical model, the purpose of the project was to conduct an employee assessment to determine the need for, interest in, and readiness for a lifestyle intervention weight loss program. …

Barriers Cardiac Nurses Face In Addressing Psychosocial Issues Of Heart Failure Patients, Debra Kay Disbrow

Walden Dissertations and Doctoral Studies

Heart failure is a chronic disease and a common cause of hospitalizations and readmissions within 30-days of discharge. To decrease the cost of care for patients with heart failure, the Centers for Medicare and Medicaid Services initiated the Readmissions Reduction Program that reduces payment to hospitals with preventable readmissions. Among the causes for readmissions of patients with heart failure are concurrent behavioral health issues that can lead to decreased medication compliance and increased risk for disease progression. The prevalence of comorbid depression is as high as 77% among patients with heart failure and may be an important factor in readmissions. …

Applying Clinical Guidelines To Curtail Opioid Overprescribing In Primary Care, Glenda Leflore

Walden Dissertations and Doctoral Studies

The purpose of this scholarly project was to evaluate an evidence-based quality improvement program implemented in 2016 in a clinical practice setting to curtail overprescribing of opioids for noncancer pain management. In 2001, the National Pharmaceutical Council and The Joint Commission on Accreditation and Hospital Accreditation initiated a standard of practice for opioid use in noncancer pain management that resulted in opioid overprescribing and a 200% increase in opioid-related deaths and incalculable societal costs. Primary care providers including nurse practitioners issue the greatest number of opioid prescriptions; therefore, to address the problem of opioid overprescribing, the 2016 Centers for Disease …

Introduction Of Evidence-Based Practice To Acute Stroke Center Nursing In Jakarta, Indonesia, Tonya Sue Stagner

Walden Dissertations and Doctoral Studies

Evidence-based practice (EBP) is a relatively new concept for nurses in Indonesia; it has not

been integrated into nursing care. This project sought to introduce EBP to nurses at an acute stroke center (ASC). The knowledge transfer team approach guided the project. The goal was to identify and analyze current data and to develop an EBP guideline for clinical nursing practice in the ASC. Sources of evidence that was used to address the practice-focused question included project team members, organizational documents, and a database search to identify EBP guidelines for the nursing care of acute stroke patients. A database search …

Nursing Student's Breast Cancer Knowledge And Breast- Self Examination Technique Confidence, Lydia E. Gaud

Walden Dissertations and Doctoral Studies

Breast cancer is the second leading cause of cancer death in women in the United States. Several factors have been identified that interfere with women's breast cancer screening practices, including lack of knowledge and confidence in the breast self-examination (BSE) technique, and lack of information provided by health care provider. One of the reasons nurses do not teach breast cancer detection could be the little emphasis given to breast cancer examination in nursing schools. The BSE is a measure of significant value in detecting cancer of the breast. However, less than half of the women in the United States are …

Nursing Education On Caring For The Dying, Holley Tyler

Walden Dissertations and Doctoral Studies

Healthcare teams can implement care initiatives to promote a positive dying experience. However, there is a lack of knowledge related to how best to care for dying patients. Nurses do not receive extensive training in nursing school to care for patients at the end of life, yet most, at some point in their careers, experience the provision of this type of care. It is important to ensure that nurses caring for dying patients have been educated about end-of-life care. The purpose of the quality improvement project was to address the lack of end-of-life care education among critical care nurses in …

Evaluating Behavioral Health Homes To Decrease Emergency Department Use, Resa Jane Noe-Norman

Walden Dissertations and Doctoral Studies

The Affordable Care Act of 2010 proposed a new integrated care model for individuals with chronic mental illness and multiple medical comorbidities by using Behavioral Health Homes (BHH). The purpose of this doctoral project was to evaluate the effectiveness of the BHH in reducing emergency department (ED) use in the community mental health outpatient setting. Guided by the American Association for Critical Care Nurses synergy model for patient care a cross-sectional, post-test only with comparison group quasi-experimental research design was used. A de-identified data set of 68 patient records in the BHH group and 73 patient records in non-BHH as …

Evaluation Of Depression Screening Practices In Comorbid Patients In The Primary Care Setting, Kristyn L. Clark

DNP Projects

SPECIFIC AIMS: To evaluate the current rates of depression screening using the PHQ-2/9 in patients with comorbid conditions at a single, urban primary care office; to explore barriers to depression screening among providers.

METHODS: A retrospective chart review was completed on a sample of 188 patients seen between January and June 2017. Patients were equally divided among four comorbid diagnoses- COPD, obesity, hypertension, and type 2 diabetes. A provider interview was conducted to identify depression screening barriers and typical treatments regimens.

RESULTS: A total of 70.2% of patients had a documented depression screening. Of 67 patients diagnosed with depression, 11.9% …

A Process Improvement Project To Increase Diabetic Retinopathy Screening Rates As Evidenced By Formal Documentation, Michelle Renae Campbell

DNP Projects

Purpose: To evaluate the effects of a referral process on diabetic retinopathy screening rates among patients with Type 2 diabetes and formal documentation completion rates of these screenings within a primary care setting.

Methods: A referral process for patient referral to an ophthalmologist for annual diabetic retinopathy screening was instituted for a 4-week period within a Norton Community Medical Associates (NCMA) primary care location for Type 2 diabetes patients. Charts of 30 patients pre-intervention were compared with the charts of 30 patients seen during the intervention phase of the study to evaluate the effects of the referral intervention. Demographic data, …

Introduction Of A Comprehensive Modified Early Warning Scoring System In A Large Rural Hospital, Beth A. Meade

DNP Projects

PURPOSE: To develop and test a comprehensive modified early warning scoring (MEWS) system for use on two medical-surgical-telemetry units in a large rural hospital in northeastern Kentucky; to educate and train nursing staff in utilization of a new MEWS system and early identification and management of clinical deterioration; and to determine nursing satisfaction regarding education, training, and use of a new MEWS system.

BACKGROUND: Adult medical-surgical patients are at risk for clinical deterioration. Rapid response systems and MEWS systems are strategies that have been employed to assist nursing staff in early identification and management of clinical deterioration. Testing of a …

The Effect Of Transition Readiness Interventions On Adolescents With Diabetes When Transitioning From Pediatric To Adult Clinic, Kimberly Walker

DNP Projects

PURPOSE: The purpose of this study was to initiate a transition readiness program which uses motivational interviewing at the Pediatric Endocrinology Clinic located within the UK HealthCare Kentucky Clinic. An evaluation of this program was conducted by assessing participant outcomes related to readiness for transitioning.

METHODS: This study was a quasi-experimental one group pretest posttest design to assess the effectiveness of transition readiness interventions on adolescent readiness and confidence in transition of care at the Pediatric Endocrinology Clinic located at the Kentucky Clinic. The sample consisted of 14 patients.

RESULTS: No statistical significance was found in the TRAQ tool and …

Screening For Sleep Apnea In Patients With Hypertension Using The Stop-Bang Tool In A Primary Care Setting, Natalie R. Jennette

DNP Projects

Obstructive sleep apnea (OSA) is a common cause of high blood pressure but often undetected in patients with hypertension. Screening tools for OSA exist but are underutilized. This project aimed to identify current practices and perceptions related to screening for OSA in patients with hypertension and improve primary care provider knowledge of OSA and screening rates using the STOP-BANG screening tool. The providers acknowledged the importance of screening patients with hypertension but there was no increase in screening after education was provided. Effective screening tools exist but effective strategies to bring this evidence to practice need to be explored further.