Nursing Commons^™

Nurse Managers And Hospital Nurse Educators’ Views Related To The Knowledge, Skill And Attitude Requirements Of Newly Licensed Nurses In The Las Vegas And Salt Lake Valleys, Delos Jones, Dnp, Msn, Rn

Doctor of Nursing Practice Projects

Background: In 2017, approximately 230,569 new Registered Nurses (RNs) were licensed in the United States. Of these, over a quarter will leave their first position in less than a year. While 90% of academic leaders feel nursing graduates are ready for practice, only 10% of clinical leaders agree. Recent changes in health care, and an intensifying theory-practice gap hint that newly licensed nurses (NLNs) may not be equipped for today’s workplace.

Objective: This qualitative project asked, “What do nurse managers and hospital educators perceive as required knowledge, skills and attitudes (KSAs) for NLNs to ensure successful and safe orientation or …

Missed Nursing Care Reported By Medical-Surgical Rns In A Community Hospital, Anne Schmidt, Dnp, Msn, Rn, Aprn-Bc, Cenp

Doctor of Nursing Practice Projects

Background: Missed nursing care is defined as any lapse in essential patient care. It is a previously studied, persistent phenomenon. If unrecognized, it can compromise patients’ recoveries, trigger adverse events, and increase healthcare costs.

Objectives: To examine the prevalence of missed nursing care reported by medical-surgical registered nurses (RNs) and contributing factors for its occurrence.

Methods: The project used a cross-sectional, correlational design. A convenience sample of 96 RNs, recruited from three medical-surgical units, completed the MISSCARE Survey between September and October 2017. An analysis of survey responses quantified the frequency, nature, and common contributing factors for care omissions. The …

Peer To Peer Review: Professional Development To Improve Feedback Skills And Self-Efficacy, Brittany H. Gnilka, Dnp, Msn, Rn-Bc

Doctor of Nursing Practice Projects

Background: Peer to peer review is the most essential form of peer review as it encourages nurses to evaluate the quality, safety, and effectiveness of nursing care amongst peers. Poor communication skills for providing feedback during peer review is a barrier identified in the literature, which can be addressed in professional development training.

Objectives: The purpose of this study was to evaluate the effect of communication-focused professional development sessions on the ambulatory care nurses’ perceived self-efficacy to successfully provide meaningful feedback during peer to peer review.

Results: The results showed a statistical significance difference between the mean pre and postGSES …

Evaluation Of The Associations Between Unplanned Readmissions And The Lace Index And Other Variables, Cathy Stankiewicz, Dnp, Msn, Rn

Doctor of Nursing Practice Projects

Background: Unplanned readmissions, within 30 days following an inpatient hospital admission, are common and costly. Research has identified factors that predict readmissions, and predictive algorithms, such as the LACE index, have been studied and widely adopted by hospitals despite demonstrated variability in predictive ability.

Objectives: To examine the associations between unplanned readmissions and the LACE index, and other variables that reflect patient- and encounter-level factors not currently incorporated in the LACE index.

Methods: A retrospective analysis was conducted utilizing data from electronic health records of inpatients discharged from a large quaternary hospital located in the southeastern United States between January …

Assessing Employee Needs To Enhance A Workplace Wellness Program, Paige Herschend, Dnp, Msn, Bsn, Ba

Doctor of Nursing Practice Projects

Background: Workplace wellness programs are increasingly prevalent, but their designs vary dramatically. While successful programs differ, those that are coordinated, comprehensive, and planned intentionally to address specific workplace needs have been found most beneficial.

Objective: This project assessed the perceived health status and wellness needs of employees at one company to determine whether its workplace wellness program could be enhanced.

Methods: This project focused on one site of a large, multi-state company. A retrospective review of data from an employees’ health and wellness survey was performed. Univariate and bivariate statistics were used to analyze the relationships among …

Measuring Nursing Students’ Perceptions Of Teamwork In A Multiple Patient Simulation, Christine Seaton, Dnp, Msn

Doctor of Nursing Practice Projects

Background: Simulation based education offers safe, reflective learning opportunities. However, data had not been obtained of nursing students’ perceptions of teamwork performed during Virtual Hospital (VH), a multiple patient simulation.

Objectives: This evaluation gap was addressed using the Agency for Healthcare Research and Quality’s (AHRQ) TeamSTEPPS® Teamwork Perceptions Questionnaire (T-TPQ). The validated survey measures self-reported perceptions of teamwork in communication, mutual support, and situational awareness on a Likert scale from 1 to 5 (AHRQ, 2014).

Methods: A pre-and post, one group design was used to measure perceptions of teamwork. Twenty participants were recruited from students, enrolled in a second-degree undergraduate …

Evaluating Patient Outcomes When Adding Licensed Practical Nurses To The Staffing Mix, Isabel C.M. Shephard, Dnp, Msn, Rn

Doctor of Nursing Practice Projects

Background: An incorporation of licensed practical nurses (LPNs) in the RN staffing mix was made in a small community hospital. Research shows that RNs at the bedside equates to less adverse patient outcomes such as falls, pressure ulcers and an increase on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

Objectives: To evaluate the effects of incorporating LPNs in the staffing mix on the number of patient falls, pressure ulcers and HCAHPS survey results.

Methods: A Pre and Post study design was used to compare baseline data obtained four months prior to implementing and four months during …

A Retrospective Study: Diagnosis And Treatment Of Depression In Breast Cancer Patients, Cheryl Ann Thaxton, Dnp

Doctor of Nursing Practice Projects

Background: One issue related to breast cancer diagnosis and treatment is the risk of depression.

Objectives: The purpose of this study is to examine ethnic differences and commonalties in the method of diagnosis and treatment of depression for female breast cancer patients.

Specific Aims: The study aims to examine the method of diagnosis and treatment of depression in Caucasian, Latino, and African American breast cancer patients.

Questions/Hypothesis: 1. Does the method of diagnosis and treatment of depression differ based on ethnicity? Hypothesis: Method of diagnosis and treatment will differ for Minorities as compared to Caucasians; 2. What percentage of patients …

Shelburne And Clark’S Harbour Quit Smoking: A Community-Based Smoking Cessation Initiative Process Evaluation, Georgeann Lois Macdonald Mn: Dnp, Anp, Rn, Accn, Np

Doctor of Nursing Practice Projects

Background: The prevalence of Canadian smokers is 14.6%. Clark’s Harbour and Shelburne’s rate of smoking increased from 15.6% in 2012 to 19.4% in 2015 (Propel Centre for Population Health Impact, 2015). It was imperative that innovative ways be found to reduce the smoking prevalence.

Objectives: 1) Identify a difference in the participants’ Stages of Change before and after completing the smoking cessation program. 2) Determine whether the participants quit smoking 3) Assess whether there was satisfaction with the program.

Methods: In this one group pre and post-test design, the participants completed a series of pre and post program questionnaires. The …

Educating Oncology Nurse Practitioners To Provide Basic Palliative Care, Lynn Adams, Dnp, Ms, Anp-Bc, Aocn

Doctor of Nursing Practice Projects

Background: Approximately 1.66 million Americans are diagnosed with cancer each year and another 589,430 die from the disease. As treatment options have expanded, many cancer patients are living longer with worsening symptoms and disabilities and an increased illness burden. These patients are ideal candidates for palliative care. Palliative care involves care delivered by a team of clinicians with specialty training and a focus on improving the quality of life for patients with serious illnesses. A number of major organizations have made formal recommendations regarding the integration of palliative care into comprehensive cancer care including the American Society of Clinical Oncology …

Variables Related To Colon Cancer Screening Rates Among Male Veterans, Patricia D. Dotson, Dnp, Msn, Aprn

Doctor of Nursing Practice Projects

Background/Problem: The Center for Disease Control & Prevention (CDC) recommends colon cancer screening colonoscopy beginning at age 50 years and every 10 years thereafter. The purpose of this study was to compare differences in meeting the colorectal cancer (CRC) screening recommendations between male Veterans and non-Veterans and identifying any association among Veterans social economic status (SES).

Methods: A descriptive-comparative design was used to address the study question, aims and hypotheses, using the 2014 Behavioral Risk Factor Surveillance System (BRFSS) data. A national representative sample of 20,360 Veterans and 36,183 non-Veterans between 50-74 years, were included in analysis. The associations between …

Referral Patterns From Long-Term Care Services To Palliative Care: Perceptions Of Directors Of Nursing, Karen S. Sharrah, Dnp, Msn, Aprn, Fnp-C

Doctor of Nursing Practice Projects

Background: Palliative care referrals are important in long-term care facilities because they are the first step in generating the services that the patient may need. This study looked at the phenomena of how Directors of Nursing in long-term care facilities that had access to palliative care services determined if a referral was needed.

Objectives: The purpose of this study was to gain a deeper understanding of the decision- making process used by Directors of Nursing for referrals. The study’s aims were to determine what factors prompt a referral in long-term care settings. The primary research question was: How …

Poster: Nursing Knowledge And Attitudes Toward Trans* And Gender-Nonconforming Patients, Christine Humphrey

Doctor of Nursing Practice Scholarly Projects

This project aims to impact nursing knowledge and attitudes toward trans* and gender-nonconforming patients. The term transgender, synonymous with the term trans*, is utilized by individuals whose gender and designated sex at birth differ from one another, compared to cisgender persons whose gender and assigned sex are aligned (Erickson-Schroth, 2014).

The trans* population remains underserved. Nurses conscious and unconscious biases impede the advancement of knowledge and attitudes needed to promote best outcomes for trans* patients. Trans* patients have many of the same healthcare concerns as cisgender individuals. However, unique needs for this population arise from compounded issues of prejudice and …

Differences In The Rothman Index Score In Evolving Emergent Events In Medical-Surgical Patients, Deborah Cardenas, Dnp, Msn, Rn, Paralegal

Doctor of Nursing Practice Projects

Background: The Rothman Index (RI), an early warning system using software integrated with the electronic medical record provides scores monitoring patient conditions. Minimal findings exist regarding RI scores in medical-surgical patients.

Objectives: Explore differences in the RI scores in medical-surgical patients who suffered rapid response, cardiopulmonary resuscitation or death events.

Methods: A retrospective comparative design of 75 subjects with a rapid response or cardiopulmonary resuscitation event on medical-surgical units over 12-months at an academic medical center using RI scores at admission, 48- and 24-hours before and at time of event. Deaths were identified immediately following the emergent events.

Results: The …

Transitioning Experienced General Care Float Pool Nurses To A Critical Care Float Pool, Troy T. Betts, Dnp, Msn, Rn-Bc

Doctor of Nursing Practice Projects

Background: A nationwide nursing shortage has resulted in a significant reduction in the number of qualified nurse applicants for critical care positions. Additional recruitment solutions for critical care staffing needed to be explored.

Purpose: The purpose of this project was to evaluate the effectiveness of an orientation program designed to transition experienced general care trained float pool nurses to a critical care float pool.

Methods: This descriptive study measured participants’ pre and post critical care orientation knowledge, and completion of core computerized competencies. Critical thinking questions, unit-based competencies, and measurement of participants’ individual perception of competence were also completed. Pre …

Differences In Preventable Cardiovascular-Related Versus Unavoidable Occupational Causes Of Firefighter Fatalities On Duty, Amy Goad, Dnp, Ms, Np-C

Doctor of Nursing Practice Projects

Background: Firefighters across the United States face high fatality rates in the line of duty of which many are likely related to preventable cardiovascular risk factors.

Objectives: To assess differences in firefighter cardiovascular-related versus unavoidable occupational-related fatalities by career status, age, smoking, obesity, and hypertension.

Methods: We used an exploratory, comparative secondary data analysis design. We extracted data from a national database of deceased firefighters over 14 years. Variables extracted were career status, age, smoking, obesity, and hypertension as well as the reason for death while on duty (i.e., cardiovascular-related or unavoidable occupational-related death). Data were analyzed using Chi-Square to …

The Impact Of Digital Education Delivery On Postoperative Pain Outcomes, Amber Stitz, Dnp, Ms, Aprn, Acns-Bc, Ocns-C

Doctor of Nursing Practice Projects

Background. Advances in technology and communication tools offer new, innovative methodologies for delivering information to patients. Research is needed to understand the clinical effectiveness of different education delivery methods on outcomes and comprehension.

Purpose. Compare the effects of digital education with conventional, written and verbal instructions on patients’ pain outcomes, knowledge attainment, and treatment participation.

Methods. A quasi-experimental design evaluated outcomes in 133 patients undergoing major hip (n=73) and knee (n=60) arthroplasty who received point-of-care pain education delivered via a dynamic mobile-computing (iPad) platform (n=65) or by conventional education (n=68). The significance level was set at 0.05. Person’s r and …

Identification Of Risk Factors Associated With Falls In The Long Term Care Setting, Jacqueline L. Patel, Dnp, Ms, Anp-Bc

Doctor of Nursing Practice Projects

Background: Falls threaten the safety of older adults in long term care (LTC).

Objectives: To assess environmental, clinical and pharmacological causes of falls as well as compare Fall Risk Assessment Score, Brief Interview of Mental Status (BIMS) score, Activities of Daily Living (ADL) scores, age and gender of residents with one fall, recurrent falls, and no falls.

Methods: Using a descriptive-comparative design, we included a convenience sample of 290 adults ≥50 years old at our LTC facility. Fall and recurrent fall groups were matched to those with no falls. We assessed environmental, clinical and pharmacological variables, Fall Risk Assessment Scores, …

The Effect Of Palliative Care Nursing Education To Improve Knowledge In Palliative Care Of Hospital-Based Nurses Caring For Patients With Chronic, Serious Illness, Madelyn Rose Balicas, Dnp, Ms, Anp-Bc

Doctor of Nursing Practice Projects

Background: Palliative care nursing provides care for the relief of pain and suffering throughout the course of a patient’s chronic, serious illness. Hospital-based nurses need to be equipped with palliative care nursing knowledge to provide optimal care for patients and their families to improve the quality of life. Lack of education in pain and symptom management and communication about goals of care can result in a suboptimal and high cost of care.

Objectives: To determine if a brief palliative care nursing education can improve the knowledge of hospital-based nurses about palliative care nursing.

Methods: A cross-sectional quantitative pre-posttest design used …

Effectiveness Of Residency Training Programs For Increasing Confidence And Competence Among New Graduate Nurse Practitioners, Heather Parkhill, Dnp, Msn, Fnp-C

Doctor of Nursing Practice Projects

Background: Nurse practitioners (NPs) are enrolling in post-graduate residency programs that provide training and mentorship during transition to practice.

Objective: This project explored whether participation in NP residency improved feelings of confidence, competence, preparedness to provide care and job satisfaction among new graduate NPs who completed a residency program compared to new graduate NPs who did not complete a residency program.

Method: This mixed-methods study collected survey data from NPs who attended the 2017 AANP National Conference and two residency programs. A modified Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS) (Misener & Cox, 2001) and Hart’s New Nurse Practitioner Preparedness …

Evaluating The Impact Of A Standardized Education Class On A Person Diagnosed With Chronic Kidney Disease, Stage Iv, Nancy K. Uhland, Dnp, Msn, Rn, Fnp-C

Doctor of Nursing Practice Projects

Background: Chronic kidney disease (CKD) is a complex, progressive, and costly disease impacting more than 26 million Americans. Providing effective education is necessary so the patient may actively participate in managing the disease process, but the effectiveness of the delivery of education to the patient with CKD is not well-known.

Objective: To evaluate the effectiveness of a standardized education class on the basic kidney knowledge of persons diagnosed with CKD, stage IV.

Method: This pilot study, using a one-group pre and post-test design, was conducted in an outpatient nephrology clinic located in Washington, D.C. The study participants, recruited using census …

Effects Of An Online Diabetes Self-Management Educational Class On Perceived Self-Efficacy In Patients With Type 2 Diabetes Mellitus, Samantha L. Sugarman, Dnp, Ba, Bsn, Msn, Fnp-C

Doctor of Nursing Practice Projects

Background: Diabetes is a complex, chronic disease that, without adequate glycemic control, may result in avoidable complications. Without proper diabetes self-management education, achieving good glycemic control is difficult. Furthermore, lacking self-efficacy to perform such tasks may prevent even the most educated patients from achieving good glycemic control. Studies have shown that live diabetes education has improved self-efficacy in patients with diabetes, but few look at the effects of a lecture-style educational format in an online approach.

Objectives: The purpose of this study is to determine if an online, lecture-style diabetes self-management educational class will improve self-efficacy among patients with type …

Culturally Sensitive Diabetic Group Education, Kelly Marie Flores

Doctoral Projects

This study assessed the effectiveness of a culturally sensitive type 2 diabetes group education program delivered to Hispanic women in Merced County. Design: A pre-test post-test design. Purposeful sampling was used. Fifteen Hispanic women from a Merced County outpatient clinic were invited to participate in a culturally relevant group education workshop over a 6-week period. Four (N=4) women accepted the invitation, completed the educational workshop, and participated in the assessments. Topics discussed in the education sessions included: (1) diabetic diet, (2) exercise, (3) blood sugar monitoring, (4) medication, and (5) preventative health. A knowledge check was completed by …

Nurse Practitioner Clinical Education: Evaluation Of A Clinical Residency Model, Lisa Wilson Hood

Doctoral Projects

A new clinical residency education model was developed and implemented in response to a family nurse practitioner program’s difficulty in securing and maintaining qualified preceptors and clinical sites for students in the program, and a community hospital’s shortage of nurse practitioners for their rural healthcare clinics. This Doctor of Nursing Practice project conducted an evaluation on this new model. The evaluation results showed that the clinical residency model met standards of nurse practitioner education, incorporated nursing leader recommendations for new clinical models, and proved to be an effective model for clinical education.

Enhancing Elderly Advance Care Planning Experience At A Primary Care Clinic, Oi Shan Wong

Doctoral Projects

The purpose of the project was to examine if the identification of readiness for an advance care planning (ACP) discussion of elderly participants would enhance the outcomes of participants' satisfaction, improve the likelihood of having an ACP discussion and increase the completion rates of an advance directive (AD) document after an office visit.

Forty-four elderly participants, who met the selection criteria, were recruited from a primary clinic in Northern California from October 1, 2017 to December 31, 2017 (Female, n =28). All participants were randomly assigned to either an intervention group (n= 22) or a control group ( …

Prevalence And Prevention Of Diabetes In School Age Children: A Parent Education Module, Christine Mary Whitmyer

Doctoral Projects

The Center for Disease Control reports that there continues to be an increasing number of children being diagnosed with childhood-onset Type Two Diabetes Mellitus (T2DM). The recommendation is to provide education to parents regarding the risks and possible risk factors of T2DM, and strategies to prevent and treat these risk factors (Center for Disease Control [CDC], 2014). Educating parents of school age children on T2DM risk factors, and prevention practices may help to slow down this rising number of new cases. The Aim is to provide educational modules that may increase knowledge, which could in-turn change behavior, that may prevent …

Understanding Occupational Injuries, Hanbit (Joyce) Choi

Doctoral Projects

The purpose of this project is to better understand the potential negative impact of longer commute times on work-related health complaints and its relationship with frequency of work-related injuries among general assembly workers from various factories in the Bay Area. Companies in the United States seek to reduce the cost of work-related injuries by investigating the causes of and implementing necessary programs in their workplaces. According to the U.S. Census Bureau, there are about 115,000 employees who spend more than 90 minutes commuting to their jobs in the San Francisco Bay and San Jose Silicon Valley areas (2013). However, there …

Perceptions Of Chinese Women Coming To The United States To Give Birth: Birth Tourism, Juanita Childs Jaramillo

Doctoral Projects

Birth experiences and perceptions vary greatly among different cultures. There has been an increase in Chinese women who specifically come to the United States (US) to give birth to their child and return back to their native country after being cleared at the postpartum checkup. This practice is known as birth tourism. The aim of this study is to explore the perceptions of childbirth and postpartum experiences among Chinese birth tourists. Twelve women self-identifying as Chinese, between the ages of twenty-four and thirty-eight, who came to the US to give birth to their child, and who were able to read …

Improving The Patient Handoff From Or To Picu In Children Who Have Undergone Cardiac Surgery Using A Standardized Handoff Tool, Amanda Taylor

Doctoral Projects

Inpatient hospitalizations for children are often costly. Children often transition from one setting to the next while hospitalized, therefore their provision of care is also transferred from one care team to the next. This transition presents a vital time for the child, that may be associated with adverse events and medical error. Adverse events can lead to poor outcomes for the child. Despite efforts to improve patient handoffs, communication failures are still abundant in healthcare. Research indicates that the use of a standardized handoff tool from one setting to the next is an effective method for improving the patient’s transition. …

Effect On Opioid Use Following The Implementation Of Evidence-Based Pain Management, Kathryn L. Ellens

Doctoral Projects

Pain is the most common reason people seek healthcare. Initiatives to prevent the undertreatment of pain have resulted in overreliance on opioids to treat pain. Despite significant increases in opioid use, pain is more prevalent than ever. Additionally, devastating consequences from opioid use have resulted, such as dependence, addiction, and increasing opioid-related deaths. Research demonstrates multimodal analgesic therapy is an effective alternative to the overreliance on opioids to treat pain. Multimodal analgesia is the synergistic use of two or more analgesics with different mechanisms of action. Multimodal analgesia produces significantly more effective and efficient pain management than opioid-only therapy. This …