Nursing Commons^™

The Potential Role Of Weightlifting Training On The Biomechanics Of Patient Movements In The Prevention Of Back Injury, Michael Lee Callihan

Theses and Dissertations--Nursing

Back injury in nursing is a significant concern for the health of the worker, the costs to the healthcare system, and the safety of the patients. Current injury prevention measures include ergonomic adjustments to the work environment, the use of mechanical lifting equipment, policies to limit manual handling of patients, and the teaching of lifting techniques. These measures have been met with limited success in reducing injury rates. Little is known about whether changing the lifting biomechanics used in the healthcare setting can lower high injury rates across the profession.

The purposes of this dissertation were to: 1) identify the …

Developing A Predictive Model For Prostate Cancer Screening Intent, Quentin E. Moore

Theses and Dissertations--Nursing

African Americans bear a disproportionately high burden of cancer incidence and mortality in this country. The purpose of this dissertation was to investigate factors associated with African-American men, who are incarcerated, making informed health decisions about participation in prostate cancer screening, as well as exploring factors that reduce modifiable risk factors for cancer. The United States incarcerates more people per capita than any country in the world and African American men are overrepresented in the U.S. prison system

This dissertation is composed of three manuscripts. The first paper reviews the current literature about the factors that influence African-American males in …

Reproductive Autonomy: The Context Of Pregnancy Intention, A Global To Local Approach, Hartley C. Feld

Theses and Dissertations--Nursing

Globally, in low and middle-income countries 4 out of every 10 pregnancies is reported to be unintended. Having an unintended pregnancy increases the risk of maternal and infant morbidity and mortality, preterm birth, low birth weight, and decreases rates of breast-feeding. The United States (U.S.) consistently has some of the highest rates of preterm birth, infant and maternal mortality of all high-income countries and 45% of all pregnancies in the U.S. are reported to be unintended. The etiology of these outcomes and their relationship to pregnancy intention are complex and multifactorial, but we know this disproportionately effects women living in …

Factors Associated With Taste Perception And Dietary Consumption Patterns In Individuals With Or At-Risk For Cardiovascular Disease, Jennifer L. Smith

Theses and Dissertations--Nursing

Excessive intake of sodium, sugar, fats, and other unhealthy dietary patterns significantly contribute to cardiovascular disease (CVD) risk and, among those with diagnosed CVD, to deleterious outcomes. Taste perception is one of the most important factors influencing dietary intake and there are many factors that can alter it such as medication and genetic variations. Yet there has been relatively little research on influences of taste perception on self-management of CVD and CVD risk.

The purpose of this dissertation is to examine the association of various factors and taste perception in order to add to our understanding of what may or …

Social Support, Relationship Quality, And Self-Care Behaviors In Patients With Heart Failure, Majdi Mohammad Rababa

Theses and Dissertations--Nursing

The purpose of this dissertation was to examine the associations among social support, gender, relationship quality, and self-care behaviors in patients with heart failure (HF). Specific aims were to: 1) compare the psychometric properties of the 12-item and the 9-item European Heart Failure Self-Care Behavior Scale (EHFScBS) when used to measure self-care behaviors in patients with HF in the United States; 2) determine whether gender moderated the association between perceived social support and daily sodium intake in patients with HF; and 3) determine whether a patient’s gender and relationship with the primary family caregiver (spousal or non-spousal) moderated the association …

Healthcare Providers’ Perceptions Of Pregnant Women, Allison Goderwis

Theses and Dissertations--Family Sciences

Health care providers’ (N = 421) implicit perceptions of pregnant women based on age, race or ethnicity, marital status, and socioeconomic status are assessed through a true-experiment design. Ordinal and binary regression analyses revealed that respondents felt more pity for an unmarried than married pregnant woman and more anger toward an unemployed pregnant woman without health insurance compared to a pregnant woman who was employed with health insurance. Male, Asian, and Hispanic respondents were less likely to help the pregnant woman, Black and protestant respondents were more likely to express some degree of anger toward the pregnant woman, and …

Reference Notes For Palliative Care Consultation, Robert F. Johnson

Open Textbooks

The interprofessional health care specialty of palliative care employs holistic evaluation and person-centered communication in the care of people with life-threatening illness. Palliative care clinicians are consulted for one or more of the following reasons:

• Symptom assessment and management
• Assistance with making difficult decisions about continued use or withdrawal of life-sustaining interventions
• Communication for planning the most appropriate care setting to meet person/family goals for end-of-life care
• Assessment of suitability and eligibility for hospice care

This resource is a compilation of previously published documents and tools useful to palliative care clinicians in preparing for and conduction these consultations. In addition, …

Innovative Lesson Plans For Active Learning: Teaching Nursing Research And Evidence-Based Practice, Susan M. Strouse Phd, Rn, Genevieve B. Elrod Phd, Rn, Ocn, Karyn Butler Phd, Rn, Fpmhnp-Bc, Cnm, Chibwe Caroline Powell Bsn, Rn, Afokoghene Odhu Bsn, Rn

Open Textbooks

Innovative Lessons Plans for Active Learning: Teaching Research and Evidence-Based Practice is a resource in research and evidence-based practice for active learning in the undergraduate nursing classroom. It is meant to supplement any nursing research text. Designed to provide educators with creative teaching ideas, this text includes a variety of lessons on nursing research topics. Topics include bias, measurement, sampling, theory and more. Lessons provide active learning for in-class, hybrid, and online formats. Each lesson includes objectives, overview, and detailed steps. As an open access resource, the text is continuously in-process. Designed to be independent of any published text, the …

Evaluation Of The N-O-T Program For Smoking Cessation Among High School Students, Whitney Jaye Erickson

Walden Dissertations and Doctoral Studies

Adolescents and young adults use more tobacco than all other adults, yet the percentage of this younger population eventually quitting the use of tobacco is lower. There is little evidence-based research to support adolescent smoking cessation programs. Using social learning theory (SLT) and the stages of change model, the purpose of this project was to evaluate the effectiveness of the Not-On-Tobacco (N-O-T) program, an evidence-based adolescent smoking cessation program, in reducing or preventing the number of cigarettes smoked by high school boarding students and to evaluate how best to individualize the program for this high school going forward. The DNP …

The Role Of Empathy In Nursing Assistant Retention, Garlina Finn

Walden Dissertations and Doctoral Studies

It is estimated that by 2020 there will be 2.8 million long-term care beds in residential facilities, staffed primarily with nursing assistants as the front-line care providers. The American Healthcare Association 2012 staffing survey showed that the median annual turnover rate for nursing assistants in the United States is 51.5%. High rates of turnover are associated not only with poorer quality of care but also with increased costs for facilities. The purpose of this project was to understand characteristics that are associated with long-term employment in the nursing assistant role by describing the personality characteristic of empathy in the nursing …

Comparing A General And Transitional Registered Nurse Orientation To Facilitate Quality Improvement, Kathryn R. Cortes

Walden Dissertations and Doctoral Studies

Most hospitals orient new graduate nurses and experienced nurses in the same generalized orientation programs. To address the cost of orientation to specialty units, a pediatric hospital developed a tailored transitional residency orientation program for experienced nurses. The purpose of this project was to describe, compare, and evaluate the existing generalized orientation program and the transitional orientation program to determine how the orientations differed in structure, process, and outcomes. Donabedian's model assessing quality of care services and Benner's novice-to-expert theoretical framework served as guides in evaluating the orientation outcomes. Qualitative data about residency classroom time, preceptor selection and time, mentor …

Nurse Supervisors And Certified Nursing Assistants: Leadership Characteristics And Job Satisfaction, Jennifer Patterson

Walden Dissertations and Doctoral Studies

Significant costs are associated with the turnover rate of certified nursing assistants (CNAs) in skilled nursing facilities (SNFs), and turnover impacts the quality of care for residents of the SNFs through disruption of care. The purpose of this quantitative cross-sectional study was to identify the leadership characteristics of supervisors most associated with the job satisfaction (JS) of CNAs in SNFs. Herzberg's dual factor theory was used as the theoretical framework to explain the relationship between the leadership characteristics and the associated JS. The research question was used to examine the independent variables of trust, teamwork, supportive supervision, leader-follower relationships, and …

Developing Neonatal Gavage Tube Guidelines To Decrease Feeding Intolerance, Elizabeth Demeester Webster

Walden Dissertations and Doctoral Studies

A nutritional method commonly used to deliver feedings to premature infants is the use of a gavage tube. To measure for any undigested breastmilk or formula, a gastric aspirate is checked prior to the next feeding. There is a gap in practice as to what to do if these aspirates signify feeding intolerance. The project question centered on identifying evidence-based guidelines in the literature that would help to define best practices related to feeding intolerance of gavage-fed infants. The Johns Hopkins Nursing Evidence-Based Practice model and the Appraisal of Guidelines Research and Evaluation provided the frameworks for gathering and evaluating …

Eliminating Or Decreasing Restraint Use And Seclusion For Adults In An Inpatient Psychiatric Facility, Charles Banks

Walden Dissertations and Doctoral Studies

Evidence from research around the world have indicated that the use of restraints and seclusion has become a controversial issue in mental health facilities relating to managing patients' aggressive behaviors. Evidence indicates that all other options should be used first and the use of restraints and seclusions should be used as a last resort when all other options have failed. The rationale is to bring about awareness of all of the options or alternative interventions that are available other than the use of restraints and seclusions, as research has indicated that restraints and seclusions provide no therapeutic value to the …

Staff Education For Registered Nurses Using The Teach-Back Method, Mary Elizabeth Sizer

Walden Dissertations and Doctoral Studies

This purpose of this quality improvement project was to develop an educational training curriculum designed for staff nurses to use the teach-back method with patients with low health literacy during discharge instructions. Health literacy is associated with the ability to read, comprehend, and make appropriate healthcare decisions; the teach-back method asks patients to restate or explain health information in their own words, aiding retention and literacy. Effective staff education plays a critical role in the education of patients during discharge teaching: Nurses must help to ensure that patients and their families understand healthcare information and apply this information in their …

Examination Of All Cause 30 Day Hospital Readmissions, Marianne Goodrow

Walden Dissertations and Doctoral Studies

Each year in the United States, thousands of people are readmitted within 30 days of being discharged from a hospital. Current research indicates that at least one-third of these rehospitalizations are preventable. The purpose of this project was to examine patient and environmental characteristics of those who were readmitted within 30 days of discharge for commonalities that may explain the gap in practice for a specific health care organization. The project was undertaken in response to the organization's need to improve a 50th-percentile ranking with the goal of reaching the top 10th percentile. A plan-do study-act framework was used as …

Provider Adherence To Recommendations For Hpv Vaccination In A Family Practice And Pediatric Clinic, Kara Saling

DNP Projects

Background: The HPV vaccination has consistently had lower adherence rates than the goal set by Healthy People 2020. The Advisory Committee on Immunizations Practices (ACIP) now recommends that children (both male and female) 11 to 12 years of age should start to receive the HPV vaccine before exposure to the virus. However, even with the change in the new guidelines, the HPV vaccine administration rates still trail other adolescent vaccinations.

Purpose: The purpose of this project is to identify pediatric and family practice provider adherence to ACIP/CDC recommendations on HPV vaccinations in a Southeastern United States health system in …

An Examination Of The Knowledge And Screening Practices For Child Maltreatment Among Primary Care Providers, Nicole Cirincione

DNP Projects

Background: Child maltreatment can affect any race, economic status, gender, and age. Primary care providers have contact with children and their caretakers daily and develop bonds that encourage open communication. Screening for child maltreatment risk factors can help discover those in danger and decrease abuse rates. Purpose: The purpose of this study was to examine provider’s knowledge of child maltreatment risk factors and assess screening and documentation practices. Methods: This was a descriptive study that included an electronic survey to primary care providers to assess current knowledge and practices for child maltreatment risk factors. Second, a retrospective chart review was …

Graduate Nurse's Perspective Of Simulation To Address The Theory-Practice Gap In Nursing, Joset Elaine Brown

Walden Dissertations and Doctoral Studies

Graduate nurses are being employed to provide care in high acuity care areas, and this becomes a problem of significance as the literature suggests that graduate nurse's experience a deficit in integrating theoretical concepts in the clinical environment, described as the theory-practice gap; which can result in a risk to patient safety and the potential for negative outcomes. Cognitive constructivism was the conceptual framework that guided this study. A qualitative phenomenological design was used to explore the lived experiences of 13 graduate nurses employed at a community hospital in northern New Jersey. After recruiting the participants through purposive sampling, semi-structured …

Successful Strategies For Financial Sustainability In Nursing Homes, Renee Walthour

Walden Dissertations and Doctoral Studies

From 2014 to 2015, deficiency fines cost Pennsylvania nursing homes more than $2.5 million. Costs associated with adhering to increased health care regulations can reduce profit and affect the financial sustainability of the nursing home industry. Some nursing home administrators (NHAs) lack successful strategies to improve state and federal regulation compliance and promote financial sustainability. Drucker's management by objectives theory was the conceptual framework for this study. The purpose of this qualitative multiple case study was to explore successful strategies NHAs use to improve state and federal regulation compliance to mitigate deficiencies and derivative fines to promote financial sustainability of …

The Effectiveness Of Screening For Comorbid Depression Among Outpatients With Chronic Diseases In Maryland, Linda Hasssan Allibalogun

Walden Dissertations and Doctoral Studies

Depression is a pervasive mental health disorder worldwide. Although being diagnosed with chronic illness exacerbates susceptibility to depression, detection and subsequent treatment of comorbid depression in primary care settings remain suboptimal because patients with chronic medical disorders are not commonly screened for depression. There is a need to initiate proactive measures by implementing routine screening in primary care settings. The plan-do-study-act (PDSA) model guided an intervention to establish a depression screening practice. This study aimed to determine if the implementation of evidence-based screening for depression using the Patient Health Questionnaire-9 (PHQ-9) tool could increase diagnosis of comorbid depression among patients …

Implementation Of A Standardized Approach To Diabetes Education, Stacey Williams Porter

Walden Dissertations and Doctoral Studies

The Centers for Disease Control and Prevention (CDC) report that Type 2 diabetes

mellitus (T2DM) is a serious health issue affecting over 24 million Americans. Adults with T2DM are 2 to 4 times more likely to experience complications of the disease such as heart disease and stroke. Efforts are needed to control the condition and prevent the complications. At a local community hospital in the southeast United States, a 2-year assessment revealed over 10,000 patients admitted with diabetes or diabetes-related complications. Staff nurses at the site were responsible for diabetes self-management education for T2DM patients at discharge; however, no standardized …

Cultural Competence To Decrease Advanced Stage Breast Cancer Diagnosis In An Appalachian Kentucky Population, Deborah Heard Stakelin

Walden Dissertations and Doctoral Studies

Despite American College of Radiology guidelines for breast cancer screening, the Appalachian Kentucky population has an increasing number of advanced stage breast cancer diagnoses related to a delay in mammogram screening initiation. A potential contributing factor for the delay in screenings is a lack of culturally competent care to support the need for early detection of breast cancer in the identified population. The purpose of this staff education project was to improve the knowledge base and skill set of health care employees concerning the most advantageous practice to increase cultural competence in the health care setting. A practice-focused question related …

Increasing Referrals Of Hospitalized Obese Patients, Tammy Elaine Cabrera

Walden Dissertations and Doctoral Studies

The rate of obesity continues to rise in the United States and globally, placing populations at

increased risk of obesity related conditions, such as diabetes, hypertension, heart disease, cancer,

and other disease states. Literature review shows that there have been many different methods

utilized to halt obesity's progression, however rates continue to increase. The United States

Preventative Services Task Force (USPSTF), American Heart Association (AHA), and other

agencies recommend obesity screening and counseling at every patient encounter, but most

hospitals do not have a current obesity policy in place to accomplish this task. The purpose of

this project is to …

Usefulness Of Medication Scanners In Clinical Practice: A Systematic Review, Laura Leonard Cure

Walden Dissertations and Doctoral Studies

Thousands of people die each year due to preventable medication errors. Barcode medication administration (BCMA) systems can reduce medication errors at the point of care, thus increasing patient safety. The purpose of the project was to gather evidence regarding BCMA usefulness in reducing medication errors. Kurt Lewin's 3-step change theory was used to guide this project. The nature of this project was a systematic review of the literature pertaining to the effectiveness of using BCMA systems to reduce medication errors in at the point of care in the hospital setting. The Johns Hopkins nursing evidence-based practice model and tool kit …

Using A Quality Workbook Committee To Improve Nurse-Sensitive Patient Indicator Scores, Nicole Robinson

Walden Dissertations and Doctoral Studies

Health care providers gather and track quality patient indicator scores to monitor patients' safety and outcomes and decrease the number of adverse events. Nursing leaders implemented a Quality Workbook Committee (QWC) within a hospital setting to improve patient outcomes and the facility's reported scores for nurse-sensitive patient indicators. The practice-focused question for this quality improvement evaluation project examined whether the implementation of the QWC improved nurse-sensitive patient indicator scores. Watson's theory of human caring was used to evaluate the gap in practice, and Rosswurm and Larabee's model for evidence-based practice change provided guidance for planning the project. Sources of evidence …

Cross Contamination In Levered Endoscopes, Ernest Lowell Thomason Jr.

Walden Dissertations and Doctoral Studies

Contamination is a prevalent issue with reprocessed levered endoscopes. The number of infections caused by resistant enterobacteriaceae in patients due to contaminated endoscopes increased to the point that the United States Food and Drug Administration released a safety alert to health care facilities that perform endoscopic retrograde cholangiopancreatography (ERCP). The purpose of this descriptive project was to evaluate if levered endoscopes used in ERCP procedures met high level disinfection criteria, were properly processed, and were germ free after reprocessing. The project was supported by 2 theories: the middle range theory of patient advocacy and the germ theory. Data (counts and …

Nurse Manager Span Of Control And The Impact On Employee Engagement, Jene' M. Kendall

DNP Projects

PURPOSE: The purpose of this study was to assess nurse manager span of control in medical- surgical, intermediate care, and progressive care units at Norton Healthcare and determine correlations between nurse manager span of control and employee engagement.

METHODS: For this descriptive, correlational study, the researcher analyzed data to identify relationships in span of control and employee engagement data for 19 nurse managers leading 23 inpatient care units. A survey to evaluate the role of the nurse manager and the assistant nurse manager also was done.

RESULTS: The average span of control for nurse managers was 52.2 full time equivalent …

The Evaluation Of Advanced Practice Providers Practice Patterns And Delivery Of Care Models In The Specialty Practice Environment, Katherine W. Rogers

DNP Projects

Background: Advanced Practice Providers (APPs), specifically Nurse Practitioners (NP) and Physician Assistants (PA), have been utilized in healthcare for decades to improve access to care for patients. Norton Healthcare’s largest population of APPs is in specialty practices. The expansion of APPs into the medical group has been rapid and without evaluation of value and role identification.

Purpose: The purpose of this study is to evaluate Advanced Practice Provider (APP) practice patterns and care delivery models within specialty practices in a large medical group. The outcome of the study will help to identify trends in practice and areas where …

Cesarean Births Rates After Implementation Of Labor Management Guidelines, Margie Allyn Bridges

Walden Dissertations and Doctoral Studies

Cesarean birth rates are associated with increased maternal morbidity. This project evaluated a quality improvement (QI) initiative implemented to reduce cesarean births among Nulliparous Term Singleton Vertex (NTSV) obstetric populations, the largest contributor to cesarean births. Variations in labor management practice contribute to cesarean birth rate; implementation of labor management bundles have been endorsed to influence practice- and system-level changes in the promotion of vaginal births. The problem addressed in this project was an organizational NTSV cesarean section rate of 30%. The purpose of the project was to use secondary data to evaluate a previously implemented labor management bundle at …