Nursing Commons^™

Using Cluster Analysis To Identify Subgroups Of College Students At Increased Risk For Cardiovascular Disease, Dieu-My Tran, Kevin A. Kupzyk, Lani M. Zimmerman

Nursing Faculty Research

Background and Purpose: To examine the co-occurrence of cardiovascular risk factors and cluster subgroups of college students for cardiovascular risks. Methods: A cross sectional descriptive study was conducted using co-occurrence patterns and hierarchical clustering analysis in 158 college students. Results: The top co-occurring cardiovascular risk factors were overweight/obese and hypertension (10.8%, n = 17). Of the total 34 risk factors that co-occurred, 30 of them involved being overweight/obese. A six-cluster-solution was obtained, two clusters displayed elevated levels of lifetime and 30-year cardiovascular disease risks. Conclusions: The hierarchical cluster analysis identified that single White males with a family history of heart …

Introduction To Special Issue By Guest Editor, Reimund Serafica, Reimund Serafica

Nursing Faculty Research

Nurses are masters at multitasking—that is performing several nursing interventions simultaneously during a patient encounter. While the new technologies such as smart pumps, bar-code medication, administration systems, electronic health records (EHRs), wearables, and smartphones being introduced into our practice environments are designed to increases efficiency, promote safety, and streamline the work of nursing, we also need to see what is current and emerging in the research arena. We need to continue to seek new evidence-based practice to care effectively for the Asian/Pacific Islander populations and promote a healing environment while incorporating the advantages and efficiencies that technologies provide.

Effect Of A Nurse-Led Lymphoma Survivorship Model Of Care: A Pragmatic Phase Ii Pilot Randomised Controlled Trial, Karen Taylor

Theses

Background: Cancer survivorship is recognised as an integral component of the cancer continuum. Robust evidence on how best to deliver tailored survivorship care is limited, particularly for individuals affected by rarer cancers such as lymphoma, a potentially curable haematological cancer. These survivors may face long-term and late effects affecting quality of life due to the aggressiveness of the disease and treatment that may not be adequately addressed in current follow-up models of care.

Aim: To develop and pilot test a nurse-led model of survivorship care intervention that utilises an individualised survivorship care plan and treatment summary (SCPTS), motivational interviewing, tailored …

Psychometric Testing Of The Endotracheal Suction Assessment Tool© (Esat©): An Exploratory Sequential Mixed Methods Study, Kylie Davies

Theses

Background: Endotracheal tube (ETT) suction is a common nursing procedure performed in paediatric intensive care settings. Significant side effects of this procedure can dramatically affect the stability of the critically ill ventilated paediatric patient. The lack of clear standards for determining when the procedure is warranted, especially in paediatrics, can present challenges for the inexperienced paediatric intensive care nurse when assessing a patient’s need for ETT suction. Previous research underpinned the development of an Endotracheal Suction Assessment Tool© (ESAT©) to guide inexperienced nurses through the decision making process to determine suction requirements. The aim of the ESAT© is to improve …

Aboriginal Women Yarning About Experiences As Undergraduate Nursing Students In Western Australian Universities, Melanie Robinson

Theses

The inequities and poor health outcomes experience by Aboriginal people in Western Australia are well documented. It has been suggested that such issues could be better addressed if more Aboriginal nurses are employed, as there appears to be a link between improved health outcomes and the inclusion of Aboriginal health professionals in practice. In recent years the number Aboriginal nursing students undertaking tertiary studies has increased, but their completion rates could be improved. Aboriginal nursing students continue to struggle to achieve success.

The aim of this study was to investigate factors that enabled (supported) or inhibited (prevented) the progress of …

The Factors Influencing Nurse Graduates Use Of Mobile Technology In Clinical Settings In Perth Western Australia: A Mixed Method Study, Benjamin Hay

Theses

The ubiquitous use of mobile technology in today’s society extends to the learning and teaching environment. Most academics in universities encourage its use, aided by libraries offering online resources. Whilst the literature highlights benefits of using mobile technology in learning, particularly for nurses to keep up-to-date, there is limited evidence on such use in clinical settings by graduate nurses in Western Australia (WA). Additionally, there is a lack of information and clarification on the use of such technology in WA hospitals. The purpose of this study was to identify and explore factors influencing the use of mobile technology by newly …

Evaluation Of An E-Learning Training Package By Nurses For Various Designations For Developing Clinical Skills And Knowledge., Nitasha A. Narayan

Theses

An essential component of nurses delivering good healthcare is continuous education. However, nurses’ [participation in continuing education can be hampered by lack of time, limited access to educational resources and cost concerns. Globally, electronic learning has emerged in the last decade as a flexible mechanism to provide education for nurses.

The purpose of this research is to evaluate an e-learning training package used by nurses of various designations for developing clinical skills and knowledge at a private hospital in Perth, Western Australia (‘The Hospital’). This study employs descriptive correlational design – a non-experimental quantitative approach. Data was collected via a …

Intensive Care Nurses’ Attitudes, Beliefs And Reported Practices Relating To Patient Sleep: A Descriptive Study, Rebecca Hahn

Theses

Empirical evidence suggests that patients treated in the intensive care unit (ICU) experience chronic sleep disturbance, leading to sleep deprivation. Multiple intrinsic and external factors contribute to poor quantity and quality of sleep among critically ill patients. Noise, light and clinical interventions are some of the external factors most disruptive to patient sleep in the ICU. Given that nurses are the gatekeepers to the ICU, understanding their perceptions and practices relating to patient sleep is necessary to elicit change. However, ICU nurses’ attitudes, beliefs and practices relating to sleep are poorly understood.

Using a descriptive survey method, this study investigated …

Development Of A Professional Practice Competency For Undergraduate Nursing Students At A Private Catholic University In Western Australia: A Mixed-Method Study, Christine Adams

Theses

This research investigating professional student nursing practice occurred at a private Catholic university in Western Australia. The objects of this university articulate the provision of education in the context of Catholic faith and values. The objects are further expressed through the university’s 10 graduate attributes, which every student should have achieved by graduation. These attributes aim to foster and grow the qualities of ethical practice, interpersonal skills, professionalism, specialist knowledge and skills to support local and global communities. Suggested university strategies for attaining these attributes include undertaking high-quality work-integrated learning and building strong and mutually beneficial relationships with industry partners …

Nicu Nurses' Suggestions For Improving Obstacles In End-Of-Life Care, Rebecca Faye Isaacson

Theses and Dissertations

Background: Approximately 25,000 pediatric deaths occur in hospitals in the United States each year with over 50% of these deaths occurring in Newborn Intensive Care Units (NICU). NICU nurses are frequently involved in end-of-life (EOL) care and face unique obstacles. Objective: The objective of this study was to obtain NICU nurses suggestions for improving obstacles in EOL care in NICUs. Methods: Suggestions were obtained through mailed survey research in qualitative study design. Returned surveys yielded 121 nurse respondents who gave a total of 138 suggestions.Results: A total of 10 cohesive themes were identified: (1) environmental design issues, (2) improved communication …

Validation Of Activity Trackers In A Laboratory Setting With Young Adults, Brandon Leslie Lewis

Theses and Dissertations

Background: Objectively tracking sedentary behavior (SB) and physical activity (PA) is becoming increasingly important as research continues to show the negative effects with increasing SB and decreasing PA. Objectives: The purpose of this study was to evaluate three commercial activity trackers with young adults regarding how they accurately measure SB and PA behaviors in a laboratory setting. Methods: 50 college-aged participants wore three wrist-based activity trackers (Fitbit Surge, Apple Watch, and Basis Peak) and two ActiGraph accelerometer devices during a series of SB and PA behaviors for five-minute intervals in a laboratory setting. The activity trackers were evaluated against direct …

Optimization Of Folic Acid Supplementation In The Prevention Of Neural Tube Defects, Shona Cawley, Daniel Mccartney, Jayne V. Woodside, Mary Rose Sweeney, Robert Mcdonnell, Anne M. Molloy, Michael J. Turner

Articles

Background We examined the relationship between timing and duration of folic acid (FA) supplementation in achieving red blood cell (RBC) folate levels in early pregnancy which are optimal (>906 nmol/l) for the prevention of neural tube defects (NTDs). Methods Clinical, FA supplementation and dietary folate details were computerized at the first antenatal visit. Maternal blood samples were analysed for RBC and serum folate. Results Of the 502 women, 98.2% (n = 493) reported taking FA. There was a positive correlation between duration of supplementation and both RBC folate (r = 0.43, P < 0.001) and serum folate (rho = 0.29, P < 0.001). The optimal RBC folate level was achieved in 80.4% (n = 46) of women who started FA 400 μg 4–8 weeks before their LMP compared with only 53.6% (n = 153) in women who started 4–8 weeks after their LMP (P < 0.001). Conclusions This study provides, for the first …

Hardiness, Adult Attachment Style, And Burnout In Nurses, Kristy A. Negri

Walden Dissertations and Doctoral Studies

The current nursing shortage is a pressing crisis that is expected to worsen over time. A key reason nurses leave nursing is burnout. The purpose of this study was to investigate personality hardiness and adult attachment style in relation to the development of burnout in licensed professional nurses. Hardiness theory and attachment theory indicated that each provided protection against burnout, but no research has been conducted to examine both factors in relation to burnout in nurses. Research Question 1 asked if there was a relationship between attachment style and total hardiness score; Research Question 2 asked if there was a …

Adherence To The Icu Liberation Abcdef Bundle Improves Patient Outcomes In The Icu, Jennifer Sweeney

Walden Dissertations and Doctoral Studies

Delirium is a frequent complication of intensive care unit (ICU) admissions manifesting as acute confusion with inattention and disordered thinking. Patients in the ICU who develop acute delirium are more likely to experience long term disability and mortality. The purpose of this doctoral project was to evaluate an existing organizational quality improvement project to guide recommendations on improving care in the ICU. The practice-focused research question was: Does improving adherence to the ICU Liberation ABCDEF bundle for patients admitted to the ICU decrease incidence of delirium compared to outcomes prior to implementation? The Program Logic Model served as a framework …

Transitional Care For The Cardiac Surgery Population: Development Of A Clinical Practice Guideline, Sheila Davies

Walden Dissertations and Doctoral Studies

Recovering from a cardiac surgery procedure and the transition to home can be an overwhelming experience for patients and caregivers. A tertiary care hospital's cardiothoracic surgery department suspended a nurse-practitioner-coordinated transitional care program in the 1st quarter of 2016. Following this decision, the readmission rate increased from its previous rate of 15.6% in quarter 1 to 20% in quarter 3. The purpose of this scholarly project was to develop a clinical practice guideline (CPG) that can bridge the gap in the transitional care process. The transitional care model informed the design of the project. A draft guideline was distributed to …

Development Of A Scholarly Educational Intervention To Improve Inpatient Diabetes Care, Sharon.Hasfal Hasfal

Walden Dissertations and Doctoral Studies

Advanced practice providers (APPs), consisting of nurse practitioners and physician assistants, face many challenges in the provision of evidence-based practice in their management of hospitalized adult patients with diabetes. Some of the barriers faced by APPs at a Northeast acute care facility are poor communication between disciplines, lack of confidence in initiating insulin, limited understanding of the management of insulin and the insulin pump, and insufficient treatment of the hospitalized patient with diabetes that aligns with current clinical guidelines for the management of inpatient hyperglycemia. This quality improvement project focused on the development of an evidence-based theory supported educational intervention …

Evaluation Of A Difficult Urinary Catheter Team In An Academic Medical Center, David Price

Walden Dissertations and Doctoral Studies

The placement of an indwelling urinary catheter (IUC) is a commonly performed clinical procedure which may become challenging for the clinician and painful for the patient. In response to urologic complications attributed to repeated failed IUC insertion attempts by nurses, a difficult urinary catheter (DUC) team program was launched in October 2012. The purpose of the doctoral project was to conduct a quality improvement evaluation of the effectiveness of the DUC team program using retrospective data from May 1, 2013 through May 31, 2017. Benner's novice to expert model was chosen as the theoretical framework to guide the additional training, …

Use Of Antipsychotic Medications In Individuals With Alzheimer's Disease In Nursing Facilities, Michelle M. Dionne-Vahalik

Walden Dissertations and Doctoral Studies

Patients with Alzheimer's disease or other types of dementia often require long-term care in nursing facilities (NF) where they may display out-of-character behaviors complicating their care. While antipsychotic medications are sometimes prescribed for NF residents, their use is considered inappropriate for the control of dementia behaviors. The Centers for Medicare and Medicaid Services have rated Texas the worst state in the country for the inappropriate use of antipsychotic medications for NF residents with dementia. This project was guided by the star model of knowledge transformation with the goal to reduce inappropriate use of antipsychotic medications through NF staff education. The …

A Staff Education Project And Screening Tool To Identify Calciphylaxis, Janice Pennington

Walden Dissertations and Doctoral Studies

Calciphylaxis is a deadly disease seen primarily in patients with end stage renal disease. Literature indicated that improved patient outcomes are seen with routine screenings. Many dialysis providers lack fundamental knowledge that would enable early identification of calciphylaxis in patients with renal disease. The purpose of this project was to design a screening instrument and develop a staff education program that would transform calciphylaxis management by promoting early identification and treatment of the disease. Knowles's theory of andragogy was used as the theoretic framework for the project. Dialysis center staff (n = 26) participated in the education. The number of …

Effectiveness Of Continuous Subcutaneous Insulin Infusion Therapy Education In A Clinic Setting, Kimberly Rizzo

Walden Dissertations and Doctoral Studies

Diabetes affects an estimated 29.1 million Americans, with approximately another 1/3 of Americans not yet diagnosed. Complications associated with diabetes include heart disease, stroke, hypertension, blindness, kidney disease, neuropathy and death. All of these complications can be prevented with optimal control of blood glucose levels. Advances in technology provide people living with diabetes (PLWD) a multitude of treatment options such as continuous subcutaneous insulin infusion (CSII) therapy. Unfortunately, sustained improvement in glycated hemoglobin A1c (HgA1c) is not always achieved even with this advanced therapy. The purpose of this doctoral project was to educate nurses on CSII therapy and promote improved …

Increasing Medication Adherence In Hypertensive Patients With Million Hearts® Health Literacy Program, Tammy Ross

Walden Dissertations and Doctoral Studies

Healthy People 2020 identified hypertension (HTN) as a controllable risk factor to prevent cardiovascular disease and stroke. Adhering to regular antihypertensive (AHT) medications improves outcomes in patients diagnosed with HTN by controlling blood pressure, reducing hospital visits, and promoting patient wellness. Medication adherence occurs when prescribed medicine regimens are utilized by the patient as directed to manage illness or disease, as evidenced by patients receiving medications at their pharmacy. The practice-focused question for this quality improvement project asked whether implementation of health literacy tools from Million Hearts® HTN Control: Action Steps for Clinicians, increased medication adherence as evidenced by regular …

An Evidence-Based Approach To Percutaneous Coronary Intervention Access, Kemi Funlayo Sanni

Walden Dissertations and Doctoral Studies

Coronary heart disease is a significant cause of mortality and morbidity in the United States; Healthy People 2020 set an objective to reduce the rate of the disease by 20% to the baseline rate of 126 deaths per 100,000 population per year. In the local healthcare setting, heart disease was responsible for a high percentage of mortality and morbidity. To address this, the local site developed a plan to improve outcomes for patients seeking care at the facility. Because the femoral approach to percutaneous coronary intervention (PCI) was used to treat coronary heart conditions at the site and complications were …

Initiating Kangaroo Care In The Neonatal Intensive Care Unit, Karen Stadd

Walden Dissertations and Doctoral Studies

Kangaroo care (KC) is a cost-efficient method to increase infant-parent bonding and neonatal health outcomes worldwide. Despite evidence supporting KC in critically ill infants, nursing perceptions regarding patient safety and interrupted work flow continued to impede practice in the local high-tech neonatal intensive care unit (NICU). Their current policy failed to address the 2-person transfer method recommended for safe practice. In addition, both staff and parents lacked training and education regarding the benefits and feasibility of KC. This doctoral project aimed to decrease practice barriers and promote earlier and more frequent KC by developing and integrating an evidence-based clinical pathway …

The Impact Of Diabetes And Obesity In The African American Population, Andrea Lynette Swails

Walden Dissertations and Doctoral Studies

Within the 21st century, Type II diabetes has emerged as a public health crisis. African Americans and Hispanic Americans have the highest rates of Type II diabetes and obesity compared to European Americans. The purpose of this DNP project was to teach medical assistants (MA) to provide self-management of diabetes and obesity for the African American population in the local clinical setting. An educational tool kit for health providers was developed to guide the educational project. The chronic care model was used to guide the development of the educational toolkit. A pretest posttest design was incorporated into the educational program. …

Analysis Of Latent Tuberculosis Infection Treatment Adherence In An Inner-City Clinic, Yvonne Washington-Turay

Walden Dissertations and Doctoral Studies

More than 10 million people in the United States are known to have latent tuberculosis infection (LTBI), and more than 300,000 begin treatment for LTBI annually. However, many fail to adhere to therapy for numerous reasons. The purpose of this project was to evaluate the impact of a new guideline, Targeted Tuberculin Testing and the Treatment of Latent Tuberculosis, at inner-city tuberculosis (TB) control clinic in the United States. The practice-focused question for the project asked if the implementation of the clinical guideline using a shorter regimen improved LTBI treatment adherence. The health beliefs model was the framework used to …

A Patient-Centered Approach To Diabetes Education In A Rural Clinic, Paul Okpuzor

Walden Dissertations and Doctoral Studies

Type 2 diabetes mellitus (T2DM) is a heterogeneous metabolic disease impacting more than 8.3% of adults in the United States. Diabetes-related care accounts for more than 11% of all patient care expenditures. The purpose of this project was to identify the primary concerns of members of the T2DM patient population in an underserved clinic in rural southcentral United States and to make recommendations for a staff diabetes education program to address these concerns. Orem's theory of self care outlined the importance of educating and supporting patients in their efforts to manage their own healthcare. Knowles's assumptions of how adult's learn …

Colorectal Cancer Awareness And Screening Guideline For African American Populations, Keyna Omenukor

Walden Dissertations and Doctoral Studies

Colorectal cancer is the 3rd leading cause of cancer-related deaths. Early screening

provides the best prospects for preventing the morbidity and mortality associated with the

disease. Nurses have the duty to promote health and prevent diseases. However, low rates

of colorectal cancer screening continue to be reported, especially among African

Americans who continue to suffer disproportionately from the disease. There is a need for

a culturally-sensitive clinical practice guideline that nurses can use to educate patients

appropriately on colorectal cancer. The practice focused question for this project was

designed to explore whether a culturally-sensitive clinical practice guideline to increase

colorectal …

Workplace Bullying From A Nurses Perspective, Dawn Reid White

Walden Dissertations and Doctoral Studies

Bullying has long been associated with school children. In recent years, however, more attention has been paid to the bullying that has reached beyond the playground and into the workforce. One population facing this problem is staff nurses. To date, no one has found an effective way to address workplace bullying in the healthcare field, nor have effective methods been found for retaining trained nurses affected by this problem. The focus of this dissertation was on understanding nurses' lived experiences and how nurses decided to remain in their current working position despite these problems. Taking a phenomenological approach and using …

Systematic Review Of The Literature On Why There Is Hospice Underutilization, Maria J Garcia

Walden Dissertations and Doctoral Studies

Despite hospice and palliative care services being available for patients at the end-of-life, it remains an easily accessible health care service which has been mostly underutilized and/or misunderstood. For this project, the practice problem was underutilization of hospice and palliative care services. A systematic review of the literature which focused on under usage of end-of-life care was conducted. MEDLINE, CINAHL, and ProQuest Nursing and Allied Source databases were searched (2005 to 2017). Studies that evaluated interventions for increasing hospice and palliative care services were selected. Conceptual variables included studies that addressed the under usage of end-of-life care. Kolcoba's comfort theory, …

Using Calcaneal Heel Ultrasounds To Screen For Osteoporosis At Alaska Health Fairs, Heather Guess

Walden Dissertations and Doctoral Studies

Osteoporosis is a major health problem. The Alaska Department of Health and Social Services reports national rates of osteoporosis at 13-18% of women and 3-6% of men over age 50, but current evidence suggests that osteoporosis rates in Alaska are more equal between sexes. Known risk factors for osteoporosis that are very common among Alaskans include arthritis and low vitamin D and calcium levels. The U.S. Preventive Services Task Force (USPSTF) recommends dual-energy x-ray absorptiometry (DXA) scans of the hip and lumbar spine as the gold standard of screening for osteoporosis; however, DXA scans are expensive, not portable, and not …