Nursing Commons^™

Implementation Of An Evidenced-Based Intervention For Pain Management In Lumbar Spine Surgery, Mary R. Draper

Doctoral Projects

Introduction: Spinal surgeries are among the top procedures responsible for the highest degree of post-surgical pain. Opioids are the mainstay of current pain management practices in the post-operative period. In light of the opioid epidemic, increased opioid tolerance, and changes in legislation, there is a calling for alternative strategies in managing acute and chronic pain. The purpose of this project is to answer the following question: Does implementation of an evidence-based intervention for preoperative administration of gabapentin reduce patients’ perception of pain and reduce opioid consumption in those who experience lumbar spine surgery?

Objectives: The goal of this project is …

A Need For A Culturally Congruent Obesity Intervention At A Community Safety-Net Clinic, Claudia D. Rivera-Salas

Doctoral Projects

Background: Obesity is an epidemic in the United States which causes numerous chronic conditions and disproportionally impacts underserved populations. The removal of barriers that prevent active lifestyles such as unaffordable facilities and inaccessibility are of primary importance in promoting a healthy lifestyle.

Objectives: Collaboration with community organizations to increase access to culturally congruent nutrition and exercise classes for underserved Latino/Hispanic patients of a Midwestern safety-net clinic to reduce obesity, increase physical activity, and improve dietary habits.

Methods: Assessment of current practices revealed the need for project development. Six-week nutrition education class and exercise classes were held for eligible patients which …

Implementing Use Of The Moss (Michigan Opioid Safety Score) Tool And Interventions To Reduce Opioid-Related Overdose Events In High Risk Patients, Michelle J. Kloss

Doctoral Projects

Opioids are among the most common pharmacological class of therapeutic medications prescribed to alleviate pain across all healthcare settings. However, opioid-related adverse events are a growing problem contributing to an increase in morbidity and mortality. Current hospital practice does not utilize a pre-opioid administration screening tool to assess patient risk of adverse events related to opioid administration. The implementation of the Michigan Opioid Safety Score (MOSS), an evidence-based risk assessment tool which utilizes patient characteristics as well as respiratory assessment for the prediction and early detection of opioid-induced adverse events. This quality improvement project evaluated the effectiveness of the MOSS …

Reducing Unnecessary Phlebotomy Testing Using A Clinical Decision Support System, Valerie Strockbine, Cathie E. Guzzetta, Eric Gehrie, Qiuping (Pearl) Zhou

GW Research Days 2016 - 2020

Overuse of phlebotomy testing offers little to improve patient outcomes but may subject patients to additional morbidity. Low-cost, high-frequency tests are ordered recurrently, unnecessarily, and contribute to the high cost of health care. Reducing unnecessary phlebotomy tests can cut costs without compromising quality. Type and screen tests are active for three days from the date the specimen is collected, yet our blood bank laboratory observed type and screen tests were often unnecessarily ordered in our organization. We set out to determine the effectiveness of a clinical decision support system (CDSS) on reducing unnecessary type and screen tests, estimate the cost …

Nursing Students’ Knowledge And Understanding Of Acute Cystitis, Kayla Weber

Undergraduate Honors Theses

Acute cystitis (AC) is characterized by a sudden inflammation of the bladder caused by bacteria. The severity of AC ranges from mild to severe and may be recurrent, especially in at-risk populations. Bacteria in the bladder may travel further into the urinary system, causes urinary tract infections (UTI’s) resulting in urosepsis. Hygienic procedures play a large role in decreasing the bacteria that causes AC, so it is important for nursing students to understand and correctly apply the knowledge learned throughout the curriculum. This study focused on the knowledge and understanding nursing students have about AC. To determine this information, a …

Gw Nursing, Spring 2019, George Washington University, School Of Nursing

GW Nursing Magazine

No abstract provided.

Students’ Perspectives Regarding Clinical Preceptors (Cps) In The Baccalaureate Undergraduate Nursing Programme In Karachi, Pakistan, Amina Aijaz Khowaja Ap, Jacqueline Maria Dias

School of Nursing & Midwifery

Introduction: Clinical practice is considered an integral part of nursing education. It is in the clinical area that the students integrate the theory learnt in the classroom into practice. An enabling clinical environment with the assistance of a clinical preceptor (CP) ensuresthat student nurses become independent practitioners and competent in their roles and responsibilities.
Design : A comprehensive study was undertaken to explore the emerging role of CPs in Pakistan. This research has been reported in the literature. This paper will deal exclusively with the perceptions of nursing students when working with CPs in the four-year undergraduate baccalaureate program at …

Factors Associated With Postoperative Pain Among Patients After Cardiac Surgery In The Tertiary Care Teaching Hospital Of Karachi, Pakistan, Sineer Micah, Rubina Barolia, Yasmin Parpio, Santosh Kumar, Hasanat Sharif

School of Nursing & Midwifery

Background: Pain is the subjective feeling of an individual, which affects the overall recovery of patients after cardiac surgery. Postoperative pain is the most inadequately managed symptom of cardiac surgery. Subsequently, there are many factors that can either hinder or facilitate pain management, including patients' beliefs, cultural values, physiological features, hospital policies, and healthcare providers' knowledge and beliefs. The purpose of this research was to identify factors associated with postoperative pain and its management, after cardiac surgery, among patients in a tertiary care hospital in Karachi, Pakistan.
Methods: Quantitative correlational study design was employed to attain the study purpose. Data …

Follow-Up Among Homeless Patients At San Francisco General Hospital: Examining The Social Determinants Of Health, Robert Gnat

Doctoral Projects

The San Francisco General Hospital emergency department has a high occurrence of homeless patients that are lost to follow-up after discharge. This Doctor of Nursing Practice project conducted a survey to evaluate the social determinants of health among this population and how they influence the participant’s ability to follow-up. This is the first phase of a three-phase project involving assessment and evaluation. The second and third phases of this project will center on intervention and re-evaluation after intervention. The survey was administered to eligible participants who presented to the emergency department at San Francisco General Hospital. Fifty participants were surveyed …

The Association Of Modified Early Warning Score On Patient Outcomes In Medical-Surgical Units In An Academic Medical Center, Gerundio Ursolino Iii, Msn, Mba, Ccrn-K

Doctor of Nursing Practice Projects

Background: A nationwide problem that has been regularly overlooked is poor recognition of deteriorating patients which can lead to increased severity of illness. One way to avoid adverse events is early detection of clinical deterioration using vital signs via Modified Early Warning Score (MEWS). However, the majority of the hospitals across the United States are not utilizing this. MEWS implementation can minimize adverse events by early recognition, which will lead to early intervention and improved patients’ outcomes.

Objective: The aim of this quasi-experimental study was to determine if MEWS implementation will reduce the number of adverse outcomes.

Methodology: …

Exploring Turnover Among Nurse Managers, Directors, And Executives In Acute Care Hospitals, Deborah Hughes Warden

Theses and Dissertations

Background: The strength and quality of the nursing leader workforce is associated with staff nurse retention and patient outcomes. While leadership turnover is not always negative, there is still uncertainty, loss of program continuity, power shifts within an organization, and significant expense for the organization in recruiting and integrating a new leader.

Purpose: The purpose of this study is to explore intent to leave and turnover experiences of acute care nurse managers, directors, and executives.

Methods: For this nationwide survey, recruitment was done via snowball sampling through state hospital associations and professional organizations across the US with a resulting sample …

Pediatric Patients With Diabetes Transition To Adult Care, Sara Jennings

Doctoral Projects

The purpose of this study was to identify the optimal age to target transition to adult care education for adolescent and young adults (AYA) with Type 1 and Type 2 Diabetes Mellitus (DM) as they transition from pediatric endocrinology providers to adult DM providers. A secondary purpose of this study was to identify if there was a relationship between attendance rate, age, gender, years diagnosed with DM, ethnicity, insurance type, Type of DM, and current county of residence with control of diabetes, measured by glycosylated hemoglobin (HgbA1c). A quantitative study through chart audits was conducted at Valley Children’s Healthcare, VCH, …

Effectiveness Of Ted Stockings On Circulation And Blood Clotting, Ashley Webb, Karlie Walter, Jessica Overby, Ashlyn Hall, Meghan Griffin

Spring Showcase for Research and Creative Inquiry

Circulatory issues can stem from many disease that cause blood clots specifically in the legs, adding compression is known to help reduce blood clotting. The goal of this research project is to better understand the purpose and effectiveness of TED stocking on circulation and blood clotting and whether it is still an effective practice. The outcome of this research project is to improve our practice through the use of TED stockings for circulation and blood clotting.

Pressure Ulcers, Kelly Jeter, Courtney Frazier, Jimmy Mcdonell

Spring Showcase for Research and Creative Inquiry

During this research project, we are investigating if repositioning an immobile patient every two hours would reduce the risk of pressure ulcers forming. Pressure ulcers are caused by increased pressure or friction on bony prominences and are most likely found on immobile patients. Pressure ulcers are a major infection risk for the patient and a huge cost factor for the hospital. When the patient is immobile it becomes the nurses job to identify the risk of pressure ulcers and help prevent them from occurring. With constant repositioning every two hours, these factors could be reduced or stopped all together.

Evaluation Of Safety Related To Current Patient Mobility Practices, Karissa Bright, Logan Callahan, Sarah Saunders

Spring Showcase for Research and Creative Inquiry

A major practice that may be overlooked in the nursing field is how to move patients. Since nurses care for a diverse patient group, some patients may have limited to no mobility. In these cases, the nursing team must decide how to move the patient to provide care while still maintaining a safe environment. The purpose of this project is to evaluate current evidence on the safest ways to move and ambulate patients, while still maintaining the effectiveness that must be present in the medical environment. Hopefully, through this research, effective and safe ambulating practices can be determined.

La Adherencia A Las Recomendaciones De Sueño Seguro Por Parte De Las Enfermeras En Unidades De Cuidado Intensiva Neonatal (Ucin) De Hospitales Públicos Y Privados En El Gran Buenos Aires / The Adherence To Safe Sleep Recommendations By Nurses In Neonatal Intensive Care Units (Nicus) Of Public And Private Hospitals In Grand Buenos Aires, Joelle M. Schauer

Independent Study Project (ISP) Collection

El Síndrome de Muerte Súbita de Lactante (SMSL) es “la muerte de un niño menor de 1 año que ocurre, aparentemente, durante el sueño y no puede ser explicada luego de una investigación exhaustiva, que incluye una autopsia completa, la investigación de las circunstancias de la muerte y la revisión de la historia clínica" (Jenik et al., 2015, p. 2). La Academia Americana de Pediatría (AAP) tiene recomendaciones sobre las prácticas del sueño seguro que pueden disminuir el riesgo de SMSL y otras Muertes Súbitas Inesperadas Infantiles (MSII).

El objetivo de esta investigación es analizar la adherencia a estas recomendaciones …

Nursing Clinical Calculations Adoption, Michelle Boyce, Sue West, Rebecca Maddox, Katie Bridges

Nursing and Health Sciences Grants Collections

This grant reports collection for Clinical Calculations is the result of a Round 12 ALG Transformation Grant.

Images Of Nursing From West Michigan: A Photo Essay, Aldina Mahmutovic

Honors Projects

The image of nursing is diverse and complex, with public perceptions influenced by traditional imagery and negative stereotypes. Few recent studies consider how nurses view their professional image. My study aimed to uncover how West Michigan nurses perceive the image of nursing. Approval was given by the local Sigma chapter (Kappa Epsilon at Large), to recruit participants from members, and by Grand Valley's IRB. Via an online REDCap survey, participants submitted an original photo and written narrative. Submissions were searched for underlying patterns using thematic analysis. Themes identified were: (1) nurses establish relationships with unique and vulnerable clients, using their …

Effects Of Weighted Blankets On College Students’ Anxiety, Amy Clapp

Honors Projects

Background: Many mental health disorders, including anxiety, are identified during young adulthood when students are beginning college. Therapies such as weighted blankets may provide anxiety relief, but information about the use of weighted blankets for students is lacking.

Purpose: To compare the effect of weighted versus regular blankets on anxiety, sleep, and GPA in a sample of undergraduate students.

Conceptual framework: Measurements were operationalized through the Overall Anxiety Severity and Impairment Scale (OASIS).

Methods: A pilot study using a convenience sample with random assignment was conducted. Participants (N = 32) self-identified as belonging to one of …

Food Insecurity Among College Students, Alison Hige

Honors Projects

Increasing collegiate education costs results in students today facing greater financial stress. As a result, students have to make difficult choices of how to allocate their monetary resources. Sometimes, students prioritize educational costs over nutrition and health necessities, impacting an individual’s ability to obtain adequate food resources. The purpose of this project was to explore the prevalence and impact of food insecurity among college students. The project included conducting a literature review yielding 26 pertinent articles from the keywords “food insecurity” and “college students.” Food insecurity affects a student’s physical and mental health, along with negatively impacting their scholastic abilities. …

A Multi-Faceted Intervention To Improve Diagnosis And Treatment Rates Of Overweight And Obesity By Nurse Practitioners In Primary Care, Susan Disser

Evidence-Based Practice Project Reports

The United States is amid an obesity epidemic (Institute of Medicine, 2012). Indiana ranks as the tenth most overweight state. (America’s Health Rankings, 2018). Despite guidelines outlining the treatment of obesity, primary care providers seldom use these guidelines (Hayes et al., 2017). In a 2010 study, only 28.9% of obese patients received a diagnosis of obesity and less than 25% of these patients received counseling on diet, exercise, or weight loss (Bleich, Pickett-Blackely, & Cooper, 2011). The purpose of this evidence-based practice (EBP) project is to determine if a multi-faceted intervention consisting of academic detailing, reminders, audit with feedback, and …

Improving Nursing Staffing Methodology And Nursing Sensitive Outcomes With The Addition Of A Patient Centered Acuity Measure, Douglas C. Howard Rn, Ms, Ne-Bc

Doctor of Nursing Practice Projects

Background: Assigning the correct nursing resources to hospitalized patients positively impacts patient outcomes. The current process for matching nurses to patients is highly variable and involves a combination of simple ratios, historical workload data, and expert opinion but lacks objective measurement of the patient’s condition.

Objectives: This project evaluated change in selected quality indicators and the daily unit-level management of nursing resources after implementing the Troubled Outcome Risk (TOR) into existing nursing staffing methodology in a Department of Veterans Affairs hospital.

Methods: TOR provides objective measurement of individual patient allostatic load. Daily calculation of TOR scores for each patient on …

Opioid Dosing’S Impact On Numeric Pain Rating Scale And Urine Toxicology Results, Christine Couperus–Mashewske Fnp-Bc, Rn

Doctor of Nursing Practice Projects

Background: Concerns about opioid prescribing in the United States have been rising (Centers for Disease Control and Prevention [CDC], 2016). Assessing pain scores, along with urine toxicology screenings can provide information to both patients and providers about prescription opioids.

Objectives: The purpose of this retrospective chart review study was to compare numeric pain scores and urine toxicology results between two different groups of patients who were being prescribed daily≥ 90mg opioid dosing.

Methods: This retrospective chart review sample was of 134 adult chronic pain patients at one pain management clinic. Patients’ average numeric pain rating while using opioids for a …

Evaluation Of Patient Throughput In An Outpatient Pediatric Hematology, Oncology, And Bone Marrow Transplant Clinic, Samantha Depadova Msn, Rn, Anp-C, Ocn

Doctor of Nursing Practice Projects

Background: Outpatient oncology clinics are complex environments. The multi-step, sequential nature of oncology treatment contributes to delays. Prolonged wait time impacts patient compliance, satisfaction, and staff satisfaction.

Objectives: To assess throughput in the outpatient pediatric oncology clinic and explore staff’s assessment of throughput and their opinions of what might be improved.

Methods: Our descriptive-comparative study used retrospective reviews to measure four time intervals for 312 visits at our mid-Atlantic outpatient clinic. Patient and appointment factors were explored. Mean interval times were calculated and differences impacting throughput were analyzed using ANOVA. Prospective survey data were obtained from 22 clinic staff …

Analysis Of Parental Attitudes Of Adolescent Vaccinations In The Retail Health Care Setting, Patrick William Denning Mph, Msn

Doctor of Nursing Practice Projects

Background: The tetanus-diphtheria-acellular pertussis, meningococcal, and human papillomavirus vaccines have been recommended for adolescents since 2005. Retail health clinics can increase the delivery of vaccinations by reaching patients outside the traditional healthcare system.

Objectives: To measure parental attitudes of adolescent vaccinations utilizing the Vaccine Confidence Scale (VCS) and assess reasons parents decided to vaccinate or not. Attitudes were compared to previous studies. Our long-term purpose was to develop targeted interventions to increase adolescent vaccinations.

Methodology: A descriptive survey design measured the parental attitudes of adolescent vaccinations from total VCS scores and subscale scores of benefits, harms, and trust. A qualitative …

Effects Of Teach-Back Method Of Education On Knowledge Of Heart Failure Self-Care Management And Post-Discharge Knowledge Retention, Ama Awuah-Asamoah Msn, Rn, Acnp

Doctor of Nursing Practice Projects

Background: Approximately forty to eighty percent of patient education is immediately forgotten, and about fifty percent of retained information is inaccurate; knowledge is an essential bridge between patient teaching, comprehension and knowledge retention by using the teach- back method (Farris, 2015; Rouse et al., 2016; Stamp et al., 2014).

Objectives: The purpose of this study was to compare teach-back education method versus standard education and care, on knowledge of heart failure (HF) self-care management at discharge and retention of knowledge at three to ten days post discharge.

Methods: A non-probability convenience sampling of 22 HF patients, 65 years and older, …

Improving Nursing Students’ Attitudes And Beliefs About Transgender Clients Through The Use Of A Simulated Clinical Experience, J. Alex Thompson Msn, M.Ed., Rn, Cne

Doctor of Nursing Practice Projects

Background: Negative healthcare experiences may lead to poor health outcomes for transgender individuals, but nursing curricula give little attention to transgender healthcare. This study engaged nursing students in a simulated clinical experience (SCE) which featured a young adult transgender male in an acute care setting to determine whether participation would have a significant impact on student nurses’ attitudes and beliefs about transgender individuals.

Methods: The convergent parallel mixed-methods design used a one group pretest-posttest and a post-case debriefing interview to examine undergraduate nursing student attitudes and beliefs toward transgender individuals. Participants (N=27) reported their feelings via the Transgender Attitudes and …

Online Sexual Health Education With Rural Independent Study Charter School Students, Crystal L. Gardner Msn, Phn, Rn

Doctor of Nursing Practice Projects

Background: Sexually transmitted infections (STIs) and unwanted pregnancies continue to be public health problems in the United States. Each year there are about 20 million new STIs in the United States with about half of the infections occurring in people 15 to 24 years old (The Centers for Disease Control and Prevention, 2016).

Objectives: The purpose of this descriptive pre- and post-test study was to determine if an online STI prevention program increased knowledge about STIs, STI related resources, and lowered STI risk-taking behaviors in rural northern California students attending an alternative high school.

Methodology: “Positive Prevention PLUS” curriculum and …

Self-Efficacy In Emerging Nurse Leaders: The Effects Of A Virtual Community Of Practice On Nurse Educators In A New Practice Role, Kevin Daugherty Hook Msn, Ma, Ms, Agpcnp-Bc, Crnp

Doctor of Nursing Practice Projects

Background: Clinical nurse educators in long-term and skilled nursing facilities have an opportunity to exercise new leadership skills in bridging the gap between education and practice.

Objective: To assess the effects of a virtual Community of Practice (CoP) on the self-efficacy of clinical nurse educators who work in newly developing leadership roles in a large long-term and skilled nursing organization operating in multiple sites across the United States.

Methodology: The exploratory pilot study used a one group pre-test/posttest method. A convenience sample was used to enroll participants with newly created roles in clinical education. The Leader Efficacy Questionnaire (LEQ) was …

A Pre/Post Intervention Study To Assess Social Capital Through Bonding And Bridging Among Federal Nurse Teleworkers, Carrie Jeffries Mph, Ms, Rn, Anp-Bc, Aacrn, Aahivs, Nea-Bc, Fache

Doctor of Nursing Practice Projects

Background: The social capital components of bonding (within groups) and bridging (between external groups) are essential to building healthy and effective teleworking relationships that are required to retain staff.

Objectives: To identify if delivering a relationship building educational intervention to federal nurse teleworkers who used the internet daily would improve their total Internet Social Capital Scale (ISCS) scores and bonding and bridging subscale scores.

Methods: Our study employed a pre/post intervention design, aiming for a convenience sample of 75% (n=41/55) of federal nurse teleworkers. We delivered, via webinar, a 45-minute educational session on telework and techniques to increase bonding and …