Nursing Commons^™

An Evidence Based Evaluation Of Patient Outcomes After The Implementation Of A New Model Of Care For Adolescent Inpatient Psychiatry, Karen Dorr

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

The use of seclusion and restraint on psychiatric units can result in physical harm or even death to patients and may inflict further harm on those who have a history of abuse (Valenkamp, Delaney, & Verheij, 2014, p. 170) (Greene, Ablon, & Martin, 2006) (Martin, Krieg, Esposito, Stubbe, & Cardona, 2008). Reduction in seclusion and restraint is a basic tenant of trauma informed care. This retrospective review and program evaluation examines the implementation of a new care model on an adolescent psychiatry unit at a large suburban hospital. The new care model incorporated the use of collaborative problem solving, an …

The Effect Of Provider Education On Discharge Information Grade Level And Readability, Amber V. Balzer

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Problem: The peri-discharge period for patients can be a complex and dangerous time. A large urban academic medical center with a readmission rate approaching 16% utilizes a standardized template called a Discharge Information Form (DIF) to convey information to inpatients at the time of their discharge. The problem is a lack of individualization with a universal template such as the DIF. Moreover, the readability and literacy level of the DIF have not been previously assessed.

Methods: A random sample of DIFs was assessed for literacy level using the Flesch-Kincaid Readability Test Tool. An in-person educational intervention was administered to a …

Video Education: A Quality Improvement Project For Patients With Type Ii Diabetes, Brandon Lipscomb

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Abstract

Background: Quality diabetes education is a key to successful diabetes treatment. Factors that hinder quality diabetes education include: allotted time for appointments, provider-patient communication, inter-personal relationship between provider and patient, and patient’s educational level. Locally speaking, the Central Virginia area has a higher rate of diabetes then compared to the average rate of diabetes in the State of Virginia. To complicate this more, the local area has a higher percentage of poverty when compared to the average poverty level of the state. Combining these two characteristics places these individuals at a higher risk for disease complications and expresses a …

An Evaluation Of A Pilot Inpatient Hospice Unit And The Impact It Has On End-Of-Life Care At An Academic Medical Center, Cynthia Minetree

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Background: Research shows that acute care hospitals with inpatient hospice units have an increase in hospice resource utilization and provide end-of-life care that is more aligned with patients’ end-of-life goals compared to hospitals that do not have inpatient hospice units.

Methods: A pilot six-bed General Inpatient (GIP) hospice unit was implemented at an acute care hospital, located in Washington, D.C., to provide hospice care for patients that were not able to transfer to another inpatient setting for hospice care. A six-month evaluation of the pilot GIP hospice unit was done to evaluate the feasibility of the unit and the impact …

What Is Baseline? A Concussion Policy Analysis, Jenny H. Crance

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Abstract Concussion symptoms are nonspecific and may be related to other causes. Symptom scores and timeline of return to activity at many institutions are based on having no symptoms at baseline with the current measurement tools. This assumption in the diagnosis and treatment of concussions may lead to prolonged return to activity, compounded concussion symptoms, and unintended psychological and social sequelae. More baseline data is needed, especially in military academies, according to the CARE Consortium Study. During the high-stress initial training period at one mid-Atlantic military college a no-symptom baseline is unlikely for first-year students. The potential overlap of concussion …

Improving Staffing At A Southern Virginia Hospital Using Bardach’S Policy Analysis And The Ihi Triple Aim Framework, Caitlin Crowder

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Nurse staffing is a major concern for healthcare organizations. Ensuring adequate staffing is crucial to providing quality, patient-centered care. The purpose of this project was to explore staffing policy options at a Southern Virginia Hospital using Bardach’s policy analysis and the IHI Triple Aim as frameworks. This policy analysis was conducted to offer a solution for staffing. The current staffing model at this rural Southern Virginia hospital resulted in ongoing, escalating costs that cannot be sustained over time. The three staffing options reviewed included: allowing the current staffing plan to stay in place, implementing a staffing committee, and implementing a …

Reducing Inpatient Falls On A Cardiovascular Progressive Care Unit: A Quality Improvement Study To Implement Interprofessional Intentional Rounding, Deidra Pennington

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Patient falls remain a significant concern for hospitals despite years of focus and research on the topic. Most hospitals have robust fall prevention policies in place containing numerous interventions, yet few demonstrate evidence of long-term sustainability in fall reduction. Patient falls impact overall health outcomes and result in higher costs for the patient and facility due to increased lengths of stay and more medical tests. The location for this study was the cardiovascular progressive care unit (CVPCU) at a Level 1 Trauma Center and academic hospital. This unit underwent a relocation and merger of two nursing units in the fall …

Improving Hepatitis C Screenings In The 1945 To 1965 Birth Cohort In Outpatient Primary Care, Betina Muse Nakoda

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Background: Hepatitis C virus (HCV) is a silent epidemic affecting a vulnerable patient population in our society. Among those considered high risk for having HCV are those individuals born between 1945 and 1965, termed the baby boomer population. Baby boomers are five times more likely to have and suffer mortality from HCV than any other patient population (CDC, 2018). HCV may not present with signs or symptoms until 20 to 30 years post contraction of the virus (CDC, 2018). In 2012, the Centers for Disease Control and Prevention (CDC) updated its recommendations for Hepatitis C screenings to include the baby …

Measuring Levels Of Preparation For Decision-Making And Patient Satisfaction In A Breast Cancer Support Group, Catherine Hagan Aylor

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

The Carilion Clinic Breast Diagnostic Center diagnoses approximately 250 women with breast cancer annually, all of whom are invited to attend the Carilion Clinic Breast Cancer Support Group (CCBCSG). The primary aim of this project was to evaluate if participants with more frequent attendance of CCBCSG had increased levels of preparation for decision-making (PDM) and higher satisfaction with breast cancer treatment decisions. A REDCap survey was emailed to 137 patients who participated in at least one CCBCSG within the past five years, with a 39.4% response rate. The survey assessed levels of patient PDM, patient satisfaction about treatment decisions, and …

The Effect Of Implementing Symptom Feedback Into Psychiatric Care At A Non-Profit Clinic, Deirdre Rea

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Background: Healthcare is moving toward a value-based system with reimbursement based on performance. Charitable organizations providing health services need to demonstrate positive outcomes for continued grant funding. Measurement-Based Care (MBC) is evidence-based, can improve patient outcomes and objectively document success. Studies show most psychiatric providers do not utilize MBC in their own practices citing lack of time, and a belief that their clinical judgment supersedes a measurement tool. The purpose of the study was to establish the use of patient-reported symptom measurement tools in a non-profit psychiatric clinic and determine if an office-based strategy to proactively and regularly report to …

Implementing A Discharge Navigator Reducing 30-Day Readmissions For Heart Failure And Sepsis Populations, Karen Weeks

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

A national focus for healthcare reform is preventing hospital readmissions. Thirty-day unplanned hospital readmissions impact patient outcomes and are costly to the healthcare system. This project explored the impact between the discharge navigator and 30-day unplanned readmissions for heart failure and sepsis populations in a 238-bed community hospital located in central Virginia. The primary aim of this discharge navigator project was to reduce 30-day readmissions for the heart failure and sepsis populations to meet the goals of the top quartile for like hospitals and the evaluation of cost avoidance for these readmissions. Heart failure and sepsis populations are high risks …

The Effect Of Integrative Medicine Practices On The Use Of Obstetric Intervention In Labor And Delivery, Rachel Cochran

All Electronic Theses and Dissertations

Background/Purpose: The purpose of this paper is to review scholarly writings to discern if the use of integrative medicine practices affects the use of obstetric intervention in labor and delivery. Theoretical Framework: The Theory of Human Caring by Jean Watson will be used as the theoretical structure of this literature review. Watson’s theory places caring at the center of all activities, decisions, and practices within the discipline of nursing and emphasizes a journey of caring for the whole person. Methods: Nineteen research articles were critically reviewed with the purpose of determining whether the use of specific integrative medicine practices affects …

Philippine-Based Filipino Women And Breast Cancer, Elizabeth S. Azutillo

Student Theses, Dissertations and Capstones

Background. The rate of breast cancer incidence in the Philippines has increased in recent years. Three out of 100 Filipino women will contract breast cancer before age 75; one out of 100 will die before age 75. Purpose. The study was used to determine the level of knowledge of the respondents about breast cancer and breast cancer screening modalities, the relationship of the level of knowledge and frequency of breast self-examination (BSE) performance; the predictive ability of their health perceptions; modifying variables for their intent to perform BSE, submit to screening mammography, and engage in clinical breast exam (CBE); their …

Ua66/14/3 Ogden College Of Science & Engineering Nursing Publications, Wku Archives

WKU Archives Collection Inventories

Publications created by and about Nursing.

The Impact Of A Revised Discharge Process From Acute Care To Home Care On Hospital Utilization In Children With Single Ventricle Heart Disease, Brian M. Stahulak

Doctor of Nursing Practice Projects

Problem Description: It is estimated that approximately ~0.5%, or ~400,000, of all U.S. children, are identified as having complex chronic conditions (CCC) and account for as much as one-third, or ~$100 billion, of health care spending for all children. The goal of this quality improvement (QI) project was to identify the impact of a revised discharge process for children with Single Ventricle Heart Disease (SVHD) on hospital utilization rates and the parent’s perception of discharge readiness during the interstage period. The QI project was conducted in a 44-bed cardiac care unit within a 336-bed freestanding pediatric, academic medical center in …

The Critical Review Of Overuse Of Medication In The Geriatric Population, Sophia A. Allwood

All Electronic Theses and Dissertations

Background: The overuse of medications is of concern among the geriatric population, especially in various settings including in-home and community-based (assisted living and independent living). This review found that older individuals take nine or more medications daily. The overuse of medications has an increased tendency to cause problems for older patients and creates adverse consequences. The adverse consequences cause problems and injuries, such as broken bones, head trauma, and death. Purpose: The purpose of this critical review of the literature is to investigate the issues related to the overuse of medication in the geriatric population and the negative impact of …

Multiple Dimensions And Correlates Of Fatigue In Individuals On Hemodialysis: A Quantitative Study, Bincy Joshwa

Wayne State University Dissertations

Background: Fatigue is present in individuals on Hemodialysis (HD). Evidence on fatigue in HD are limited by focus on unidimensional aspect of fatigue, flawed unidimensional tools, lack of objective measures, and variability in the correlates of fatigue. Purpose: To examine severity and trajectory pattern of fatigue; delineate influencing physiological and situational factors pre-dialysis and post-dialysis. Theoretical Framework: The Theory of Unpleasant Symptoms was used to guide the study. Methodology: A descriptive, correlational, before-after design was utilized. Measures were Piper Fatigue Scale (PFS)-12, Patient Reported Outcomes Measurement Information Systems (PROMIS)-Fatigue, Charlson Comorbidity Index and six-minute walk test (6MWT). Adults, cognitively intact …

Developing A Business Case For The Care Coordination And Transition Management Model: Needs, Methods, And Measures, Sheila Haas, Beth A. Swan, Rachel Start, Regina Conway-Phillips, Laura A. De La Pena, Diane Storer Brown

Nursing: School of Nursing Faculty Publications and Other Works

In this descriptive qualitative study, nurse and healthcare leaders' experiences, perceptions of care coordination and transition management (CCTM®), and insights as to how to foster adoption of the CCTM RN role in nursing education, practice across the continuum, and policy were explored. Twenty-five barriers to recognition and adoption of CCTM RN practice across the continuum were identified and categorized. Implications of these findings, recommendations for adoption of CCTM RN practice across the care continuum, and strategies for reimbursement policies are discussed.

Optimizing Strategies For Care Coordination And Transition Management: Recommendations For Nursing Education, Beth Ann Swan, Regina Conway-Phillips, Sheila Haas, Laura A. De La Pena

Nursing: School of Nursing Faculty Publications and Other Works

The purpose of this descriptive qualitative study was to explore nurse and healthcare leaders' experiences and perceptions of care coordination and transition management (CCTM®). Four barriers emerged that added insight into the lack of adopting and integrating CCTM knowledge, skills, and attitudes in nursing education in the following categories: curriculum redesign, silos of care settings and care providers, knowledge gap, and faculty development/resistance. Recommendations and implications for education, for both nursing students and practicing nurses, are described.

Mentorship Through Storytelling Program, Debra Marie Perry

Theses and Graduate Projects

The Mentorship Through Storytelling Program began in response to an urgent need to reduce registered nurse (RN) turnover rates and improve nurses’ satisfaction on a medical surgical unit in a Midwestern Hospital. The unit was challenged to hire, integrate, and retain a multigenerational team of RNs. Guided by Jean Watson’s Theory of Human Caring, the Mentorship Through Storytelling Program was initiated in the fall of 2018 after doing a broad literature review and adapting the Academy of Medical Surgical Nurses’ Mentorship Program to include the concepts of storytelling, mentoring, and caring. Digital recordings of five expert nurses’ oral histories (stories) …

The Heart Of Atrial Fibrillation: Integrating Yoga For Holistic Care, Jessica Lee Mcalpine

Theses and Graduate Projects

Atrial fibrillation (afib) is a chronic disease with no reliable cure that is caused by a chaotic heart rhythm. The heart has both metaphysical and physical meaning as the place where the spirit resides, a symbol of love, and as an organ that provides life. Yoga can be integrated as a holistic modality that has both physical and metaphysical benefits. Literature demonstrates that yoga can reduce self-assessed symptoms of afib, secondary outcomes, and objective episodes of afib. Negative emotional states can increase afib frequency. Yoga has been found to improve emotional states, ability to cope with chronic disease, perceived wellness, …

Ethical Patient Care Overview For Doctoral Nursing Students, Courtney Reinisch

School of Nursing Faculty Scholarship and Creative Works

Clinical care is guided by knowledge, competency, and the maintenance of ethical standards. Maintenance of ethical standards is necessary by all care providers across disciplines. Attention should be paid to the following ethical tenets: autonomy, beneficence, non-malfeasance, justice, veracity, and confidentiality. Avoiding paternalism is a goal for providers to optimize outcomes for individuals and families. Providers who demonstrate a thorough understanding of ethical principles best serve individuals, communities, and populations by strengthening trust with adherence to ethical standards.

Grit Associated With New Graduate Registered Nurse Initial Competency, Joan Marie Kavanagh

Student Theses, Dissertations and Capstones

The delivery of highly reliable health care is in jeopardy as many new graduate registered nurses (NGRNs) enter clinical roles under-prepared for demands of professional practice. Identifying and addressing challenges to safe practice early in the onboarding process were paramount for patient safety at a large Midwestern healthcare system (HCS). Post-hire and pre-practice Performance Based Development System (PBDS) assessments were administered to more than 7,600 NGRNs between January 2011 and December 2018. Only 19% of NGRNs demonstrated entry-level competencies and practice readiness; 26% were unsafe for novice independent practice. Data analysis revealed no differences in competence ratings by nursing degree …

Evaluating The Knowledge And Attitudes Of Orthopedic Nurses Regarding The Use Of Sphm Algorithms As A Standard Of Care, Terry L. Doire

Student Theses, Dissertations and Capstones

Background: Healthcare workers are ranked among one of the top occupations for musculoskeletal disorder (MSD) injuries that affect the muscles, the bones, the nervous system and due to repetitive motion tasks (Centers for Disease Control and Prevention, 2017). Numerous high-risk patient handling tasks such as lifting, transferring, ambulating and repositioning of patients cause injuries that can be prevented when evidence-based solutions are used for safe patient handling and mobility (SPHM) tasks.

Purpose: The purpose of this quality improvement project was to evaluate the knowledge and attitudes of orthopedic nurses regarding the use of SPHM algorithms as the standard of care …

The Effect Of Nursing Interventions And Health Promotion On Childhood Obesity: A Literature Review, Grace N. Mageloff

Honors Undergraduate Theses

Childhood obesity is a growing epidemic in the United States that has short-term and long-term health consequences for the children affected. Nurses are patient advocates and are responsible for speaking up for the patient; in the pediatric population, a nurse must act as an advocate on behalf of the child. The purpose of this literature review is to look at different barriers to nursing interventions in regard to childhood obesity. A literature review was done by using different databases, with 11 articles having similar themes and interventions used. The main themes from the literature review were parental willingness and involvement …

Exploring Stress Management And Coping Mechanisms In Parents Of Infants In The Neonatal Intensive Care Unit (Nicu), Samantha E. Day

Honors Undergraduate Theses

The purpose of this study was to conduct a literature review that examined parental coping mechanisms and stress relief techniques for parents of infants admitted to the neonatal intensive care unit (NICU). A search was conducted using multiples databases using key terms such as stress AND coping, parent* OR caregiver, ped* OR child*, support* or aid, NICU OR neonatal intensive care unit, and nurs*. The results were limited to scholarly, peer reviewed journals in the English language. Exclusion criteria included not relating to parents or caregivers and mechanisms of coping with stress or if they pertain to palliative or end-of-life …

Evaluating Interventions To Mitigate Compassion Fatigue Among At-Risk Nursing Populations, Emily R. Derayunan

Honors Undergraduate Theses

This thesis examined the experience of compassion fatigue in nurses through analysis of research studies conducted within the past ten years. A literature review was completed using CINAHL Plus with Full Text, MEDLINE, and PsycINFO databases. Efficacy of current management strategies and interventions was evaluated. Findings indicate that educating nurses working in high-risk units improves self-recognition and lowers compassion fatigue levels. Institutional factors such as a lack of managerial support and organizational commitment contribute to the experience of compassion fatigue. An organization's involvement in maximizing compassion satisfaction through meaningful recognition of nurses' contributions to care and implementation of organizational prevention …

Lesbian, Gay, Bisexual, And Transgender (Lgbt) Healthcare In Rural Settings: An Integrative Review Of The Literature, Caitlin Cox

Honors Undergraduate Theses

The lesbian, gay, bisexual, and transgender (LGBT) community is a unique population that has specific health issues and health care needs associated with lifestyle behaviors that increase risk for certain diseases. Health concerns include mental and behavioral health, issues associated with gender identity and relationships (i.e. intimate partner violence), sexually transmitted infections, and chronic illnesses. The research suggests poorer health outcomes for the LGBT population compared to heterosexual and/or cisgender counterparts. Most research conducted with LGBT populations occurred in more populated urban settings with very few studies focusing on this population in the rural context. Consequently, there is a paucity …

Understanding The Healthcare Experiences Of Deferred Action For Childhood Arrivals (Daca) Recipients, Jacob A. Kluesener

Honors Undergraduate Theses

Background: There is limited research on the healthcare experience of Deferred Action for Childhood Arrivals (DACA) recipients both before and after enrollment in the program. DACA is a program designed to defer deportation to children and young adults in the United States for up to 2 years. The goal of this qualitative study is to explore the lived experiences of DACA students with regards to access to healthcare and perceptions of treatment. Method: This study is qualitative and uses a phenomenological approach. DACA Recipients (N = 5) were recruited from the UCF student population and 1:1 interviews were conducted. Interviews …

Effects Of A Plant-Based Vegan Diet On The Risk Of Cancer: An Integrative Review Of The Literature, Chelsie M. Silavent

Honors Undergraduate Theses

Cancer, an aggressive chronic disease, impacts the lives of millions of people every day. There are numerous proposed triggers related to the diagnosis and much remains to be learned about the causes. Associated with this disease's variability is the challenge to identify a single causative agent that lead to its prevention. Specific topics that need additional evidence relate to environmental factors and lifestyle behaviors in the development, treatment and, in some instances, even suppression of disease progression. Specifically, a diet that excludes animal-based products but consists of a variety of fruits and vegetables (i.e., plant-based vegan diet) is reported to …