Nursing Commons^™

Multidisciplinary Simulation Training To Improve Nursing Knowledge Of Intraoperative Malignant Hyperthermia, Heather Burrell

Walden Dissertations and Doctoral Studies

Malignant hyperthermia (MH) is a rare but severe reaction that can occur in the operating room. Due to the low volume of these reactions, nurses are often unprepared to handle the event; however, not recognizing the event and intervening can lead to the death of the patient. This is a practice problem that can be addressed through a nursing staff education simulation training program. The purpose for this doctoral project was to develop a multidisciplinary MH simulation program that could improve nursing knowledge when caring for patients experiencing an MH crisis in the operating room. The practice-focused question for this …

Screening For Depression During The Early Perinatal Period, Loretta Ann Donnelly-Moreno

Walden Dissertations and Doctoral Studies

The clinical practice guideline (CPG) is the implementation of a depression screening tool to be used in the early perinatal period. The practice change occurred in a rural Obstetrical and Gynecological (OBGYN) practice in the southern United States. The CPG change has been guided by recommendations from both the American Congress of Obstetrics and Gynecology and the American College of Nurse Midwives. Implementation of this CPG change addresses the gap in practice of not doing depression screening during the perinatal period, and only screening during the postpartum period, which was being done at the OBGYN office. Theorist Lewin’s ‘change theory’ …

Development Of Nursing Staff Education For Central Line Maintenance, Doreen Lynn Farley

Walden Dissertations and Doctoral Studies

Patients with cancer who receive bone marrow transplants (BMT) are at increased risk for central line-associated blood stream infections (CLABSI), a serious complication leading to increased costs, length of stay, and even death. Recognition of an increased CLABSI rate at one BMT unit in the southwestern United States prompted development of an evidence-based staff development education program to improve nurses’ knowledge of central line maintenance and CLABSI prevention practices. Guided by Lewin change theory, the program was developed based on a nurse-led analysis and synthesis of the evidence, and a formative evaluation of the educational program conducted by a 3-member …

A Urinary Catheter Insertion And Care Program For Reducing Catheter-Related Infections, Rodney R. Hauch

Walden Dissertations and Doctoral Studies

Many inpatients in U.S. hospitals acquire an hospital-acquired infection (HAI), the majority of which can be attributed to an indwelling urinary catheter. The use of urinary catheters is a common practice within the acute care setting although the placement comes with risk. Improper catheter placement or a lack of care and maintenance can increase patient morbidity and mortality, as well as increase financial strain for the hospital. The purpose of this quality improvement (QI) evaluation was to determine if using a safety checklist and a 2-person urinary indwelling catheter-insertion team would reduce the rate of catheter-associated urinary tract infections (CAUTIs). …

Reducing Falls In The Vulnerable Elderly: Implementing An Inpatient Fall Prevention Program, Bibi Farida Khan

Walden Dissertations and Doctoral Studies

Inpatient falls are a leading cause of fatal and serious injuries among hospitalized elderly patients, often with devastating consequences. This quality improvement project was conducted on a geriatric unit in a large southeastern U. S. hospital, following recognition of an increase in the number of falls with several sustained injuries. After an analysis of the previous fall prevention strategies, a panel of stakeholders who formed a falls prevention committee determined that implementing an evidence-based fall risk assessment tool to help identify risk factors, as well as implementing interventions to address those risk factors, would make fall prevention more patient specific …

Effects Of Teach-Back On Children’S Treatment In Parents With Low Health Literacy, Marion Ines Kopulos

Walden Dissertations and Doctoral Studies

Health literacy (HL) skills are necessary to understand the context of medical information provided to patients in all settings including the emergency room. People with low health literacy (LHL) have difficulty comprehending and implementing basic tasks such as understanding medication administration. The purpose of this quasi-experimental study guided by Orem’s self-care theory was to determine the effect of using the teach-back method for discharge instructions compared to standard written instructions based on parents’ learning style and HL skills assessed during their visit to the emergency room. The Newest Vital Sign (NVS) tool was reworded to assess the parents’ HL. A …

Relationship Between Post-Resuscitation Debriefings And Perceptions Of Teamwork In Emergency Department Nurses, Kerri Lyman

Walden Dissertations and Doctoral Studies

Emergency department nurses are faced with traumatic patient events while functioning as members of multidisciplinary teams. Critical incident debriefing has been shown to benefit health care professionals and patient clinical outcomes. The purpose of this quantitative correlational study was to examine the relationship between the use of formal post-resuscitation debriefings and perceptions of teamwork in emergency department nurses. The study also addressed the type and timing of debriefing to determine whether these factors impacted perceptions of teamwork. The nurse as wounded healer theory served as the theoretical framework. Data from the Nursing Teamwork Survey were collected from 68 emergency department …

Development Of A Tele-Healthcare Clinical Practice Guideline For Diabetic Patients, Kathy J. Montgomery

Walden Dissertations and Doctoral Studies

Lack of access to healthcare in rural communities has resulted in increased morbidity and mortality rates among diabetic patients. The problem identified in this project was the lack of access to healthcare among diabetic patients living in rural southeast Ohio. Tele-healthcare is a strategy that provides healthcare remotely and has been introduced into the rural setting and offers an appropriate healthcare delivery mode for the rural community. The purpose of the project was to develop a tele-healthcare clinical practice guideline, including smart phone applications, for the management of diabetic patients. An expert panel consisting of 2 advanced practice nurses in …

Director Of Nursing Role Conflict And Ambiguity, Commitment, And Intent To Stay, Amy Elizabeth Thiesse

Walden Dissertations and Doctoral Studies

High rates of turnover and the limited tenure of directors of nursing (DONs) in long-term care creates instability in the nursing workforce and the quality of care provided. Organizations, industry, and stakeholders have made little progress to change this turnover crisis. The purpose of this quantitative study, guided by organizational role and social exchange theories, was to determine if there was a difference in levels of affective organizational commitment and intent to stay mediated by leader-member exchange in long-term care DONs with different levels of role conflict and role ambiguity. The key variables were measured with the Role Questionnaire, Leader-Member …

Destination Arrival And Discharge Unit To Improve Patient Flow, Shelia Celeste Jeter

Walden Dissertations and Doctoral Studies

The increase in patients presenting to the emergency department (ED) for primary care poses a serious safety issue in the care that can be provided. In a care area that is overcrowded, physicians, nurses, ancillary department staff, and other care team members may have a difficult time delivering care. Poorly managed flow in the ED leads to overcrowding, and patients with life-threatening illnesses are less likely to be transitioned to designated specialized areas in a safe and efficient manner. The practice-focused question was whether processes to improve the flow of patients entering the ED decreased the number of patients leaving …

A Practice Guideline For Triaging Mental Health Patients In The Emergency Setting, Florence Nguh

Walden Dissertations and Doctoral Studies

Today's emergency departments (EDs) are challenged with increasing numbers of patients with behavioral health (BH) issues and associated management problems. Patients presenting in the ED are increasingly in need of BH services due to a lack of available services in the community. The implication is that ED staff are faced with conducting a comprehensive review of their systems and processes for BH care delivery to ensure that the needs of this population are safely met. Specifically, this DNP project addressed the lack of evidence-based screening tools for the ED triage area for patients with BH issues. The purpose was to …

A Systematic Review Of Nurse Staffing Models, Elizabeth Ndidi Ubochi

Walden Dissertations and Doctoral Studies

Appropriate nurse staffing is essential to the delivery of high-quality patient care. Nursing leadership identifies nurse staffing model as an evidence-based staffing model following problems with nursing staff retention on 4 acute care units in a recently opened hospital. The linkage model guided the review of evidence on nurse staffing models and the relationship to nurse job satisfaction and nurse retention and to explore strategies that could lead to recommendations to nursing leadership. The 466 articles found were reduced to 7 articles, 2 at Level 1 (systematic review), 4 at Level VI (quantitative descriptive), and 1 at Level VII (expert …

Direct Care Staffs’ Experiences And Perceptions Of Person-Centered Care Training, Jennifer Miranda Strollo

Walden Dissertations and Doctoral Studies

Many long-term care (LTC) facilities within the United States have replaced the institutional model of care with one that accepts person-centered care (PCC) as the guiding standard of practice. Quality training ensures that direct care staff have the skills and the knowledge in the delivery of quality PCC. However, many nurses and nursing assistants have expressed the desire for further training in PCC practices to effectively deliver quality care. The purpose of this study was to explore the types and length of training and education provided based on the perceptions and experiences of direct care staff related to their implementation …

Impact Of Transitional Care Model On Readmissions Of Adults With Chronic Heart Failure, Sheila Delaine Stuckey

Walden Dissertations and Doctoral Studies

Chronic heart failure (CHF) is often associated with high morbidity, mortality, and increased health expenditures. The readmission rate of patients with CHF is approximately 30% within 30 to 60 days following discharge. This project examined the literature to identify best practices based on the use of the transitional care model (TCM) in the reduction of hospital readmissions among older patients with CHF. The review included articles that were published between 2015 and 2019, used a quantitative study methodology, were peer-reviewed, and written in English. Keywords used in the search were chronic heart failure, the transitional care model, and hospital readmissions. …

A Phenomenological Study Of Lived Experiences Of Transport Nurses Experiencing Patient Death, Joshua B. Wall

Walden Dissertations and Doctoral Studies

Experiencing a patient death can directly affect the well-being of health care professionals; however, this phenomenon and the effects of patients' deaths are not well understood in the transport setting. Transport nurses work in unique settings with complex patients and significant autonomy in determining the plan of care; therefore, the experiences of other health care professionals may not be applicable in this environment. The purpose of this qualitative study was to explore the lived experiences of transport nurses who have experienced patient death using Husserl's life-world and phenomenological philosophies as a theoretical framework. Semistructured interviews were completed with 8 transport …

Effect Of Multiple Entry Levels Into Nursing Practice And Professionalism, Ogechi Abalihi

Walden Dissertations and Doctoral Studies

Entry into professional nursing practice in the United States occurs at varied education levels including a diploma, an associate degree, and a baccalaureate degree. These multiple entry levels into practice create a situation where academic preparedness for nursing practice varies, which may influence the professional behavior of nurses and, consequently, patient care and outcomes. The purpose of this quantitative comparative study, guided by Miller's wheel of professionalism in nursing, was to determine if there is a difference in the professional behaviors of associate degree prepared registered nurses (RNs) compared to the professional behaviors of baccalaureate degree prepared RNs. The Behavior …

Bedside Nurses' Perceptions Of Pursuing An Academic Career As Nursing Faculty, Suzanne Lynne Benfield

Walden Dissertations and Doctoral Studies

There is a nursing faculty shortage at a Mid-Atlantic associate degree nursing program. In response, program administrators have hired adjunct faculty with bachelor of science in nursing degrees (BSNs), hired full-time faculty with master of science in nursing degrees in areas other than education who also are not certified nurse educators, and reduced its minimum requirement for nursing faculty clinical experience. The nursing faculty shortage combined with the resulting gaps in practice are problematic because they may (a) negatively influence the program's ability to produce degreed nurses; (b) increase faculty workload; (c) decrease the quality of student education, which may …

Improving Nurses' Knowledge Of Central Line-Associated Bloodstream Infection, Misty Cooper

Walden Dissertations and Doctoral Studies

Central line-associated bloodstream infections (CLABSI) are usually attributable to suboptimal line insertion, care, or maintenance and are associated with poor patient outcomes. Nursing plays a pivotal role in preventing CLABSI, because nurses are generally responsible for the routine care and maintenance of central lines. The purpose of this project was to determine if CLABSI nursing education and demonstration-based competency could improve nurses' knowledge on a neurology unit as compared to current practice of an annual e-learning module as the sole source of nurse education. This project was informed by Lewin's planned change theory and involved changing behaviors, attitudes, and practices …

Staff Education Intervention To Enhance Care Planning For Older Adults, Mozhgan Peiravi

Walden Dissertations and Doctoral Studies

The increased prevalence of cognitive deterioration has increased the challenges of caring for older adults. This study's project site offers a psychiatric program for older adults with customized care for complex geriatric mental health patients. Clinical assessment and care management are often overlooked in geriatric mental health patients diagnosed with behavioral and psychological symptoms of dementia (BPSD). The purpose of this project was to deliver an education program developed from the Staff Training in Assisted Living Residences-Veterans Administration, P.I.E.C.E.S model and the Castle framework to 42 nursing and allied health staff of the project site. The project question explored whether …

Educating Medical--Surgical Nurses To Improve Nursing Knowledge And Understanding Of Health Literacy, Heather Smith

Walden Dissertations and Doctoral Studies

Low health literacy levels put patients at greater risk for poorer compliance and access to care, which leads to worse patient outcomes. Nurses must understand health literacy to improve health literacy for their medical surgical patient population. It is necessary for a formal education program on this topic. The purpose of this project was to increase medical surgical nurses' awareness and knowledge of the importance of health literacy and to introduce the REALM-SF tool to assess a patient's literacy level, allowing a nurse to better individualize the education provided to the patient. Lewin's change management theory was key in the …

Decreasing Catheter-Associated Urinary Tract Infections In The Acute Care Setting, Marshanell Wright

Walden Dissertations and Doctoral Studies

The most important risk factor for developing a catheter-associated urinary tract infection (CAUTI) is the prolonged use of the urinary catheter. To address the CAUTI rate at the project site, which was higher than the national benchmark, a team of healthcare practice leaders developed an evidence-based algorithm addressing the appropriate indications for inserting or discontinuing a patient's Foley catheter. Using the plan-do-study-act model, the purpose of this quality improvement evaluation project was to evaluate the effectiveness of the evidence-based Foley algorithm for decreasing the use of Foley catheters and reducing the CAUTI rate and to explore whether using the Foley …

Development Of An Online Resource Manual And Online Protocol To Facilitate Care Coordination, Leonore Bingham

Walden Dissertations and Doctoral Studies

Persons with disabilities tend to be in poorer health compared to those without disabilities, and timely coordination of care is essential for maintaining optimal health and wellness. The problem addressed in the Care Coordination Referral Project was the lack of timely access to health care and preventive care services for clients with disabilities in the organization for which this project was developed. Using the appraisal of guidelines research and evaluation II model, the purpose of this DNP project was to analyze and synthesize the evidence-based literature to support the project and develop an online health care resource manual and protocol. …

Patient's Compliance With Diabetes Self-Management In The Primary Care Setting, Chidinma Onyegwu

Walden Dissertations and Doctoral Studies

Diabetes is a chronic disease that can be self-managed to control the disease and its adverse consequence. The purpose of this systematic literature review was to examine the barriers to patients' successful adherence to the self-management plan and to examine strategies used to improve patients' compliance with self-care behaviors. Three practice-focused questions focused on the personal characteristics or factors influencing patients' compliance with self-management, the barriers to patient compliance regarding diabetes self-management, and the effective strategies used to improve patients' compliance with diabetes self-management at primary care clinics. The literature review used the preferred reporting items for systematic reviews and …

Development Of An Interactive Game For Education Regarding Sexually Transmitted Infections, Sherri Arrington

Walden Dissertations and Doctoral Studies

Sexually transmitted infection (STI) prevalence rates are increasing in the United States and globally. Education has been found to be an important strategy for increasing STI testing and treatment rates among sexually active young adults. The goal of this project was to develop an interactive educational game suitable for young adults to decrease the social and economic burden of STIs. The health belief model informed the project. A moderated usability evaluation was conducted using the concurrent think-aloud technique. The participants (N = 5) were a purposive sample of professionals who played the interactive game and then completed Schnall, Cho, and …

Systematic Review Of Alternative Therapies To Treat Cancer Pain, Karla Michelle Bonilla Carmona

Walden Dissertations and Doctoral Studies

Cancer pain is a complex symptom that affects the quality of life of oncology patients, caregivers, and families. The limitations of pain management treatment for cancer patients can be attributed to the lack of knowledge and availability of nonpharmacological treatments. The purpose of this project was to identify and gather evidence on the effectiveness of nonpharmacological interventions in the treatment of cancer pain using the methodology of a systematic review. Watson's theory of human caring supported the project by incorporating the perception of treating the human being holistically during the illness process. The Johns Hopkins nursing evidence-based practice model provided …

Educating Nurses About Nurse Residency Program, Tammy Lea Franklin

Walden Dissertations and Doctoral Studies

Educating Nurses About a Nurse Residency Program

by

Tammy Lea Franklin

MSN, Walden University, 2012

BSN, Oklahoma City University, 2010

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

May 2019

The problem addressed in this project was the challenges related to retention of new graduate nurses. This includes Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Bachelor of Science Nurses (BSNs) on two medical/surgical units in an acute care facility. The purpose was to work with a project team to develop an education module and accompanying resources to present to …

Patient Satisfaction With Nursing Care Related To Hospital Magnet Designation, Sharon Haylett

Walden Dissertations and Doctoral Studies

Many U.S. hospitals have historically failed to recognize nursing as essential to quality of care. Given the relationship between the patients' experiences, measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), and government reimbursement, stakeholders now value the role of nurses in the care experience. Some hospitals have pursued Magnet designation, which is a rigorous and costly process, in order to promote patient satisfaction through nurse autonomy and retention. The purpose of this study was to understand whether non-Magnet hospitals received similar HCAHPS scores. Expectancy disconfirmation theory provides a framework to understand the components of patient satisfaction …

Teach-Back Process As A Best Practice In Patient Education, Laura Hoffman

Walden Dissertations and Doctoral Studies

Limited health literacy is a national problem. Nurses are in a position to address patients' limited health literacy skills using a universal precautions approach through the teach-back process. The purpose of this project was to plan a program to educate nurses on best practices in patient education. The theoretical framework informing this work was Bandura's social cognitive theory, which asserts that increases in knowledge and self-efficacy are precursors to affecting behavior change. The logic model was used to guide the project planning processes. Evidentiary sources included literature obtained online and through database searches, input from a team of experts and …

The Nurse And Certified Nursing Assistant Perception Of Person-Centered Care, Latonya Dickerson Hughes

Walden Dissertations and Doctoral Studies

Over the last decade, long-term care facilities have transitioned from institutional care models that focus on person-centered care, in which the resident is the center of the care. The purpose of this study is to explore the nurse and certified nursing assistant perception of the person-centered care services they deliver. Jean Watson's theory of human caring is the theoretical framework that guided this study. The theory focusing on the human caring experiences and person-centered care is being characterized as a caring feeling. The carative factors of Watson's theory, the fundamental concept of caring, has been associated with improved outcomes for …

Venous Thromboembolism Prevention Education For Practitioners In The Acute Care Setting, Eppie Ann Labiche

Walden Dissertations and Doctoral Studies

During the last several decades, venous thromboembolism (VTE) has been identified as a preventable health condition. The gaps in clinical practice have led to an increased incidence of VTE. The lack of using existing evidence-based VTE prevention guidelines in practice has limited the implementation of VTE risk assessment stratifications and affected the appropriateness and timeliness of addressing pharmacologic and mechanical prophylaxis. The purpose of the scholarly project was to educate practitioners on existing VTE prevention practice guidelines. The practice-focused question explored whether an educational learning activity on evidence-based VTE prevention guidelines improved the awareness, knowledge, and compliance with existing evidence-based …