Nursing Commons^™

Quality Improvement On The Long-Term Care Ventilator Unit: Interventions To Increase Patient Safety And Prevent Patient Harm, Billie Anderson, Joanne Samuels

DNP Scholarly Projects

BACKGROUND: Tracheostomy patients are susceptible to life-threatening emergencies when their airways are compromised. Epidemiologic data suggests that 3.2% to 30% of tracheostomy patents have a complication. The long-term care ventilator unit (LTCVU) is a 25-bed unit in a nursing home. It has noted that 40% of patients have a complication. A group of hospitals demonstrated a 90% reduction in complications through five interventions.

METHODS: The Johns Hopkins Nursing Evidence-Based Practice model was utilized to take the Global Tracheostomy Collaborative interventions and apply them to the LTCVU with the aim of reducing the number of airway complications on the unit by …

Implementation Of Safe Patient Toileting To Decrease Patient Falls On Medical-Surgical Unit, Kimberly A. Goldsborough

DNP Scholarly Projects

BACKGROUND: Patient falls are a serious safety concern in the hospital setting throughout the country. Falls are one of the most challenging patient safety events to prevent, as there are many contributing factors with toileting activities producing the highest incidence. Fall prevention bundles are used to minimize and reduce these such events although multifaceted. The project was conducted with an academic medical center on an acute inpatient medical-surgical unit primarily housing burn wound patients. Nursing leaders and front-line nursing staff participated.

METHODS: Literature review to determine the gap in knowledge of interventions to prevent acute inpatient falls was completed. Concepts …

Evaluation Of Shared Governance Implementation At A Community Hospital, Teresa Nardontonia

Walden Dissertations and Doctoral Studies

Shared governance is a model in which staff collaborate through a decentralized decision-making structure, sharing ownership and accountability and partnering to make decisions about clinical practice, professional development, patient experience, quality improvement, and research. The hospital shared governance project team aligned its shared governance model with the American Nurses Credentialing Center Pathway to Excellence standards. The purposes of this project were to do a process evaluation of shared governance implementation at one 64-bed community hospital in central Florida and make recommendations for continuous quality improvement. The project followed the plan-do-study-act methodology developed by Deming. Through the collection of meeting minutes …

Improving Compassion Fatigue And Vicarious Trauma Knowledge For Psychiatric Nurses, Natalie P. Rebelo

Walden Dissertations and Doctoral Studies

Nurses are exposed to traumatic patients and high stress regularly; this repeated exposure can increase rates of compassion fatigue and vicarious trauma. When nurses are not properly educated about compassion fatigue and vicarious trauma, it can impact their ability to provide effective patient care and result in harmful effects including insecurity, altered cognitive functioning, loss of empathy and diminished self-esteem. This project focused on educating psychiatric nurses regarding compassion fatigue and vicarious trauma. The theory guiding the project was the Neuman's system model. Fifty-six psychiatric nurses were administered a pretest consisting of 10 multiple choice test questions. They were educated …

Quality Improvement Initiative To Improve Patient Attendance In Diabetes Self-Management Education Classes, Charon Denise Randel

Walden Dissertations and Doctoral Studies

Diabetes self-management education (DSME) is a key resource in the battle against diabetes and its secondary effects. This quality improvement project was conducted to address the decreased attendance rates of DSME classes in a community health center in the southern United States. The practice question for this project explored process-related strategies to increase patient attendance in DSME classes. Based on review of patient reports of reasons for nonattendance and an evaluation of peer reviewed literature on improving attendance in DSME, the following strategies were implemented: (a) alternative solutions such as providing patients with the dates for a year of initial …

An Education Program For Improving Knowledge Of Experienced And Aspiring Mentors, Joy-Marie Quiambao Calunsag

Walden Dissertations and Doctoral Studies

Using a staff development approach, this doctor of nursing practice project addressed the preparation of nurses who serve in the role of mentors. Developed and carried out in an American Nurses Credentialing Center Magnet-designated hospital, the primary aim of the project was to develop and implement a staff education program for mentors focusing on best-practice strategies for mentoring new nurses. The secondary purpose was to conduct a literature review on evidence-based practice strategies for mentoring new nurses. This project was guided by Knowles' adult learning theory and Benner's novice to expert model. A 2-hour education program was attended by 16 …

Development Of A Standardized Oral Care Staff Education Program, Katrina Detoye

Walden Dissertations and Doctoral Studies

Hospital-acquired infections such as nonventilated hospital-acquired pneumonia (NV-HAP) are significant patient safety concerns. The lack of oral care in the nonventilated acute care patient population is a major contributor to NV-HAP. Nursing staff are on the frontline in the provision of oral care to hospitalized patients, but a lack of knowledge regarding the relationship between oral care and NV-HAP was identified as a gap in practice at the project site. The purpose of the project was to develop a staff education program on oral care of the nonventilated patient population. The practice-focused question addressed whether an evidence-based education for nurses …

Nurse Practitioner Attitudes, Perceptions And Knowledge About Antimicrobial Stewardship, Evelyn C. Fabian

Walden Dissertations and Doctoral Studies

Resistance to antibiotics has increased dramatically in the United States, with serious associated medical, social, and economic consequences. The purpose of this project was to assess nurse practitioners' attitudes, perceptions, and knowledge about antimicrobial stewardship and knowledge in the management of anaerobic infections as well as resistant gram-negative bacteremia. Data were collected using a web-based survey in a hospital facility. The practice question explored whether nurse practitioners' attitudes, perceptions, and knowledge about antimicrobial stewardship significantly increased after an education program on antimicrobial stewardship. The project was framed by Knowles's adult learning theory. A 16-item survey was administered before and after …

Doctor Of Nursing Practice Roles In Academia, Jodi Renee Raisor

Walden Dissertations and Doctoral Studies

Over 15,000 master’s and doctoral degree students in the United States were denied admission to nursing schools in 2014 because of insufficient nursing faculty. In 2016, over 64,000 undergraduate and graduate students were unable to gain admission to nursing school due to the effects of faculty shortages. This project explored the role of the Doctor of Nursing Practice (DNP)-prepared nurse in academic settings using a systematic review of the literature to determine the role of DNP-prepared nurses in academia. Souza’s systematic review model and Melnyk’s levels of evidence were used to guide the search, review, and the selection of scholarly …

Reducing Patient Falls And Decreasing Patient Safety Attendant Utilization With Careview Communication Technology, Maura Marisela Stanford

Walden Dissertations and Doctoral Studies

Attention to quality outcomes, cost reduction, value-based purchasing, and improved initiatives for hospital-acquired conditions (HACs), as well as labor utilization savings, provide a foundation for hospitals to achieve safety and quality outcomes. Falls resulting in fractures, joint dislocation, or other physical injuries are considered HACs and can produce unexpected consequences such as an increase in costs related to an increased length of stay. The CareView Communications system, a fall prevention management program that uses video surveillance technology, offers a strategy to prevent patient falls by customizing patient rounding, conducting fall risk assessments, and generating reports. Guided by Donabedian's framework, this …

Implementation Of A Trauma-€Informed Care Program For The Reduction Of Crisis Interventions, Renae Denise Hale

Walden Dissertations and Doctoral Studies

Childhood trauma is the primary reason children and adolescents display behavioral issues that require hospitalization. Implementation of a trauma-€informed care (TIC) program was the intervention chosen at a child and adolescent behavioral health hospital to decrease physical holds and seclusion rates for patients aged 3 to 17 and to reduce the risk of retraumatization of children needing psychiatric care. Six core strategies from the National Association of Mental Health Program Directors was the framework for this project. The number of crisis interventions before and after implementation were 440 and 259, respectively. The number of seclusions before implementation was 215, and …

Strategies For Patient Engagement In A Self-Management Program For Adults With Diabetes, Carolinee Jokotola Ogungbayi

Walden Dissertations and Doctoral Studies

Patients' lack of adherence to diabetes self-management education and support (DSMES) recommendations is a challenge for healthcare. One approach to addressing patient noncompliance with DSMES is through education of staff on current guidelines. In an outpatient facility in South Texas, staff training on current DSMES guidelines was recommended as one of the solutions to the problem of Type 2 diabetes mellitus (T2DM) complications observed among clinic patients. An educational module was created to increase staff knowledge on T2DM and to assist staff members in teaching patients to self-manage T2DM. The module was built on the self-management and health promotion models, …

Nurses' Lived Experiences Of Comfort Care Among Residents At The End Of Life, Ezekiel Olufemi Osundina

Walden Dissertations and Doctoral Studies

Nurses provide comfort care for individuals who are at the end of life and reside in the long-€term care environment. However, how nurses provide comfort care to those who are dying and nurses' perceptions about providing comfort care are not known. The purpose of this phenomenological study, guided by Kolcaba's theory of comfort, was to examine nurses' lived experiences of comfort care among residents at the end of life in long-term care facilities. The research questions were designed to elicit rich data about the lived experiences of nurses in providing comfort care to dying residents to find out factors that …

Telehealth And Type 2 Diabetes Management, Blessing Nneoma Ikpeama

Walden Dissertations and Doctoral Studies

The use of telehealth in healthcare has grown in recent years; however, little is known about the effectiveness of this delivery method in the management of Type 2 diabetes mellitus (T2DM). Guided by the chronic care model and telehealth in chronic disease model, the purpose of this systematic literature review was to explore evidence related to lowering hemoglobin A1c levels and managing T2DM using telehealth in the outpatient setting. The practice-focused questions explored telehealth interventions used in T2DM management and their effectiveness. The Joanna Briggs Institute (JBI) method for conducting systematic literature reviews was the process, and data were compiled …

Nurse Faculty Perceptions Of Role Stress And Faculty-To-Faculty Incivility, Anne Kraft Kleinhesselink

Walden Dissertations and Doctoral Studies

The purpose of this study was to determine the relationship between nurse faculty perceptions of role stress and faculty-to-faculty incivility using the stressor-emotion model of counterproductive work behaviors. A convenience sample of 79 nurse faculty from 39 undergraduate nursing programs in Iowa responded to an online survey. The survey consisted of two instruments: Workplace Incivility Civility Scale and Role Strain Scale. Findings revealed 76 participants perceived incivility as a problem and identified stress (n = 64) and demanding workloads (n = 54) as contributing factors. Pearson correlation results revealed a positive relationship between experienced incivility and nurse faculty perceptions of …

Faculty Incivility And Academic Nurse Administrator Job Satisfaction, Kimberly S. Lindquist

Walden Dissertations and Doctoral Studies

Academic nurse leaders hold an essential role in preparing future nurses who have the skills and abilities to meet complex healthcare system. However, vacancies in academic leadership positions are on the rise and may be connected to faculty incivility which affects job satisfaction of academic nurse leaders. The purpose of this descriptive correlational study, guided by Herzberg'€™s two-factor theory, was to explore the relationships between perceptions of and experiences with faculty incivility and job satisfaction in a population of academic nurse leaders. Leader perceptions of and experiences with faculty incivility were measured using the Workplace Civility/Incivility Survey and leader job …

Fostering Self-Care And Nurse Resilience, Cheryl Jean Mcnamara

Walden Dissertations and Doctoral Studies

Role expectations and stressful work environments place nurses at high risk for burnout. Nurses at an urban hospital were experiencing unhealthy work environments and not engaging in self-care to promote health and wellbeing. The purpose of this project was to evaluate the effectiveness of an existing quality improvement (QI) initiative developed to encourage nurses to engage in self-care. Pender'€™s health promotion model supported the premise that despite barriers, nurses will engage in self-care. A survey elicited responses from 1,248 participating registered nurses on the extent of their engagement with self-care and perceived effect on their health, health knowledge, stress level, …

Decreasing Hospital Admission Rates In Long-Term Care, Melanie R. Meissner

Walden Dissertations and Doctoral Studies

Each year, hospitalizations from long-term care (LTC) settings occur, in part, due to underdeveloped nursing assessment skills, ineffective communication with primary care providers (PCPs), and delayed intervention. Through staff development nursing education, the quality and timeliness of care can be improved. The practice question that guided this doctoral project focused on whether evidence-based research information would assist in decreasing LTC-to-hospital admission rates through improved nursing assessment skills and better communication with PCPs. Using the logic model, the effectiveness of a program was evaluated and the impact of interventions on a predicted outcome was determined. Sources of evidence included obtaining best …

Addressing Bullying Behavior In Pediatric Patients Using A Clinical Practice Guideline, Barnitta Latricia Moses

Walden Dissertations and Doctoral Studies

Childhood bullying can lead to adverse physical and mental health outcomes for both the victim and the bully. Risk factors for bullying can be related to gender, race, sexual preference, and having any type of disability. A pediatric primary care clinic in a large, metropolitan area, the focus for this project, did not have an evidenced-based clinical practice guideline (CPG) for providers to facilitate the management of children who presented with reported bullying. The project, guided by the Tanner'€™s integrated model of clinical judgement, addressed the question whether a CPG would facilitate the early recognition and treatment of bullying in …

Developing An Educational Program For Tracheostomy Care, Joy Onuoha

Walden Dissertations and Doctoral Studies

Medical-surgical nurses at the project site demonstrated a knowledge deficit regarding the care of adult patients with a tracheostomy. Such knowledge deficits could expose patients to higher risks for infection, bedsores, prolonged hospital stays, increased costs, increased caregiver burden, and death. The purpose of this project was to develop an educational program to improve nurses'€™ knowledge and confidence in the provision of evidence-based tracheostomy care to answer the question if the content of an evidence-based educational program developed to improve nurses'€™ knowledge and confidence in managing adult patients with tracheostomy on a medical-surgical floor would meet the expectations of a …

Noise Pollution/Reduction Education For Frontline Staff In The Acute Care Setting, Lopa Patel

Walden Dissertations and Doctoral Studies

Noise levels in hospital settings have risen beyond the recommended range of 35-40 decibels, resulting in poor patient healing outcomes and other health conditions ranging from sleep deprivation, anxiety, agitation, delirium, depression, and high heart rate and blood pressure. These negative patient health experiences are evidenced by poor scores for the Hospital Consumer Assessment of Healthcare Providers and Systems, which are indicators of patients' perceptions of care. This project explored whether an educational activity for 48 direct care staff, who include registered nurses and nursing assistants, in a cardiac unit on the impact of noise pollution on patient healing would …

Lived Experience Of Tongans With Obesity And Diabetes, Gladys Adjei-Poku

Walden Dissertations and Doctoral Studies

People of Pacific Island descent are afflicted by obesity and diabetes more than other populations. Although interventions have succeeded in reducing these conditions among other groups, they have been unsuccessful among Tongans and other Pacific Islanders. Furthermore, little is known about the cultural perspectives of this population with a high rate of obesity and diabetes. Accordingly, this descriptive phenomenological study was conducted to investigate the lived experiences of Tongans with obesity and diabetes in a western metropolitan area of the United States to understand their predisposition toward these conditions and suggest appropriate interventions. Purposive sampling was used to recruit 11 …

Reducing Door-To-Provider Times By Using Nurse Practitioners In Triage, Megan Lynnell Anderson

Walden Dissertations and Doctoral Studies

Increased patient wait times it the emergency department (ED) have been linked to poor patient outcomes and adverse health care events. The purpose of this quality improvement project was to determine if placing a nurse practitioner (NP) in the triage area would reduce door-to-provider times and improve patient throughput within the ED. The primary question for this quality improvement project was whether the use of NPs in the triage area would improve patient throughput and decrease wait times in the ED. A secondary question identified was if implementing an NP in the triage area would decrease patient length of stay …

Primary Care And Behavioral Health Services In A Federally Qualified Health Center, Svetoslav A. Arsov

Walden Dissertations and Doctoral Studies

Between 2013 and 2016, 8.1% of U.S. adults 20 years and older suffered from depression, but only 29% of them sought help. This project addressed the low depression screening rate in a Federally Qualified Health Center (FQHC) that supported integrated care. The purpose of the project was to evaluate the integration of behavioral health into primary care in an FQHC through the rate of depression screenings. Two theoretical frameworks, the find-organize-clarify-understand-select/plan-do-study-act model and the Centers for Disease Control and Prevention's framework for program evaluation in public health were combined into a list of questions and data validity tests that were …

Strategies For Nursing Staff Working In A Correctional Facility., Ima James

Walden Dissertations and Doctoral Studies

As primary care providers in correctional facilities, correctional nurses are expected to balance inmates' healthcare needs with the security demands of the facility. This project explored whether an evidence-based education program could provide strategies for promoting health, a healthy work environment, and a sense of well-being to improve the knowledge, coping skills, and well-being of nurses working in a correctional occupational setting. Twenty nurses participated in an educational intervention project that was guided by the transactional theory of stress. Using a pretest/posttest design, data were collected over a 2-week period and calculated using means and percentages. The descriptive statistics using …

Effectiveness Of Physiological Alarm Management Strategies To Prevent Alarm Fatigue, Amy Clemens

Walden Dissertations and Doctoral Studies

There is limited clinical research on the effectiveness of alarm management strategies and nursing behaviors related to alarms in clinical settings. As many as 76% of physiological monitor alarms are overlooked as clinically insignificant by nursing staff. Excessive alarms may impact patient outcomes and cause cognitive overload for nurses that can result in medical errors and missed patient resuscitations. The purpose of this systematic review was to rate alarm management studies on level of evidence for interventions, nursing responses to alarms, and impact on alarm fatigue behavior. The nursing role effectiveness model guided this project. Twenty-seven studies were reviewed to …

Building A Compassion Fatigue Toolkit, Stephanie C. Correa

Walden Dissertations and Doctoral Studies

Compassion is an important tenet of nursing care delivery. When compassion is compromised, such as with compassion fatigue (CF), not only is patient care compromised, but also caregivers can be physically and psychologically affected, resulting in stress and burnout. The purpose of this project was to create a web-based educational toolkit focused on prevention of CF, establish the content validity of the elements in this toolkit, and make recommendations regarding its implementation and sustainability. Watson's theory of human caring guided this project. Ten experts with at least 10 years of experience and CF knowledge, a bachelor's degree in nursing, and …

Reducing 30-Day Readmissions For Patients With Stroke, Faith Omomen Ighile

Walden Dissertations and Doctoral Studies

In a stroke-certified 500-bed acute care hospital, the 30-day readmission rates for patients discharged to rehabilitation centers or skilled nursing facilities were higher than the rates for patients discharged to home. A review of data by the stroke team showed 44 patients readmitted within 30 days of initial stroke discharge between October 2016 and January 2017. The rate of re-admission for those discharged home was 41% (18 patients), whereas the rate for those discharged to acute inpatient rehabilitation, long-term acute care, or skilled nursing facilities was 59% (26 patients). The practice-focused question for this project assessed whether using a re-admission …

Evidenced-Based Staff Education Program For Novice Perioperative Nurses, Marjorie Jasinski

Walden Dissertations and Doctoral Studies

Knowledge of surgical procedures, instruments, and supplies is essential to the perioperative nurse working in the operating room (OR). Nursing school curricula do not specifically educate surgical nurses; therefore, it is difficult to fill open OR positions with experienced perioperative nurses. The purpose of this doctoral project was to develop a perioperative educational program for RNs newly hired in the OR. The practice-focused question asked whether an evidence-based staff education program for the novice perioperative nurse would increase the nurse's knowledge of OR procedures and protocols for patient management. The novice-to-expert framework was used to explore how adult learners acquire …

Acuity-Based Nurse Staffing And The Impact On Patient Outcomes, Sara Kollman

Walden Dissertations and Doctoral Studies

The costs of healthcare in the United States are of national concern. The systematic review of the literature (SRL) explored the practice-focused nursing question regarding the relationship between the use of acuity-based staffing (ABS) models and positive patient outcomes. Analyzing the impact of ABS models on patient quality outcomes and the potential economic value could provide evidence essential for the healthcare executives responsible for fiscally prudent labor management and for creating an evidence-based business case for adequate, patient-centric nurse staffing. The synergy model for patient care and Covell's nursing intellectual capital theory guided the doctoral project. The Preferred Reporting Items …