Nursing Commons^™

Improving Perioperative Communication Through The Use Of A Nurse Navigator: An Integrative Review, Elizabeth Irene Christman

Doctoral Dissertations and Projects

Patient-centered communication practices are critical for ensuring that patients have optimal care experiences and clinical outcomes. Unfortunately, today’s health care environment often presents numerous barriers to consistent and clear information exchange. These barriers are magnified in dynamic and fast-paced care environments such as the perioperative setting, where numerous interactions and communication exchanges must occur. The purpose of this integrative review is to examine the value of the nurse navigator role within the perioperative setting and evaluate whether it can improve patient and family satisfaction with communication and the care experience. The review includes the identification and appraisal of relevant literature …

Using Patient Safety Principles To Prevent Patient Harm, Octavia Reed Wynn

Doctoral Dissertations and Projects

While healthcare is intended to promote and restore optimal health and quality of life, it has been realized that patients often experience unintended harm while consuming healthcare services. In a project conducted in a 12-bed intensive care unit, nurses completed a pre-survey to identify a baseline understanding of patient safety principles. They then completed online educational modules designed to teach patient safety principles including patient and family centered healthcare, systems safety, and culture of safety. Following the educational intervention, a postsurvey to assess for increased understanding was administered. Forty-seven nurses completed the presurvey and education showing improved understanding of patient …

Improving Central Venous Catheter Infection Rates Through The Use Of A Bundle: An Integrative Review, Janice Laverne Harris-Hall

Doctoral Dissertations and Projects

The role of Central Venous Catheters (CVC) is significant for the End-Stage Renal Disease (ESRD) population. The placement of the CVC for a HD (HD) patient is not only necessary, but life-sustaining. CVCs are usually placed for an emergent HD treatment, while awaiting a permanently placed arteriovenous fistula or graft (AVF/AVG), or when the permanent access becomes non-functioning. There are multiple risk factors related to having a CVC placed, the most predominant complication being catheter line-associated bloodstream infections (CLABSIs). Studies have shown that implementing a CVC prevention bundle was associated with a significant reduction in the CLABSI rates within the …

Using Screening, Brief Intervention, Referral To Treatment To Address Problematic Alcohol Use At A University Student Health Center, Tajuane H. Dockery

Doctoral Dissertations and Projects

Problematic drinking is a public health concern on college campuses. College students who do not have their risky drinking behaviors addressed are at greater risk for developing Alcohol Use Disorder (AUD). Despite known risks associated with drinking on college campuses, many college health centers miss an opportunity to address these behaviors because they lack a systematic process for identifying students at risk and referring them for treatment. This evidence-based project evaluated the effectiveness of using Screening, Brief Intervention, Referral to Treatment (SBIRT) to identify students with risky drinking behaviors and the impact the screening process had on facilitating a referral …

Pharmacogenomics In Primary Care: Barriers To Implementation, Joshua Michael Fleming

Doctoral Dissertations and Projects

As technology and research evolve it is essential that practitioners in healthcare remain aware and cognizant of the changes that are going on around them and how these advancements may aid them in providing the best care to the patients that seek care from them. The largest breakthrough in the field of genetics has been the complete sequencing of the human genome. This landmark has paved the way for innumerable insights into every part of how care is delivered and stands to change the landscape of medicine entirely. Pharmacogenomics testing exists as a subset of genetic testing, and pertains to …

A Case Study Of Factors That Influence The Implementation Of Full Spectrum Contraceptive Care In A University Student Health Center, Cecile Dahlquist

Electronic Theses, Projects, and Dissertations

Large, prospective cohort studies such as The Contraceptive Choice Project have been conducted regarding safety, efficacy, satisfaction, and usage of Long-Acting Reversible Contraception (LARC) such as the Contraceptive Implant (Nexplanon) and Intrauterine Contraception (Winner, Peipert, Zhao, Buckel, Madden, Allsworth & Secura (2012). Despite these findings, access and financial barriers remain for many women, and less than 7 percent of women utilize the most effective methods of contraception in the United States (Winner et al., 2012). Barriers to effective LARC methods exist at a higher rate with our young, poor, and non-white marginalized populations (Finer & Zolna, 2016).

Unplanned pregnancies have …

Improving Latent Tuberculosis Infection (Ltbi) Screening And Treatment In A School-Based Setting, Andrea Bell

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: San Diego County’s tuberculosis (TB) incidence rate is nearly double than the national rate. In 2019, there have been 5 cases of active TB in the county’s public high schools, which have demonstrated the need for prevention interventions in this setting.

Objectives: This evidence-based project is aimed to increase awareness, screening and treatment of latent TB infection (LTBI) in the school setting.

Methods: A TB risk assessment form and consent was sent in the registration packets. A one-time TB educational presentation was given to high school freshman students with a pretest and posttest. For students at-risk, a confidential …

Effects Of Standardized Self-Care Behavior Education On Self-Efficacy Outcomes In Type Ii Diabetes Mellitus, Nishita Patolia Bsn, Rn, Dnp Student

Doctor of Nursing Practice Final Manuscripts

An evidence-based practice (EBP) project was implemented in a primary care setting to decrease Hemoglobin A1c (HgbA1c) levels and increase self-efficacy in Type II Diabetes Mellitus (T2DM) diagnosed individuals. According to the Centers for Disease Control (CDC), 30.3 million adults have diabetes in the United States, and one in four do not know they have it (CDC, 2017). It is a disease that can be managed and reversed with standardized self-management education. Self-management interventions can improve diabetes knowledge and encourage patient participation in caring for their health (Flode, Iversen, Aarflot, & Haltbakk, 2017).

The purpose of this evidence-based project was …

Utilization Of Evidence-Based Telehealth For Routine Follow-Up Visits In Outpatient Palliative Care, Nienke Sahelijo Bsn, Rn, Dnp-Fnp Student, Kori Fitzgerald Dnp, Fnp-C, Joseph F. Burkard Dncs, Crna

Doctor of Nursing Practice Final Manuscripts

Objectives: Palliative care services constitute a vital part of the oncology treatment plan. Much of the suffering associated directly with cancer itself or as a result of treatments can be mitigated with the early incorporation of palliative services. Unfortunately, access to palliative care remains elusive due to a lack of qualified providers. This evidence-based project was implemented in an effort to address gaps in care for advanced cancer patients. The goal was to provide telehealth visits for follow-up of stable patients to manage symptoms and psychosocial challenges with equivalent or improved satisfaction as compared to their last in-office visit …

Enhancing Chronic Pain Management: Motivational Interview Among Lower Back Patients –Phase Ii, Valerie Gates, Melissa Hines-Antico

Doctor of Nursing Practice Final Manuscripts

Purpose: Chronic low back pain in adults is difficult to manage and can lead to clinical, psychological, and social consequences. Providers often have restricted clinic time that prevents patient education regarding self-care and non-pharmacological therapies.

Design: This nurse practitioner-led, evidence-based project incorporates monthly telephone calls to improve patient pain, enhance quality of life, decrease opioid usage, increase physical activity, and promote the utilization of non-pharmacological multimodal therapies.

Methods: Implementing a monthly telephone call utilizing motivational interviewing and a 5 A’s guided questionnaire assisted in providing individualized treatment plans. Data outcomes include pain scores, quality of life scores, number of opioid …

Insulin Injection Re-Education For Improved Glycemic Control, Daniela Shon

Doctor of Nursing Practice Final Manuscripts

Title: Insulin Injection Re-education for Improved Glycemic Control

Background: Patients on insulin therapy often continue to show suboptimal glycemic control. Data from adult patients with T2DM have demonstrated that 56.1% had poor control, despite adherence to treatment, oral and injectable. Poor glycemic control stems from many sources, including poor self-efficacy regarding insulin dosage adjustment, inaccurate insulin dosing, expired insulin, lipohypertrophy of the injection site and technique, and equipment issues.

Purpose: This project aimed to implement and assess the efficacy of re-education in the insulin injection technique for improved glycemic control.

Methods: This project was conducted based on …

Nurse Practitioner Occupational Burnout: A Focus On The Variables And Themes, Tanya G. Schlemmer

Nursing Faculty Publications and Presentations

Purpose: The prevalence of occupational burnout is high amongst service professionals and the nursing profession is no different. The rate of occupational burnout amongst nursing professionals and medical professionals is high. The themes or impact of occupational burnout amongst Nurse Practitioners is not well described in the literature. Herein this article describes the investigation into the issue of nurse practitioners and occupational burnout.

Data Sources: Scientific literature review, CINHAHL Complete and other online literature databases and resources. A State of the Science systematic review was conducted to further examine this issue to identify the prevalence of the problem amongst nurse …

Nursing And Provider Safety Checklist For Covid-19 Patients, Michele Decastro, Msn, Crnp, Jennifer Zak, Bs, Rn, Pccn, Andrew Thum, Msn, Ml, Rn-Cc, Ccctm, Kristine Meagher, Rn, Msn, Acns-Bc

Health Equity and Quality Improvement (HEQI) Summit

What's the Problem?

As increasing numbers of Covid-19 patients were admitted to the hospital, multiple Med-Surg and Telemetry units were needed to provide care. All healthcare providers noted difficulty in communicating patient plans of care across multiple units and multiple teams. Providers, Clinical Nurses, and Nursing leadership all noted differences in processes for care and communication among units and teams.

Monitoring Patient And Caregiver Adherence To Treatment In Management Of Vascular Ulcers, Angela N. Ikeri

Theses and Graduate Projects

Chronic diseases have increased the incidence of vascular ulcer development. These ulcers require long-term wound management and other interventions from different health care specialists to achieve healing and decrease further complications. Following acute hospital and clinic vascular ulcer care interventions, patients are discharged home or to other facilities in the communities with vascular ulcer care instructions. Often, these patients come back to the vascular clinic or get readmitted into the hospital with deterioration of their wounds. This project used questionnaires to determine what barriers vascular ulcer patients and their caregivers have in the management of these wounds in the community. …

Increasing Autism Awareness In The Somali Community, Safiya Ahmed

Theses and Graduate Projects

Autism spectrum disorder has become more prevalent in recent years, especially in the Somali community in Minneapolis. Early detection, diagnosis and interventions are essential for children with this disorder. A recent study on the prevalence of autism spectrum disorder in Minneapolis, Minnesota reported that Somali children not only have the highest prevalence of this disorder among all races and ethnicity but also receive late diagnosis and interventions. A comprehensive literature review identified lack of awareness, cultural stigma, and difficulty to access services as barriers for early diagnosis and interventions for Somali children. The literature also supported the importance of early …

The Relationship Of Span Of Control To Nurse Manager Satisfaction, Jeffrey Batcher

Master of Science in Nursing Final Projects

Purpose: The purpose of this study was to examine the relationship between span of control (SOC) and nurse manager job satisfaction for nurse managers working in a hospital system. The study may help administrators identify how wide and narrow SOC correlates to the overall job satisfaction of nurse managers.

Design: A non-experimental descriptive correlational study design was used.

Methods: Data were collected from a convenience sample of nurse managers working within an eleven-hospital healthcare system. Survey Monkey was used for data collection and included a demographic questionnaire, The Ottawa Hospital Model of Nursing Clinical Practice (TOH MoNCP) Clinical Management Span …

Predictors Of Nonadherence To Radiation Therapy Schedules Among Head And Neck Cancer Patients, Jennifer Lynn Miller

USF Tampa Graduate Theses and Dissertations

Nonadherence to radiation therapy schedules is a documented problem among head and neck cancer patients. This retrospective dissertation study examined whether demographics, clinical characteristics, or physical and psychological symptoms were related to nonadherence in head and neck cancer patients. The electronic medical records of 262 head and neck cancer patients at a southeastern U.S. cancer center were reviewed to determine whether nonadherence was related to symptom scores and other patient and clinical-related factors. Nonadherent patients were more likely to be female, be admitted to the cancer center as inpatients during treatment and receive outpatient IV fluids during treatment. Nonadherent patients …

Individual Characteristics And Shared Decision Making For Stroke Prevention In Atrial Fibrillation, Patricia Nadraus

Theses & Dissertations

With the advent of patient-centered care, individuals with Afib are asked to participate in the shared decision-making (SDM) process. Choosing therapies in thromboembolic risk reduction is complex, involves trade-offs along with considering risks and benefits of therapeutics. Afib affects between 2.7 million and 6.1 million American adults (January et al., 2014), and with the growing elderly population that number is expected to double by 2030 (Colilla et al., 2013). In 2016 Medicare required a SDM process for individuals considering left atrial appendage for stroke prevention. There have been no studies reported examining individual characteristics and participating in SDM in individuals …

Longitudinal Evaluation Of The Effects Of Illness Perceptions And Beliefs About Cardiac Rehabilitation On Quality Of Life Of Patients With Coronary Artery Disease And Their Caregivers, Patricia Thomson, Neil J. Angus, Federico Andreis, Gordon F. Rushworth, Andrea R. Mohan, Misook L. Chung, Stephen J. Leslie

Nursing Faculty Publications

Background

Patients’ negative illness perceptions and beliefs about cardiac rehabilitation (CR) can influence uptake and adherence to CR. Little is known about the interpartner influence of these antecedent variables on quality of life of patients with coronary artery disease (CAD) and their family caregivers. The aims of the study were: 1) to assess differences in illness perceptions, beliefs about CR and quality of life between patients with CAD and their family caregivers upon entry to a CR programme and at 6 months follow-up; and 2) to examine whether patients’ and caregivers’ perceptions of the patient’s illness and beliefs about CR …

The Significance Of Bridging The Health Literacy Gap, Ella Bermudez

DNP Qualifying Manuscripts

Objective: In the veteran population, almost one in every five patients has inadequate or marginal health literacy (Haun, Patel, French, Campbell, & Lapcevic, 2015). Having low health literacy predisposes patients to high emergency room (ER) utilization and hospital readmission (Mitchell, Sadikova, Jack, & Paasche-Orlow, 2012) and low treatment adherence (Miller, 2016). This manuscript aims to review the literature about health literacy and to encourage effective, standardized health education delivery to increase health literacy.

Method: An integrated review of the literature from Cochrane, Joanna Briggs Institute (JBI), Scopus, CINAHL, and PubMed databases showed the importance of bridging the health literacy gap. …

Situations Éthiques Vécues Par Des Infirmières En Lien Avec La Santé Et La Sécurité Au Travail, Chantal Caux, France Dupuis, Kathleen Lechasseur, Laurence Fortin-Pellerin, Jocelin Lecomte

Rapports de recherche scientifique

L’éthique de la santé fait partie intégrante de la pratique infirmière. L’éthique définit des principes, tels la bienfaisance ou le respect de l’autonomie, qui viennent baliser cette pratique. Ainsi, l’éthique est imbriquée dans toutes les interventions des infirmières et infirmiers (ci-après les infirmières). Il n’est pas rare toutefois que les infirmières vivent des expériences qui sont problématiques d’un point de vue éthique. On parlera souvent dans la littérature de dilemmes éthiques. Ces dilemmes peuvent avoir un impact négatif sur la santé de ces dernières. En effet, en raison de la détresse générée par ces dilemmes, les infirmières peuvent ressentir des …

Veteran Specific Risk Factors For Delirium, Allison Perkins

Dissertations

Purpose/Aims: This study explored the relationships between military characteristics such as combat experience, mental health issues such as post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), depression, anxiety and substance use disorder (SUD), physical comorbidities such as coronary artery disease (CAD), other risk factors, and delirium diagnosis among hospitalized veterans.

Background: Delirium is a common disorder experienced by 25% of all hospitalized adults 65 years and older. No published studies to date have examined whether combat, TBI and PTSD are associated with the incidence of delirium in the hospitalized veteran.

Methods: A retrospective cross-sectional cohort design with a sample size …

Combined Effects Of Gender Affirmation And Economic Hardship On Vulnerability To Hiv: A Qualitative Analysis Among U.S. Adult Transgender Women., Larissa Jennings Mayo-Wilson, Eric G. Benotsch, Sheila R. Grigsby, Sarah Wagner, Fatmata Timbo, Tonia Poteat, Lauretta Cathers, Ashlee N. Sawyer, Shelby A. Smout, Rick S. Zimmerman

School of Nursing Faculty Publications

Background: Transgender women ("trans women"), particularly African-American and Latina trans women, have disproportionately high prevalence of HIV in the United States (U.S.). In order to decrease gender dysphoria and overcome discrimination, trans women affirm their gender through social and medical transition, often in contexts of economic hardship and sexual risk. This study qualitatively examined how gender-affirming behaviors enhance or diminish vulnerability to HIV in light of structural and economic barriers to gender transition.Methods: We conducted individual interviews with 19 adult trans women in two U.S. cities (Richmond, VA and St. Louis, MO) who reported one or more sexual risk behaviors …

Unplugging: An Evidence-Based Project To Reduce Screen Time And Improve Healthy Media Use In The Adolescent Population, Erica Persichetti

Doctor of Nursing Practice Final Manuscripts

Abstract

Background:Excessive media use is an emerging health concern amongst the pediatric population. The American Academy of Pediatrics (AAP) recommends less than 2 hours per day of recreational screen time, yet the national average is between 7 to 9 hours per day for adolescents. A media-saturated lifestyle has consequences on a child’s mental, physical, and emotional health. Despite guidelines stating media use should be assessed at annual well-visits, only 16% of providers are following this recommendation. This gap in care leaves many families with a limited understanding of the impact of media on their child's health and represents a …

Mental Health Screening For Low Income Adolescents: An Evidence-Based Project, Allison Bryden

Doctor of Nursing Practice Final Manuscripts

Abstract

TITLE: Mental Health Screening For Low-Income Adolescents

BACKGROUND: Nearly 80% of adolescents in the United States will suffer from a mental illness and not receive evaluation or services. Children from low socio-economic backgrounds have an increased risk of mental health disorders which permeate into adulthood, leading to additional negative sequel and lower quality of life. Among adolescent mental health conditions, depression and anxiety are the most common. Literature has suggested provider intuition alone has low sensitivity and specificity for detecting mental illness and that screening tools are indicated.

PURPOSE: The aim of this project is to implement standardized routine …

Barriers And Facilitators To Opioid Use Treatment And Recovery Services During Pregnancy, Loralie Woods

Dissertations

Purpose: To identify barriers and facilitators to opioid use treatment and recovery services among pregnant and nonpregnant women who misuse opioids.

Background: Over 130 Americans die daily after overdosing on opioids. Women have not been immune from opioid use disorders (OUDs), with a 4-fold increase from 1999-2010. The prevalence of opioid use among pregnant women increased from 1.5 per 1,000 hospital deliveries to 6.5. Although the annual National Surveys on Drug Use and Health (NSDUH) has provided information on risk factors for OUD related to socioeconomic and demographic factors, no studies using this data have identified barriers to opioid use …

Skin And Soft Tissue Infections In The Emergency Department, Nicole Martinez

Dissertations

Background/Purpose: Skin and soft tissue infections (SSTI) represent a diverse group of infections varying in clinical presentation and degree of severity. The International Classification of Diseases codes for patients presenting with cellulitis or abscess account for $5.5 billion in annual health care costs and 1.4% of all hospital admissions nationally. Data are needed to inform admission and management decisions. The purpose of this study is to examine relationships among sociodemographic, physical examination findings, and treatment modality and management in patients with SSTIs.

Theoretical/Conceptual Framework: Web of Causation Theoretical Framework explores multiple causative factors treated with equal prominence, thus …

Peer-Led Education Expedites De-Prescribing Proton Pump Inhibitors For Appropriate Veterans, Mary H. Bowman

Doctor of Nursing Practice Final Manuscripts

Costly proton pump inhibitors (PPIs) have been widely prescribed since the 1990’s for prevention and treatment of ulcers and gastroesophageal reflux disease (GERD). Evidence published since 2012 demonstrates risks associated with taking PPIs longer than eight weeks. Primary care providers (PCPs) mostly de-prescribe PPIs for persons not meeting criteria for long term use. Many patients resist discontinuation.

A three-month evidenced based practice (EBP) education project was conducted by a nurse practitioner to improve PCP peer de-prescribing successes with appropriate patients in an outpatient California based veteran Primary Care Clinic. Fifteen PCPs were pretested about usual care practices between two comparable …

Reducing The Rate Of Falls In Hospice Patients: A Fall Prevention Pilot Program, Allison Floyd

Doctor of Nursing Practice Final Manuscripts

Background and Evidence Problem: As the population ages, there is an increase in the incidents of falls. Falls are the predominant cause of both nonfatal and fatal injuries among adults aged 65 years and older (Bergen et al., 2016). Extensive research has been conducted in fall prevention in hospitals, skilled nursing, and rehabilitation units. End-of-life care in a hospice setting presents a greater challenge in risk identification and prevention of falls. A local hospice had 457 falls between July 2018 to mid-March 2019 with a lack of consistent, detailed, fall education and documentation.

Evidence-Based Practice Intervention: Utilizing the American Geriatrics …

Screening For Post-Menopausal Osteoporosis In Women Ages 30-64 Review Of A Pilot Program In Primary Carescreening For Post-Menopausal Osteoporosis In Women Ages 30-64 Review Of A Pilot Program In Primary Care, Elaine Henson

Doctor of Nursing Practice Final Manuscripts

The risk of an osteoporotic hip fracture is greater than the combined risks of breast cancer, myocardial infarction, and stroke, yet research shows less than 25% of women are being screened. Post-menopause, either surgical or natural, is a risk factor for osteoporosis. Nurse practitioners are in an excellent position to lead the way in osteoporosis screening. This article presents findings in a recent osteoporosis screening program in a primary care office.