Nursing Commons^™

Creating Restful Environments: Applying Evidenced-Based Interventions To Increase The Patients Perceptions Of Room Quietness At Night, Timothy Marks

West Chester University Doctoral Projects

Florence Nightingale first described the detrimental effects of noise on patients as an element nurses could control. Hospitalized patients who sleep in the hospital are at risk for poor periods of rest from unwanted noise in the care environment. This Doctor of Nursing Practice Project will assess interventions aimed at increasing the patient’s perception of quietness around the care environment at night for a pilot population. Swanson’s Theory of Caring will be utilized as a framework for the project. Outcomes of nursing interventions were reviewed for the improved patient perception of the care environment at night and resultant health outcomes. …

Heart Failure Self-Care At Home, Dinah Warren

West Chester University Doctoral Projects

Abstract

This evidence-based quality improvement project was implemented to improve self-care behaviors in homebound heart failure patients. Heart failure is a complex disease with significant challenges for patients, caregivers, healthcare providers, and the healthcare system. Educating and engaging patients in self-care management skills can reduce the clinical and financial burden of this disease. Heart failure self-care management skills can decrease 30-day readmission rates, improve quality of life, and reduce mortality. The self-care management program was implemented over a 6-week period. The Self-Care of Heart Failure Index (SCHFI) was administered at baseline to assess self-care and reevaluated after 6-weeks. During the …

Chronic Care Model For Management Of Diabetes Mellitus, Junecia White

Walden Dissertations and Doctoral Studies

Diabetes mellitus is a serious chronic disease affecting individuals at various stages of life. More than 114 million Americans are at risk of developing complications of diabetes. It is the leading cause of kidney failure, nontraumatic lower-limb amputations, heart disease, stroke, and new cases of blindness among adults in the United States. This quality improvement project sought to understand if important clinical indicators of diabetes mellitus such as HbA1c, blood pressure, serum cholesterol, high-density lipoprotein, low-density lipoprotein, serum creatinine; and estimated glomerular filtration rate would improve after implementation of a team-based guideline-informed approach to diabetes care management. The chronic care …

Periodic Skills Education To Improve Competency In New Nurses, Karen Broomes-James

Walden Dissertations and Doctoral Studies

On entry into the nursing profession, new graduate nurses (NGNs) possess some knowledge and skills competency but self-report learning gaps in various areas. Experienced nurses have reported that new nurses do not always have knowledge and competency in essential nursing skills. Undergraduate nursing programs and organization orientation programs provide valuable foundational knowledge but are sometimes limited in providing multiple exposures to content. Lagging skills acquisition contributes to self-doubt, lack of confidence and high attrition among NGNs. There is little data in the literature about the provision of supplemental education to new nurses immediately after orientation, and this doctor of nursing …

Effectiveness Of An Educational Intervention To Reduce Preanalytical Specimen Errors, Carol Ann Lineberry

Walden Dissertations and Doctoral Studies

A rejected blood specimen can be very costly to a hospital as well as to the patient. Many errors occur in the preanalytical phase in which nurses and assistive personnel are often involved because they are usually not trained to do so. This staff education project was designed to decrease the number of laboratory rejections of blood specimens in a local hospital setting. Knowles’s adult learning theory was combined with the knowledge translation framework, proposed by Fredericks, Martorella, and Catallo, so that evidence-based changes in practice could occur more readily. There is a 20-minute in-service educational intervention followed by an …

Perceptions Of Newly Licensed Registered Nurses About Homecare As A Practice Area, Tamara M. Kelley Frazier

Walden Dissertations and Doctoral Studies

The demand for competent nurses working in a home care setting continues to grow because of decreased length of stay in hospitals and population needs for chronic care management when homebound. Nursing educational programs introduce students to community health and home care nursing, which could influence a student nurse's choice of home health care as an initial practice setting. This qualitative study examined the perceptions of newly licensed registered nurses (NLRNs) about home care as an initial practice area. Ten NLRNs not working in home health care areas responded to 16 open-ended interview questions that were based on the career …

Eating Disorders And The Gap Of Education, Sara Jane Camden

Walden Dissertations and Doctoral Studies

Eating disorders are described as excessive dieting, limiting food intake, and withholding of food. Over 30 million people suffer from eating disorders. Some people may also have preconceived notions that this disease is easily fixable and that eating more and stopping dieting will solve the problem. Registered nurses struggle with having preconceived ideas, a lack of confidence in their assessment skills, and fear of using the eating disorder diagnosis. Barriers that have surrounded the eating disorder mental health disease need to be addressed. The staff development project was based on the question if nursing knowledge would improve on eating disorders …

Integrating Technology In Improving Communication To Reduce Discharge Cycle Time, Julieta Fajardo

Walden Dissertations and Doctoral Studies

One of the most important milestones during a patient’s transition to care is discharge from hospital. Consequently, delays in the discharge process can lead to patient dissatisfaction and affect outcomes in intensive care and emergency rooms. The purpose of the project was to evaluate the tools built into the electronic system to improve communication and reduce the discharge cycle time. The focus of the project is to enter the expected date of discharge (EDD) and identify discharge barriers within 24-48 hours of admission to reduce this time. Evidence was from the project site’s discharge initiative dashboard. Analysis of the problem …

Minority Pregnant Women Perspective On Health Disparities And Health-Related Outcomes, Lorna Robinson

Walden Dissertations and Doctoral Studies

Health agencies have recognized persistent health care disparities as the primary causes of mortality among minority populations. The emphasis of published studies on the health of minority women in the United States has revealed a knowledge gap in prioritizing prenatal care (PNC). The purpose of this narrative descriptive study was to explore access disparities in PNC and the effect the overall experience had on first-time pregnant minority women in receipt of PNC. The health services utilization framework provided the theoretical lens to analyze and interpret the findings of this study. The key research questions explored how the self-reported experiences of …

Nurse-Physician Collaboration During Bedside Rounding: What Is The Impact On The Nurse?, Martha Decesere

Electronic Theses and Dissertations, 2020-2023

Poor communication is identified as the root cause for the majority of sentinel events in hospitals, including wrong site surgery, medication errors, and failure to rescue. Interdisciplinary rounding (IDR), a long-standing practice in the Intensive Care Unit (ICU), provides a forum for communication and collaboration and has been linked to improved patient outcomes. Most of the research regarding IDR has been performed in the ICU setting within academic medical centers. IDR outside of the ICU has demonstrated similar clinical outcomes but a gap exists in the literature regarding the impact of IDR participation on the nurse, particularly for nurses working …

Perinatal Staff Education On Opioid Use Disorder, Theresa J. Engle

Walden Dissertations and Doctoral Studies

According to the Centers for Disease Control and Prevention, opiate use disorder (OUD) crosses all demographic areas, ethnicities, and social classes. In 2016, over 42,000 Americans died from opiate overdose with more than two million Americans having OUD. The need to care for patients with OUD has crossed all realms of nursing, including the perinatal specialty. Framed within the Iowa model of evidence-based practice, the purpose of this project was to develop a perinatal staff education program on OUD focusing on addiction as a brain disorder with care of the perinatal woman and identification and treatment of the newborn with …

A Systematic Review Of The Literature On Bedside Shift Reports, Dana Wickersheim

Walden Dissertations and Doctoral Studies

AbstractIn 2017, The Joint Commission issued a sentinel event alert regarding inadequate nurse hand-off communication. Inadequate hand-off communication can lead to medication errors, delay in treatment, falls, and wrong-site surgery. To help ensure safe handoff of care between nurses by involving the patient and family, bedside shift report was created. Bedside shift report was developed to help improve patient safety and quality, patient experience of care, nursing staff satisfaction and time management, and accountability between nurses. Despite the implementation of bedside shift report in nursing practice, it continues to be inconsistently applied, which poses risks to patients and can lead …

Hospital Nurses’ Perceptions Of Computer-Assisted Instruction For Professional Development, Katherine Irizarry

Walden Dissertations and Doctoral Studies

Computer-assisted instruction (CAI) is increasingly being used for professional development. However, at one hospital in the northeast region of the United States, it was observed that nurses were not completing their CAI professional development modules and were failing to meet continuous education requirements. This qualitative case study explored professional nurses’ perspectives regarding the usefulness of CAI as a mode of professional development. The conceptual frameworks used to guide this study were Davis’ theory of technology acceptance, and Knowles’s theory of andragogy. The research question explored how professional nurses perceived the usefulness of CAI to assimilate new learning. The participants in …

Preventing Aspiration Pneumonia Using An Aspiration Prevention Protocol, Lee James-Pettway

Walden Dissertations and Doctoral Studies

Hospital-acquired pneumonia, which includes aspiration pneumonia (AP), is a preventable condition that is costly to all healthcare institutions (more than $17,000 to $ 30,000 per episode), because insurance no longer covers the cost of hospital-acquired harms. Each episode in the hospital setting can lead to patient complications, increased use of antibiotics, patient mortality, as well as decreased patient survey scores. Several factors put patients at risk of developing AP, and screening for these risk factors on admission and implementing preventative nursing interventions can decrease the incidence. Based on an extensive literature review, an evidence-based, clinical practice guideline (CPG) was identified …

Increasing Primary Care Nurse’S Recognition Of Symptoms Related To Job-Related Stress, Beverly Diann Butler

Walden Dissertations and Doctoral Studies

AbstractMany nurses become accustomed to stressful situations and often do not recognize the signs of stress until it has in some form affected them. Nurses often lack education for recognition of signs regarding job-related stress. The practice-focused question for this doctoral project addressed whether knowledge of stress recognition increase in nurses after an evidence-based educational program (EBP) regarding signs of job- related stress.” The purpose and significance of this project was to develop, deliver and evaluate an EBP regarding recognition of signs regarding job-related stress. The project was guided by the Job Demands-Resource (JD-R) theory and Lewin’s Change Theory to …

Parents’ Perceptions Of Healthcare Influences On Their Decisions To Vaccinate Their Children, Patricia Frances Badiola Harris

Walden Dissertations and Doctoral Studies

Declining immunization rates are associated with higher incidents of vaccine-preventable diseases. The purpose of this qualitative phenomenological inquiry was to explore the perceptions of vaccine-hesitant parents regarding their healthcare experiences. Ajzen and Fishbein‘s theory of reasoned actions and its key concepts (the intention to perform behaviors, attitudes, subjective norms, and external variables) was used as a framework to understand influences on parents' decisions to vaccinate their children. The research questions for the study examined the healthcare experiences of vaccine-hesitant parents, how these experiences influenced their decisions to vaccinate their children, and how this group perceived the current strategies promoting vaccinations …

Hypertensive Self Care: An Educational Tool For Advanced Practice Nurses, Kelisia Burks Mckay

Walden Dissertations and Doctoral Studies

Poorly controlled hypertension is a serious public health problem. Persons with high blood pressure are required to perform a variety of self-care behaviors. Advance practice nurses can improve health outcomes for hypertensive patients when they provide self-care education along with prescribing appropriate medications needed to treat high blood pressure. The purpose of this study was to educate rural advance practice nurses about hypertension medication and self-care management using the Hypertension Self-Care Activity Level Effects (H-SCALE) and the 8th National Joint Committee (JNC- 8) hypertensive guidelines. Twelve primary care advanced practices nurses (APN's) participated in an educational presentation that included pre …

Evaluation Of A New Nurse Mentor Program, Corinne Romano

Walden Dissertations and Doctoral Studies

Novice nurses in the facility had a turnover rate of 32% in 2017 and 2018, despite participation in a novice nurse residency program. This project was the 3-month formative evaluation of a 1-year mentor program designed for novice nurses. The mentor program had been created to augment the residency program and support practice transition for novice nurses. The project questions explored the results of the process evaluation at the 3-month mark of the year-long mentorship program for the first cohort and recommendations to the mentor coordinators for continuous quality improvement. This quality improvement project followed the PDSA (plan-do-study-act) methodology. The …

Adults On The Autism Spectrum: A Quality Improvement Project To Develop A Patient-Centered Nursing Care Guideline For The Acute Care Setting, Elizabeth Cirelli

DNP Scholarly Projects

Abstract

Background: Incidence of autism spectrum disorder is increasing. Current prevalence rate is 1 in 59 people, which translates to roughly 1% of the U.S. population. These adults have higher rates of epilepsy, gastrointestinal disorders, obesity, cardiac dysfunction, and mental health disorders. Healthcare system utilization is resultantly greater than their neurotypical counterparts, coupled with longer lengths of stay and decreased patient satisfaction reports.

Purpose: Most nurses report little to no formal training about the disorder or how to develop interventions sensitive to the needs of this population yet are crucial care givers to ensure patient-centeredness. A guideline to …

An Overview Of The Utilization Of A University Health Center, Ashley Rosato, Dhara Patel, Jailene Martinez, Rhianna Teates, Kaylee Campoverde, Sarah Kelly

Student Research Symposium

Background: College students often do not visit university health centers or attend scheduled appointments. Missed appointments affect not only the students’ health, but also the health center. Missed appointments cannot be easily rescheduled, limit appointment times for others, and lead to a higher cost for the university. The purpose of this study is to explore student usage of a university based health care center.

Method: A retrospective review of 400 electronic health records, from college students enrolled in a State University from 2016-2017, were examined. The information collected focused on the use of the university health center, reason for appointment, …

Comparison Of Novice Versus Expert Certified Registered Nurse Anesthetists Self-Perceived Competency Levels, Toni Brice

Doctor of Nursing Practice Projects

The purpose of the study is to describe the correlation of self-perceived competency levels between novice and expert Certified Registered Nurse Anesthetists (CRNAs) in the perioperative setting. Self-reflection on competence enables CRNAs to know their most reliable and weakest performance characteristics; thus, they can improve the efficiency of their work performance across surgical settings. The proficiency of the anesthetist is important in surgical settings when the anesthesia provider is often performing independently. Psychometric instruments such as surveys can aid in evaluating perioperative performance, yet psychometric tools for explicitly assessing nurse anesthesia competence are limited. The methodology for this study is …

Opioid Reduction Or Elimination With The Utilization Of Transversus Abdominis Plane Blocks In Gynecological Surgeries, Chris Ivy

Doctor of Nursing Practice Projects

The purpose of this retrospective study was to evaluate the efficacy of Tansversus Abdominis Plane blocks in women undergoing gynecologic surgery and the decreased or eliminated opioid need. The opioid crisis has sparked interest in alternatives to traditional pain therapies in the surgical patient. Regional blocks are being added to the surgical patient's plan of care. In gynecologic surgeries, the Transversus Abdominis Plane block (TAP), has been increasing in popularity due to ease of learning and effectiveness. This project evaluates the efficacy of the TAP block and the elimination or decreased usage of opioids. A retrospective chart review was conducted …

Substance Use Disorder Policy For Certified Registered Nurse Anesthetists: A Policy Analysis, Justin D. Mcadoo

Doctor of Nursing Practice Projects

Substance use disorders (SUDs) negatively impact society and communities while causing substantial harm to families and friends. The leading occupational hazard for Certified Registered Nurse Anesthetists (CRNAs) is SUDs. It is estimated that 15% of actively practicing CRNAs in the United States will have a SUD during their career. In order to address SUDs related to CRNAs in the workplace, anesthesia groups and healthcare facilities must develop, implement, and evaluate policies and procedures based on the translation of evidence-based research into the practice of anesthesia. This Doctor of Nursing Practice (DNP) project analyzed LifeLinc Anesthesia’s SUD policy for CRNAs, compared …

Health-Related Quality Of Life And Ptsd-Symptoms In Survivors Of Extracorporeal Membrane Oxygenation (Ecmo) Support, Jennifer Bauman

DNP Projects

Background: Extracorporeal membrane oxygenation (ECMO) survivors have shown to have poor physical and mental health outcomes post decannulation and hospitalization; thus leading to an overall decreased quality of life. Identifying and managing the psychological components of care in this patient population can improve their physical, emotional, and mental well-being.

Purpose: To assess the incidence of impaired health related quality of life (HRQOL) and posttraumatic stress disorder (PTSD) like symptoms in survivors of ECMO; identify which constellation of patients (respiratory vs. cardiac) have poorer HRQOL outcomes post ECMO; and compare the tools used to measure post procedural outcomes in this patient …

Timely Follow Up Care After Initiation Of Adhd Medication In Children: A Quality Improvement Project, Rebecca Haas

DNP Scholarly Projects

Background: Enhancing medication safety, strengthening compliance and mitigating side effects requires close monitoring. A child, defined by Centers for Medicare and Medicaid Services, as being between the ages of 6 years and 12 years of ages, with Attention Deficit Hyperactivity Disorder (ADHD) must have an initial medication visit within 30 days of a first-time trial of ADHD medication. Increasing staff awareness of organizational policy of expected timeframe for medication checks and annotating appointment slots as initial medication checks will decrease the number of days between the first-time trial of ADHD medication and a child’s medication assessment. Methods: The Model for …

Optimizing The Effectiveness Of Naloxone Distribution In The State Of New Hampshire: A Program Evaluation, Lisa M. Armes

DNP Scholarly Projects

In order to develop an understanding of the state-funded community naloxone distribution program in New Hampshire, a program evaluation was conducted. The project collected data on distributed naloxone and opioid overdose deaths between the years of 2014-2018 but focused primarily on comparing data from 2017 and 2018. There were 409 opioid deaths in 2017 and 399 opioid overdose deaths in 2018 in New Hampshire. Between 2017 and 2018, naloxone supply was increased by 38%-493%, varying widely across New Hampshire counties. Statistically significant increases in naloxone distributed to target users occurred only in Hillsborough and Strafford counties. Significant changes in death …

Engaging Patients With Dementia In The Acute Care Setting: A Quality Improvement Initiative For Staff, Andrea Lee

DNP Scholarly Projects

Caring for dementia patients in the acute care setting can be challenging. Staff is trained to manage the acute illness and the symptoms of dementia can impact that care. Training for the care and management of the patient with dementia is not routinely provided for the acute care setting. According to the Alzheimer’s Association (2018), 5.7 million people are living with Alzheimer’s Dementia with the numbers projected to continue to rise. Training in the management of symptoms can alleviate stress and complications for not only the patient but staff members as well. The goal of this project is to educate …

The Flame, 2020-2021, Mennonite College Of Nursing

The Flame (1985-present)

The Flame is a newsletter of Illinois State University's Mennonite College of Nursing

Nursing Administration And Faculty Perceptions Of Their Self-Efficacy With Active Learning Methods, Lindsey Ann Helm

Walden Dissertations and Doctoral Studies

A lack of active teaching was identified in a small, rural college in a midwestern state, resulting in negative course evaluations that referenced students’ learning preferences as not being met. This qualitative case study was aligned with Bandura’s theory of self-efficacy to explore the perceptions of nursing administrators and nursing faculty about their teaching methods and self-efficacy regarding the implementation of active learning strategies. A purposeful sampling method was used to select a total of 8 participants: 6 nursing faculty and 2 nursing administrators. Selection criteria included nurse educators and administrators who had worked at the college within the last …

Enhancing Nurse- Patient Communication Through Commit To Sit, Cherrielyn E. Quiambao

Walden Dissertations and Doctoral Studies

The patient experience is considered by healthcare policy experts as one of the essential components of healthcare quality. The project site implemented a program called “Commit to Sit” to help promote direct bedside communication with patients. This quality improvement project examined the impact of the Commit to Sit program on patient experience in an acute care setting. The purpose of this evaluation focused on determining whether communication between the frontline nurses and patients improved through the implementation of “Commit to Sit” campaign on a pilot unit in a community hospital. The Duffy’s Quality Caring Model was utilized because it encourages …