Nursing Commons^™

Implementing A Medication App For Transplant Recipients, Allison Arnold

MSN Capstone Projects

The purpose of this benchmark, evidence-based practice project is to evaluate the utility of medication adherence app for transplant recipients to reduce rejection. Studies have shown that medication apps can improve adherence, reduce transplant rejection, and be helpful to patients. The Perx Health app rewards patients for taking their medications, provides patients with reminders, and provides healthcare providers with data from patients. The Perx app will be implemented at a single, large volume, pediatric transplant center. Historical data related to rejection rates and medication level variability indexes will be compared to data collected after app implementation. In addition, patient surveys …

Meeting The Needs Of Gen Z Nurses To Improve Nurse Retention, Ronna M. Best

MSN Capstone Projects

This benchmark project explores the unique learning styles and generational characteristics of Generation Z nurses (those born between 1995 - 2012). The need exists for a change in traditional orientation and onboarding processes to meet the needs of Gen Z nurses. Gen Y and Gen Z nurses are expected to make up 50% of the workforce by 2024. Retention of these nurses is critical to a hospital organization as it is an effective strategy in dealing with the nursing shortage. Specific strategies for engaging the gen Z nurses include incorporating more digital platforms in the orientation and onboarding process, face …

Retention Drivers Post-Pandemic, Maria Charles, Christina Gonzalez

MSN Capstone Projects

The Covid pandemic influenced the world in many ways that we still witness a need for recovery. One significant concern that remains apparent is the culture change within the healthcare system. This study is directed to cover only one aspect of this culture change but remains to be a very significant topic for the nursing workforce (AHC Media, 2021). Even though we have managed to find a downward trend of Covid cases, the pandemic has devastated nursing retention to well established facilities. There is currently an exodus of nurses in high acuity departments or simply bedside nursing entirely. This causes …

Nursing Students’ Perceptions Of Using Branching Simulation: A Qualitative Descriptive Study, Mohammad Rababa, Dania Bani-Hamad, Shatha Al-Sabbah

The Qualitative Report

Previous intervention studies have shown that branching simulation (BS) unfolds the complex multidimensional aspects of challenging health problems. The present study aimed to examine graduate nursing students’ perceptions of using BS in professional training. This study used a qualitative descriptive design with semi-structured interviews with a sample of 20 graduate nursing students. Four main themes emerged from the results: (a) BS as a support to students’ professional training, (b) BS leads to changes in clinical practice, (c) whether BS is a stressful learning experience, and (d) BS versus traditional lecturing. The participating students perceived BS as a valid learning tool …

Mental Health Navigators Bridging The Gap Of Care For Clients With Schizophrenia: A Review, Valentina Loreto-Ashley, Valentina Loreto-Ashley

DNP Qualifying Manuscripts

Background: Schizophrenia is a thought disorder. As such it affects an individual level of function, and often leads to acute hospitalization. When clients with schizophrenia disorders are discharged, they are a great risk for suicide and danger to others. Services aimed at bridging patients from an acute facility to their community setting could be essential in helping the client in treatment to reach functional recovery and avoid relapse.

Objective: This article explores the role of mental health peer navigators in improving treatment adherence for adult clients with schizophrenia spectrum disorder being discharged from a psychiatric facility into their unique community …

Bedside Nurse Shift Length: Evidence-Based Intervention On Nursing Burnout, Natalie Suzanne Medina Bsn, Kristen Morreale Bsn, Bryanna Whitehurst Bsn

MSN Capstone Projects

With the aging baby boomer population, employee burnout, and lack of quality medical training, the United States is facing one of the most detrimental nursing shortages in history. Before the COVID-19 pandemic, the United States Health and Human Services projected the demand for nurses to be much higher than the actual number of employed registered nurses through 2030. Since 2016 the nursing population was widely composed of nurses between 25 to 34 years old. After the global pandemic hit, the number of nurses in that age group declined by 5.2 percent, and nurses aged 35 to 44 have reduced by …

Changing Hand-Off Communication In The Pacu Setting, Alisa M. Berndt

MSN Capstone Projects

Through extensive research on the importance of hand off communication in the PACU setting a correlation between patient safety and hand off report was found. Lack of a standardized hand off communication report in the PACU setting may lead to compromised patient safety and negative patient outcomes. In year 2021- 2022, the PACU there had several occurrences of miscommunication that were considered “near misses” in their incident reporting system. The objective of this capstone project is to investigate if utilizing a standardized hand off communication tool to guide healthcare professionals when transferring patient care to the next provider will mitigate …

Using Debriefs To Reduce Nursing Burnout In Nurses Caring For The Oncology Population, Courtney M. Wilkes

MSN Capstone Projects

Nurses are a critical part of healthcare and make up the largest section of healthcare professionals in the United States. According to the World Health Organization (2020), there are approximately 29 million nurses and midwives globally. The increasing need for nurses is not a new discovery. According to the American Association of College of Nurses, more registered nursing jobs will be available through 2022 than any other profession in the United States. The number of nurses leaving the workforce each year has been growing steadily from around 40,000 in 2010 to nearly 80,000 in 2020. Nursing burnout is a known …

Reducing Suicide Reattempts With A Telephone Follow Up Program, Bailey Breaux

MSN Capstone Projects

Suicide is one of the leading causes of death in the United States. Most people can say they know at least one person who has committed suicide or has considered suicide. The number of deaths continues to rise, and they aren’t stopping anytime soon. Many of these patients visit emergency rooms around the country seeking help for their depression and suicidal ideation. Some are brought into the emergency department following a suicide attempt and their visit only predicts another one happening in the near future. Some hospitals around the globe has tried to stop this recurrence of suicide reattempts by …

An Integrative Review: The Experiences Of Stress, Burnout, And Compassion Fatigue By Ambulatory Care Nurses, Rajean Adams

Master of Science in Nursing Final Projects

Abstract

Aim: One aim of this integrative review is to highlight workplace issues outpatient (ambulatory care) nurses experience, related to stress, burnout, and compassion fatigue. Another aim is to bring awareness to and discuss recently implemented tools and strategies to help alleviate these manifestations.

Background: Stressors in the outpatient setting date back to the 1970s when psychologist Herbert Freudenberger mentioned the burnout he experienced while in a Free Clinic. In modern-day, half of nurses experiencing workplace burnout, confess to feeling emotional exhaustion. Various studies discuss the challenges nurses endure in the inpatient setting, but only a few focus on ambulatory …

Nursing Considerations For Post-Traumatic Amnesia After A Traumatic Brain Injury, Hannah Grant

Senior Honors Theses

A period known as post-traumatic amnesia (PTA) often follows a traumatic brain injury (TBI). PTA is characterized by anterograde and retrograde amnesia, confusion, disorientation, and agitation. The duration and severity of PTA is a key indicator of the long-term prognosis after a TBI, so proper assessment and nursing care of a PTA patient is crucial. TBIs range from mild to severe, but primarily affect the fronto-temporal lobes. In PTA, both neural lesions and white matter damage within the parahippocampal region can cause PTA. A nurse must perform a thorough assessment of a TBI patient, but, since PTA is a key …

Reducing 30-Day Hospital Readmission Among Mentally Ill Homeless Men With Substance Use Disorder, Chibuogwu Ugbana

DNP Qualifying Manuscripts

Abstract

Background: Psychiatric inpatient readmission of mentally ill homeless men is greater than that of the overall population. Substance use disorders co-occur with high prevalence in patients diagnosed with mental illness. For mentally ill homeless individuals discharged after inpatient treatment, substance use disorder negatively impacts health behavior, and medication non-compliant, resulting in hospital readmission.

Problem: In an acute care psychiatric facility in Northern California, the greatest readmission after inpatient hospitalization occurs at 53.9% in a week and 74.8% in two weeks of discharge. For homeless individuals, substance use disorder complicates personal problems and decreases the likelihood of a long-term …

Contributing Factors And Solutions For Inappropriate Use Of The Emergency Department, Lesia M. Kozych

Honors Capstones

Emergency departments are overwhelmed with the sheer quantity of patients, many of which are there for the non-emergent reasons. The purpose of this project is to identify factors that contribute to emergency department (ED) misuse, initiatives or programs that have been successful in decreasing ED misuse, and ED personnel’s opinions on contributing factors and potential solutions. A literature review followed by semi-structured interviews of ED personnel produced the necessary information. Common themes were drawn from participant responses in the interview portion. A major barrier to appropriate use of the emergency department is access to primary care. Others include: lack of …

Promoting Sleep To Decrease Delirium, Stephanie Mayne

MSN Capstone Projects

Delirium is potent risk factor for complications, an increase length of stay, and mortality. Hospital acquired delirium is a prevalent and serious health condition that can occur in patients, especially the older adult population, when admitted to the hospital. It has the ability to be prevented if properly addressed and interventions are set in place to help reduce the occurrence of hospital acquired delirium. Many factors can contribute to the development of delirium, including a disruption of one’s circadian rhythm. Sleep is not always a high priority in the hospital, therefore there are little interventions and goals aimed at improving …

Regional Anesthesia In Outpatient Total Joint Arthroplasty, Laci Caesar

MSN Capstone Projects

Within the past five years, outpatient total joint arthroplasties have increased three-fold due to the change in insurance companies’ reimbursement plans. After continuous literature research collection, support for spinal anesthesia was higher than compared to general anesthesia (GA) for outpatient total joint arthroplasty procedures. Healthy patient who receives regional anesthesia showed decreased post-operative pain, increased rehabilitation, and, most of all, a decrease in facility stays (Macfarlane et al., 2009). This has allowed healthy patients who meet physician, anesthesia, and facility requirements to transition from hospitals to ambulatory surgery centers for total joint replacement procedures. With this new transition comes change …

Remote Patient Monitoring: Decrease Rehospitalization For Spinal Cord Injury Patients, Abegail Cabunoc-Garcia

Student Scholarly Projects

Practice Problem: The lengthy distance required to access specialty care, the overall higher cost of SCI/D care, complications associated with SCI, and the potential negative impact of shortened hospital stays are all compelling reasons to use telehealth technologies to deliver specialty services for medical issues.

PICOT: The PICOT question that guided this project was in adult spinal cord injury patients with chronic disease receiving primary care at a spinal cord injury center (P), how does the implementation of a remote patient monitoring home telehealth for SCI patients recently discharged from acute-care setting (I) compared to the usual practice …

Nursing Students' Knowledge Of And Attitudes Towards Near-Death Experiences, Laura Lee Varela

Theses & Dissertations

Incidence of reported near-death experiences (NDEs) has increased over decades; however, they continue to be inappropriately pathologized or dismissed. These types of responses to disclosures of NDEs by patients can potentially lead to them having problems integrating the experience into their lives. The purpose of this study was to assess undergraduate nursing students’ levels of accurate knowledge of and attitudes towards NDEs and to determine the predictors of nursing students’ knowledge of and attitudes toward NDEs. Additionally, I explored the sources in which nursing students acquire NDE knowledge. I accomplished this by using a cross-sectional, correlational research study design. I …

Influence Of Job Stress, Fatigue, Happiness On Sleep Quality Of Shift Work Nurses, Minjeong Kang, Yeon Sook Kim, Insun Jang

Nursing Faculty Publications

Purpose: This descriptive study aimed to identify relationships among shift work nurses’ job stress, fatigue, happiness, and sleep quality and the factors causing decrease in sleep quality to establish fundamental data for effective intervention strategies. Methods: The data were collected using a structured questionnaire from June 11 to 19, 2018, and study participants were 198 nurses working rotating shifts in a university hospital. Results: The quality of sleep showed a mean of 15.77±5.30 and was varied depending on the number of night shifts (p=.001), health status (p=.008), and the number of discomforts at work (p<.001). Sleep quality also showed a significant relationship with job stress (r=.15, p=.040), fatigue (r=.35, p<.001), and happiness (r=-.24, p=.001). Multiple regression analysis (Adj R2=.275) indicated that factors affecting the quality of sleep included the number of discomforts (β=.31, p<.001), fatigue (β=.22, p=.002), and the number of night shifts (β=.19, p=.002). Conclusion: This study suggests that individuals, hospitals, and social systems need to coordinate the number of night shifts and improve discomfort and fatigue by considering factors influencing rotating shift work nurses’ sleep quality.

Implementing Evidence-Based Adult Psychiatric Inpatient Depression Assessment, Treatment, And Post-Hospitalization Referral, Lucy Flores

Doctor of Nursing Practice

Purpose: This project was designed to strengthen the quality of depression assessment with evidence-based depression assessment tools in inpatient psychiatric units.

Background: Missed diagnosis and treatment of depressive disorders contribute to the most severe outcome of depression: suicide. A crisis stabilization facility with inpatient psychiatric units had significant opportunities to improve clinical outcomes by screening for depression in adults and to monitor symptoms with evidence-based tools.

Methods: The 12-week quality improvement project included implementation of staff education sessions of evidence-based tools to screen, monitor, interpret scores, and detect risk modifiers. The design and build with Information …

Effects And Outcomes Of Different Laboring Positions And The Influence From Societal Norms, Amberlyn Heskett

Nursing | Senior Theses

Background

Within labor and delivery, every birth is different. Alarmingly, the U.S. has the highest maternal mortality rate, including death during labor, among developed countries (World Health Organization, 2022). Many maternal deaths may be preventable.

In the U.S., the use of forceps, vacuum-assisted birth, episiotomies, and emergency C-sections are common for women during childbirth. Even though some laboring positions may assist birthing more than others, there often is resistance to allowing various positions due to outside influences, including societal norms, hospital management, and healthcare professional training. Women in labor are vulnerable and look to their nurses for support during the …

The Emerging Epidemic Of Type 2 Diabetes And Obesity Amongst Young Children, Juliana Morales

Nursing | Senior Theses

Background:

In the past years childhood obesity has increased tremendously and currently ⅓ of children in the United States are obese today. Obesity and Type 2 Diabetes are illnesses that can later on lead to more severe health complications when as a child enters adulthood. Children who are obese have a greater risk of developing Type 2 diabetes, and currently more than 80% of children who already are diagnosed with Type 2 diabetes are obese. In school and often by health care providers we are told daily physical activity and healthy diet are the best ways to maintain optimal health, …

Retrospective Evaluation Of Depression Screening Process Among Older Adult Patients In Primary Care For Quality Improvement., Ashley Dru Larson

Doctor of Nursing Practice Papers

Background: Depression is not a normal process of aging; it is a diagnosable and treatable medical condition. The US Preventive Services Task Force (USPSTF) recommends that older adults be screened for depression annually.

Aim: The purpose of this evidence-based practice (EBP) project was to evaluate the depression screening process for older adults (age 65+) in a primary health care setting and provide recommendations to the primary health care clinic for improving it.

Methods: This EBP project involved collecting retrospective data from August to October 2022, including aggregate data (demographics), from all older adults who were seen in …

Blind Spot: Implicit Bias In Health Care And Its Awareness Among Nursing Students At The University Of Southern Mississippi, Debora Skaliks

Doctoral Projects

While prejudice and bias are eminent topics in our society, implicit bias or unconscious bias is not as easily detected. Even though implicit bias may be a familiar concept to many, numerous healthcare workers frequently do not recognize the extent of harm such biases can impose on patients' health and outcomes. The Blind Spot DNP project exposed in this research paper explores the relentless question of the correlation between implicit bias awareness, implicit bias education, and its impact on health care. This Doctor of Nursing Project (DNP) project aimed to analyze whether implicit bias education and testing could increase unconscious …

A Single Centre Experience Of Local Perforator Flaps In Oncoplastic Breast Surgery: A Cross-Sectional Study, Sana Zeeshan, Lubna Vohra, Uzma Shamsi, Nida Zahid, Danish Ali, Nargis Asad, Cristina Garusi

Section of General Surgery

Background & objectives: Various oncoplastic techniques have emerged over the years to preserve breast cosmesis and symmetry without compromising the principles of tumor excision. One of the newer techniques for breast volume replacement to achieve symmetry and cosmesis is the use of fasciocutaneous pedicled chest wall perforator flaps or local perforator flaps (LPF). The objectives of this study were to document the details of the surgical procedure as well as patient-reported satisfaction and well-being following the procedure using a validated BREAST-Q tool among Pakistani women.
Materials & methods: This cross-sectional study was conducted from March 2019 to February 2021 enrolling …

Factors Affecting Health-Seeking Behaviour Among Men Who Have Sex With Men In Starehe Sub-County, Nairobi City County, Anthony Omariba

MSc in Advanced Practice Nursing

Men who have sex with other men (MSM) exist in Africa, as they do elsewhere. The continued proscription of MSM behavior leads to exclusion and discrimination. According to a global report, MSMs are responsible for most HIV transmission. MSMs in Kenya constantly fear being hurt because of their sexual orientation, and there is scant knowledge of their health-seeking behavior. There is a need to improve the health of this group to lower disease spread to achieve global HIV reduction. This study aims to explore MSM healthcare-seeking behavior, describe barriers to healthcare-seeking, and establish perceptions of the sexual risks associated with …

Perceived Quality Of Senior Care In An Assisted Living Facility Following The Outbreak Of Covid-19, Kaylie Hill

Theses/Capstones/Creative Projects

The COVID-19 pandemic has posed a monumental obstacle to the healthcare field in terms of severely reducing the number of healthcare workers. Among the many industries affected by staffing shortages are assisted living facilities (ALFs), in which residents are dependent on care staff for daily assistance. This study sought to investigate whether long-term residents of ALFs perceive a difference in the quality of their care under the circumstances of the pandemic as opposed to those of pre-pandemic times. Semi-structured interviews were facilitated with 10 long-term residents who have been residing in an Omaha ALF since prior to the outbreak of …

Optimizing Diabetes Self-Management Using Continuous Glucose Monitoring And Improving The Transition Of Care For Adult Patients Discharged From The Hospital, Nikki Rose Angeles

Doctor of Nursing Practice

Background: Diabetes mellitus is a chronic medical condition that affects more than 34 million Americans (Centers for Disease Control and Prevention, 2020). The financial impact of diabetes is significant. Americans spend $327 billion on direct medical costs to treat the disease and its associated complications (American Diabetes Association, 2018). The management of diabetes requires a multidisciplinary approach that involves healthcare providers, diabetes self-management support resources, and a high level of commitment from the patient. Patients with diabetes discharged from the hospital often receive fragmented and inconsistent information about managing their health issues. As they transition from hospital to home, their …

An Interprofessional Prediabetes And Diabetes Self--Management Education Quality Improvement Project Among Vulnerable Populations At A Tuberculosis Hospital, Robert Saul Castro Natal

Doctor of Nursing Practice

Background. Patients greatly benefit from diabetes self-management education (DSME) as it boosts knowledge and self-efficacy, decreases body weight, fasting blood sugar, and hemoglobin A₁C levels, and improves overall health outcomes in a cost-effective manner. Unfortunately, many individuals with prediabetes and diabetes who qualify for DSMEs do not attend these classes nor receive sufficient prediabetes and diabetes support elsewhere to attain guideline recommended metrics. However, individuals from vulnerable populations and without DSME education experience disproportionate diabetes-related complications worsening health outcomes. Aims: Increase general prediabetes and diabetes knowledge, facilitate behavior change, improve glycemic, metabolic, and lipid values, and increase …

Addressing Obstacles In Following Prescribed Medication Regimens In Patients With Type 2 Diabetes Mellitus, Cristina Sarro

Doctor of Nursing Practice

Background. Type 2 diabetes is the ninth leading cause of death in the United States. Micro/macro vascular complications are common in diabetes. Purpose. To implement an evidence-based protocol addressing obstacles for patients with type 2 diabetes in following their prescribed medication regimens to reduce glycosylated hemoglobin levels. Evidence. Failure to follow treatment plans increases diabetes complications. Perceptions and complexities of treatment plans, side effects of therapies, and cost contribute to patients not taking their medications as prescribed. Goals. To increase the number of patients with type 2 diabetes who follow their prescribed medication regimen and reach their targeted glycosylated hemoglobin. …

Implementing The Depression Screening Tool Phq-9 In The Annual Wellness Exam Of Concierge Family Medicine, Eric Iglesias

Doctor of Nursing Practice

Abstract

Background: Depression has been one of the most common mental health disorders that our population fact but is underdiagnosed and undertreated. Primary care providers are often the first line of defense in detecting depression. Because of this, implementing a depression screening tool in a primary care setting will improve holistic management of care and improve quality of life.

Project Aim: The aim of this project was to increase the number of clients who are evaluated for depression by using the PHQ-9 screening tool during their annual wellness exam and initiate treatment according to the Veteran’s Affairs/Department of Defense Depression …