Nursing Commons^™

Empowering Patient Care Technicians To Reduce Non-Ventilated Hospital-Acquired Pneumonia In An Acute Care Hospital In Northern California, Barbra Pacatang

Master's Projects and Capstones

Abstract

Problem: Non-ventilator hospital-acquired pneumonia (nv-HAP) is increasingly becoming a significant concern in healthcare settings. Studies have indicated that nv-HAP accounts for a substantial portion of hospital-acquired pneumonia cases, with a high associated mortality rate. The prevalence of nv-HAP underscores the importance of implementing robust HAP prevention bundles. Prevention, early recognition, and appropriate management of nv-HAP are essential to improve patient outcomes and reduce the burden on healthcare facilities.

Context: A 28-bed capacity Stroke Telemetry Unit incurred six nv-HAP incidents in 2023. Patients needed to be more compliant with the nv-HAP prevention bundles. Patient care technicians (PCTs) are instrumental nurses’ …

Quality Improvement Project Integrating Telemedicine To Reduce Patient No-Shows, Ferdinand Akoko

Doctor of Nursing Practice Projects

No-show among psychiatric outpatient clinic patients is a major problem due to disrupted clinical flow, reduced productivity, and financial losses. This quality improvement project implemented telehealth services to decrease the no-show rates in an outpatient psychiatric clinic in Texas. This project employed quantitative methods to compare the no-show rates pre- and post-intervention for 90 days. The quantitative data were analyzed by paired t-tests. A total of 1,790 appointments were sampled during the implementation period. The obtained results are statistically significant in decreasing the rates of no-shows for all adult appointments from 18% to 13% (p ≈ 0.0067). New appointment no-shows …

Development And Implementation Of An Emergency Preparedness Policy And Procedure, Educational Intervention, And In-Situ Simulation In A Pediatric Primary Care Office: A Quality Improvement Project, Kaitlin Patel

Doctor of Nursing Practice Scholarly Projects

Background. Pediatric primary care offices are frequently unprepared to respond to clinical emergencies that may present to or occur at their site. The purpose of this project was to improve office emergency preparedness at a pediatric primary care office to align with the American Academy of Pediatrics policy statement for pediatric office emergency preparedness.

Methods. A PRISMA-guided literature review found support for both educational interventions and in-situ simulation to improve aspects of emergency preparedness. The aim of this project was to develop a practice-specific emergency preparedness policy and procedure and implement a training and in-situ simulation to increase medical and …

Obstetric Education For Critical Care Nurses, Anna Forberg

DNP Projects

Background The purpose of this study was to educate ICU nurses on the care of obstetric women in critical care through the use of a toolkit with intentions to increase knowledge and confidence.

Method The toolkit was created via the platform WordPress™ and topics were chosen based on the most common admission diagnoses found during the literature review. Data were collected via forms manager and voluntary participation among ICU nursing staff was obtained.

Results Mean scores from the pretest to the post-test showed improvement from 7.08 to 8.50 and the minimum and maximum scores increased from pretest to post-test supporting …

The Impact Of The Covid-19 Pandemic On The Incidence Of Sexual Assaults And Victim Services, Jessica Hunter

Student Works

The Impact of the Covid-19 Pandemic on the Incidence of Sexual Assaults and Victim Services

Purpose: The purpose of this literature review is to discuss incidents/rates of sexual assaults (SA), access to or accessibility of SA victim services, and the utilization of SA services during the COVID-19 pandemic.

Background: In the U.S., 1 in 5 women experience rape or attempted rape, while 1 in 4 men experience some form of sexual violence in their lifetime. Additionally, SAs affect roughly one-third of the world's population, making SA a prominent problem worldwide.

Methods: Electronic searches in CINHAL and MEDLINE were performed using …

Improving Patient Awareness And Compliance With Telephone Follow-Up Calls Post Visit, Ajibola Kutti

Student Scholarly Projects

Practice Problem: In a high-volume clinic without current follow up practices post visit, a telephone follow-up (TFU) intervention was implemented within three days of patient outpatient appointments.

PICOT: The PICOT question that guided this project was: In adult patients in a high-volume clinic (P), does the implementation of telephone follow-up calls by nurses (I) compared to current practices (C) improve patient compliance and post-office follow-up visits (O) over 10-weeks (T)?

Evidence: The literature provided recommendations and evidence that supported the effectiveness of following up with patients within three days of leaving the healthcare clinic. TFU’s are a cost-effective intervention that …

Nurse Leaders Promoting Well-Being Through Mindfulness, Laura G. Cockrell

Walden Dissertations and Doctoral Studies

Becoming a nurse is not just a career but a calling. With this calling comes an ethical duty to the patient, but the duty remains to provide care for oneself. During the COVID-19 pandemic, a strained nursing profession felt the effects of a self-care deficiency. Mindfulness is one self-care tool that can allow nurses to maintain a state of well-being. This project followed Orem’s self-care deficit theory, in which people can use self-care to maintain wellness. The purpose of this project was to develop, deliver, and evaluate an education program for registered nurse leaders on mindfulness activities to address whether …

Barriers To Implementation Of Practice Guidelines In Heart Failure, Mary Geisenhof

DNP Projects

In 2022, the most recent guidelines for care of the patient with heart failure (HF) were released by the American Heart Association (AHA), the American College of Cardiology (ACC), and the Heart Failure Society of America (HFSA). In summary, this group did not recommend fluid restriction for patients with heart failure, unless they are in the end stages of heart failure, and only if fluid restriction may be beneficial (Heidenreich et al., 2022). Despite this recommendation, some providers and nurses continue to restrict fluids. The aim of this DNP project, therefore, was to analyze barriers to implementation of best practices …

Student Nurse Experiences Of Retention Strategies And The Perceived Contribution To Academic Progress, Jessica Dugas

Walden Dissertations and Doctoral Studies

There is a worldwide nursing shortage that has been heightened by the COVID-19 pandemic. Several factors have contributed to the worsening shortage, including high attrition rates in nursing programs. Retention strategies have been suggested to support nursing students during their education to have success and graduate. The purpose of this descriptive qualitative study was to explore how nursing students experience retention strategies and their perceived contributions to academic progress. Bandura’s social cognitive theory was the theoretical framework used to guide the study. Data were collected from one-on-one interviews with 12 nursing students recruited using purposeful and snowball sampling. Data were …

Using Home Telehealth To Reduce Hospital Readmission Rates In Heart Failure Patients In The Emergency Room, Margaret Ashby

Student Scholarly Projects

Practice Problem: In one hospital, the readmission rates and emergency room visit for patients who are diagnosed with heart failure (HF) was increasing.

PICOT: Among veterans who are hospitalized for HF (P) does the enrollment into a care coordination program for these veterans (I) compared to current practices (C), reduce the hospital readmission rates and emergency department visits (O) within 10-weeks (T)?

Evidence: The literature supports the idea that home telehealth as a home monitoring program for patients who have chronic diseases such as heart failure (HF) and has had success in patients with hypertension amongst patients. Transition strategies from …

Quality Improvement Project: Incivility In Nursing Education: Utilizing An Educational Module And Professionalism Guide To Address Incivility In A Nursing Students, Jennifer Schadler

Doctor of Nursing Practice Projects

Incivility is a well-documented issue in the nursing profession that begins in nursing education and follows graduates into nursing practice. Nursing academia has a responsibility to address incivility to prevent inappropriate behaviors from becoming embedded into the culture. The problem addressed in this quality improvement project is incivility among nursing students at a private college. The purpose of this project was to apply evidence-based incivility interventions to address uncivil behaviors of nursing students. The hypothesis was that the implementation of a civility mentor module and professionalism guide would impact perceived incivility among nursing students. The project was conducted using the …

Reducing Rates Of Blood Culture Contamination In The Emergency Room, Erika Goldberg

Student Scholarly Projects

Practice Problem: In one emergency room (ER) blood cultures (BC) drawn by nurses had a high contamination rate due to lack of collection standards, which lead to poor patient outcomes.

PICOT: The PICOT question that guided this project was; In adult emergency room patients where blood cultures are drawn (P), how does implementation of an evidence-based practice method (I), compared to the standard method of obtaining blood cultures (C), affect blood culture contamination rates (O), within ten weeks. (T)?

Evidence: Based on multiple sources within the literature; best evidence for lowering blood culture contamination rates (BCC) is done using EBP …

The Impact Of Hourly Safety Rounding On Pediatric Fall Rates, Natalie Doskal-Poe

Dissertations

The Impact of Hourly Safety Rounding on Pediatric Fall Rates

Abstract

Problem: Falls are a common adverse event in the inpatient pediatric setting and are a significant risk to patient safety. Environmental factors, such as unclear pathways, bed rails down, beds in high position, and call lights out of reach, are considered avoidable causes of patient falls. The site’s fall data in a 12-month period from January 2023 to January 2024 showed (n=9) patient falls occurred with (n=5, 55.6%) due to environmental factors. The purpose of this Quality Improvement (QI) pilot project was to assess the …

Self-Harm In Female Youth With Undiagnosed Adhd: Implementing American Academy Of Pediatrics Screening Guidelines, Roselie M. Woodard

Dissertations

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. If undiagnosed or untreated, ADHD can lead to severe psychosocial issues such as academic failure, substance abuse, unplanned pregnancy, and incarceration. The financial burden in the U.S. from diagnostic errors creates an immense, rising fiscal impact. Early diagnosis and management are crucial to prevent these complications.

Females with ADHD, particularly those with the inattentive subtype, often face diagnostic challenges due to symptom masking and over-compensation. This results in poorer cognitive functioning and self-esteem compared to males with ADHD. ADHD is linked to autonomic nervous …

Transformative Learning: Changing Nurses’ Perceptions About People In Poverty, Jacqueline Debrew

Journal of Social, Behavioral, and Health Sciences

Background: Meaningful learning experiences with clients in poverty may help nursing students change their perceptions towards those experiencing poverty and, thus, provide unbiased, nonjudgmental care when they become nurses.

Purpose: The purpose of this research was to understand what learning activities and experiences nursing students found meaningful and led to a change in prior perceptions of people in poverty.

Methods: Guided by Mezirow’s Theory of Transformative Learning, accelerated BSN students enrolled in a mental health nursing course (n = 14) were assigned reflective journals throughout the semester on their assigned clinical experiences, which were analyzed for emergent themes.

Results: …

Using An Evidence-Based Practice Nurse Recognition Practice To Improve Job Satisfaction, Hali Bianchi

Student Scholarly Projects

Practice Problem: The project targeted low job satisfaction and high nurse turnover in a Central Florida bone marrow transplant unit, impacting patient care and costs.

PICOT: (P) For registered nurses (RNs) on the bone marrow transplant unit, (I) does implementing an evidence-based practice employee recognition program (C) compared to no employee recognition program, (O) lead to an increase in job satisfaction (T) over 10 weeks?

Evidence: The evidence supported the effectiveness of meaningful recognition programs, such as personalized verbal acknowledgment from leadership, in boosting job satisfaction among nurses.

Intervention: The intervention involved nurse managers using a weekly employee recognition …

Nurse Retention Amid Workplace Adversity: Examining Strategies And Outcomes, Horace Smith

Student Scholarly Projects

Practice Problem: This project aimed to evaluate the effectiveness of nurse retention strategies in enhancing job satisfaction, focusing primarily on Emergency Department (ED) Registered Nurses (RNs). A comprehensive approach was adopted within the ED of a veteran hospital in the Southeast, aimed at promoting staff retention.

PICOT: The PICOT question guiding this project is as follows: In a veteran hospital's Emergency Room (ER) located in the southeast (P), how does the implementation of nurse retention strategies (I) compared to current standards (C) increase their job satisfaction (O) over a period of ten weeks (T)?

Evidence: This project …

Implementation Of A Standardized Acute Care Plan For Complex Care Medicine Service Patients: A Quality Improvement Initiative, Tracy Markwell

Doctor of Nursing Practice Scholarly Projects

Abstract

BACKGROUND: Care transition plans, locally called Acute Care Plans (ACPs), are created specifically for super utilizers of the Complex Care Medicine Service (CCMS) and are a target for improvement. The purpose of this project was to improve care for CCMS patients by developing, implementing, and evaluating a standardized CCMS ACP. A multidisciplinary approach was chosen to facilitate the transitions of care process during an admission or discharge from the hospital.

LOCAL PROBLEM: The purpose of the ACP is to get a quick summary of how to treat a patient when they come to the hospital. The ACPs are …

Implementing Pain Screening In A Parkinson’S Disease Clinic: A Quality Improvement Initiative, Anne Marie Desmond

Doctor of Nursing Practice Scholarly Projects

Background: Pain is a multifaceted, non-motor symptom often unnoticed and undertreated in Parkinson's disease (PD). PD pain is associated with decreased quality of life (QOL) and is found in 30-85% of PD patients. The effective diagnosis and treatment of PD pain could improve patient QOL. Barriers to appropriate diagnosis and treatment include a valid and reliable PD pain assessment tool. There was an opportunity to improve the assessment of PD-related pain at the movement disorder clinic in this suburban clinic of a tertiary safety net hospital. The local movement disorder clinic did not have a standardized PD-specific tool to assess …

Assessing Medical Adherence In A Volunteer Community Health Clinic, Jessica Clark, Matthew Anderson, Janelle L. B. Macintosh, Corinna Trujillo Tanner, Kristen Erekson

Student Works

Purpose: The purpose of this project was to identify the rates of and reasons for nonadherence in medical follow-up care among patients who utilize the Volunteer Care Clinic (VCC).

Background: The VCC is a free outpatient care center for acute medical conditions. The VCC serves uninsured, low socioeconomic residents of Utah County, and many of the patients who come to the clinic primarily speak Spanish. The director of the VCC expressed concern that patients who were assigned medical follow-up care to complete after their visit were not completing these assignments. Nonadherence is associated with increased costs, more hospitalizations, and worse …

Non-Cognitive Factors Influencing The Development Of Clinical Judgment In Undergraduate Nursing Students, Kathryn Robinson

Graduate Theses, Dissertations, and Capstones

A nurse’s ability to form sound clinical judgments is directly related to safe patient outcomes. Pre-licensure nursing programs are focused on developing students’ clinical judgment ability; however, an academic-practice gap continues to exist. The Implicit Theory of Intelligence and Achievement Goal Theory provide insight into how mindset beliefs and goal orientation impact the teaching and learning environment. The performance goal orientation, ineffective learning strategies, and avoidance of challenging tasks associated with a fixed mindset may negatively impact the development of clinical judgment. This exploratory study sought to determine if there is a relationship between the non-cognitive factors, mindset beliefs and …

“We Rely On Each Other”: A Qualitative Exploration Of Rural Eastern Region Native American Experiences During The Covid-19 Pandemic, Robin M. Dawson Phd, Rn, Cpnp-Pc, Hunter M. Boehme, Stephen Criswell Ph.D., Julia Dunham-Thornton, Melissa S. Nolan Ph.D., Mph

Publications

Background: Native American communities suffered disproportionately negative effects during the COVID-19 pandemic, yet no research has explored the experiences of rural Eastern Region Native Americans. Methods: Informed by the Native Reliance Model and Indigenous Standpoint Theory, we conducted a qualitative descriptive project in the Spring and Summer of 2022; data included semi-structured interviews and focus groups with 24 individuals representing five South Carolina tribal groups. Findings: Thematic analysis yielded four emergent themes: 1) “Let's just finish the Indians off”: Pandemic distrust rooted in historical and contemporary Native American experiences; 2) “We have been misled”: Making sense of conflicting public health …

The Price We Pay: An Integrative Review Exploring The Effects Of Wellness Culture On Nurse Burnout Rates, Rebekah Lillian Vance

Doctoral Dissertations and Projects

The purpose of this integrative review is to identify cultural factors contributing to nurse burnout and to explore the strategies and effectiveness of wellness culture and cultural changes on nurse burnout rates. Nurse burnout has been attributed to a myriad of factors and has been identified in nursing since the 1970s. While other professions with similar burnout issues have investigated and implemented culture-wide changes to address burnout, nursing has remained stagnant in the field of burnout research, often applying single interventions that fall short of creating significant, lasting change. An integrative review of nursing, peer-reviewed literature was conducted in an …

Examining The Effects Of An Isbarr Educational Intervention On Self-Efficacy Of Senior-Level Nursing Students Within A Transition To Practice Course: A Quasi-Experimental Study, Stacy Nicole Taylor

Doctoral Dissertations and Projects

The purpose of this study was to examine the effects of an introduction, situation, background, assessment, requests/recommendations, and repeatback/readback (ISBARR) educational intervention on self-efficacy of senior-level nursing students' within a Transition to Practice course at one Christian university in the southeast United States. The theoretical framework utilized in this study was Bandura's theory of self-efficacy. This study was a quasi-experimental design with a control and intervention group. The control group was in the Fall 2023 semester, and the intervention group was in the Spring 2024 semester. Each participant completed a pre-test and post-test, which was the New Generalized Self-Efficacy Scale. …

Anticoagulation Stewardship Initiative For The Outpatient Management Of Atrial Fibrillation, Ryleigh Hawker

Doctoral Dissertations and Projects

Anticoagulation prescribing for patients with atrial fibrillation at a local primary care and urgent care office has largely been conservative and unstandardized, leaving patients at risk for cardioembolic strokes. As more and more patients are diagnosed with this condition, the greater the need becomes for appropriate management within these settings. This includes preventing strokes with anticoagulation and utilizing an integrative or collaborative approach between specialty and non-specialty centers. The Anticoagulation Stewardship Initiative is the first step in promoting effective and safe anticoagulation practices in primary and urgent care centers, while simultaneously streamlining care for newly diagnosed patients. Some of the …

Educating Nurses On The Components Of A Healthy Work Environment, Kathryn L. Scott

Doctoral Dissertations and Projects

It is essential to look at the entire picture to ensure patient care is offered in the highest quality manner possible. One must look at patient satisfaction, quality outcomes, and job satisfaction experienced by the nursing staff providing care to accomplish this goal. Research has shown that nurse burnout has increased exponentially as of late. Some blame the COVID-19 pandemic; others look at the generation of nurses graduating from nursing school and starting in the field, comparing the baby boomer nurse to the Gen Z nurse. Many factors are involved, and with the recent addition of paying particular attention to …

Provider Implementation Of Probiotics As An Adjuvant Treatment Modality For Patients With Anxiety And Or Depression In A Primary Care Setting, Sarah Dedmon

Doctoral Dissertations and Projects

The prevalence of anxiety and depression among Americans is growing rapidly. Patients are seeking out traditional treatments as offered by their primary care providers, but also frequently look toward integrative or complementary methods of managing their symptoms. The use of dietary supplements is at an all-time high, yet the U.S. Food and Drug Administration does not regulate these substances for potency and purity or evaluate them using quality standards as it does pharmaceuticals. Most providers lack education regarding the physiological interaction their patients may experience when using these substances and are naïve to their place in primary care medicine. The …

The Effects Of An Emotional Intelligence And Empathy Interactive Education Program With Prelicensure Nursing Students, Karen Browne

Doctoral Dissertations and Projects

A dissertation is presented on a teaching program for emotional intelligence (EI) and empathy with a cohort of nursing students enrolled in a traditional, undergraduate nursing college in the Northeast region of the United States (US). An interactive teaching program was used with various media to present new material and learning activities during the spring semester. The importance of teaching nursing students the aspects of EI was to prepare them for the rigors of the profession by allowing them to delve into their own self-awareness and emotional regulation, which in turn helps to connect with patients in a more robust …

Improving Use Of Water Immersion And Birth Satisfaction During The First Stage Of Labor Through An Educational Handout, Dana E. Taylor

Doctoral Dissertations and Projects

Although using the birthing tub for hydrotherapy during the first stage of labor has been proven to be a safe and effective method of low-intervention pain management, as well as research that indicates potential other benefits such as a reduction in the use of an epidural, improvement in breastfeeding rates, and promotion of physiologic birth, its use is often limited. Chief reasons for the lack of its use include difficulty and time constraints with tub set-up and lack of knowledge about its benefits, especially the length of time used. A quasi-experimental evidence-based project at a suburban magnet-designated hospital using a …

Health Policy: Food Allergy Restaurant Education Law, Joanna Ko

Doctor of Nursing Practice Projects

Food allergies are a rising public health concern with no indication of deceleration. The purpose of this Doctor of Nursing Practice (DNP) project is to enact an Arkansas state law to protect the food allergy community in dining out at restaurants to increase quality of life and decrease adverse allergic reactions. The current Arkansas state legislation for restaurant food allergy employee training is absent and action needs to be taken to safeguard the food allergy community from life-threatening reactions. The methodology involved contacting the six states that have previously implemented similar food allergy legislation. It encompassed performing a thorough search …