Nursing Commons^™

Effective Coping Mechanisms For Nurses Following Patient Death, Tiffany Gagliardo

Senior Honors Projects

The loss of a loved one affects family and friends but also the nurses and health care providers. At the time of death, nurses are at the bedside providing comfort and words of support. But who is there to support the nurses when the patient dies? The objective of this research project is to identify positive coping mechanisms that nurses can use on a daily basis through an extensive analysis of the literature and individual nurse interviews.

Unfortunately, patient death may be more common for nurses who work on Intensive Care Units (ICU) and Hospice agencies. With the daily requirements …

The Effect Of Standardized Patient Encounters On Undergraduate Nursing Student Empathy And Self-Efficacy In Therapeutic Communication, Alana M. Urness

Evidence-Based Practice Project Reports

Therapeutic communication between the nurse and patient is an essential component of optimal nursing care. Current evidence supports the use of standardized patient (SP) encounters to assist students in learning therapeutic communication skills. In addition to offering students an opportunity to practice in an environment free of clinical consequence, SP encounters have been shown to increase clinical knowledge and skill, improve diagnostic reasoning, and improve communication skills and interviewing skills. The purpose of this evidence-based practice project was to assess the effect of SP encounters on undergraduate nursing student empathy and self-efficacy related to therapeutic communication. Secondary outcomes included participant …

Implementation Of A Nursing Workload Tool To Reduce Nurse Burnout, Nicole K. Greives

Evidence-Based Practice Project Reports

Nursing burnout and workload is a complicated issue with far-reaching effects. Nursing burnout and inappropriate nursing workload have been linked to increased risk of urinary tract infection, respiratory infections, decreased patient satisfaction, decreased quality and safety of care, and increased mortality. The purpose of the project was to decrease nursing burnout on a Medical Progressive Care Unit (MPCU) by moving patients with high workloads and medical instability to a higher level of care. Within this project, Rosabeth Kanter’s Theory of Structural Power was used for the theoretical framework, and the Stetler Model guided the implementation. The intervention consisted of a …

The Effects Of Education On Compassion Fatigue Experienced By Oncology Nurses, Ina Wilson

Evidence-Based Practice Project Reports

Oncology nursing is widely viewed as a rewarding and emotional challenging specialty. Oncology nurses witness terminal illness, death, physical, and emotional suffering which increases their risk of developing compassion fatigue. The purpose of this evidence-based practice (EBP) project was to increase awareness of compassion fatigue among oncology nurses by providing them with knowledge, effective coping skills, and self-care management skills. The Theory of Human Caring was used as the theoretical framework to support this EBP project and the intervention was guided by The Iowa Model of Research-Based Practice to Promote Quality Care. The project used a pre-test and post-test design. …

Breastfeeding Education For Fathers: An Intervention To Increase Breastfeeding Rates, Jill Marie Frisz

Evidence-Based Practice Project Reports

If every infant were breastfed within an hour of birth, exclusively breastfed until six months, and given breastmilk up to two years, almost 800,000 lives would be saved annually (who, 2014). Nationally, breastfeeding rates drop significantly from three to six months. A search of literature yielded significant evidence as fathers for facilitators to increase breastfeeding rates. The purpose of this evidence based practice (EBP) project was to determine the effects of best practice measures to educate fathers about breastfeeding to increase anytime breastfeeding rates. The social support theory and ACE Star model guided the literature search and implementation of this …

Implementing An Intervention To Reduce Seclusion And Restraints In An Inpatient Psychiatric Hospital, Amanda B. Lykins

Doctor of Nursing Practice Projects

The need to enhance nursing staff’s knowledge, perceptions and attitudes around alternatives to seclusion and restraint has been well validated in the literature. Seclusion and restraint use in the inpatient psychiatric setting are highly dangerous physical interventions, used to control the behavior of a mentally ill patient who is a danger to self or others. Seclusion and restraint events have the potential to cause emotional trauma, physical injury to patients or staff and the possibility of patient death. The purpose of the capstone project was to implement an evidence-based education program to, improve nursing staff’s (RN, LPN, MHA and SRNA) …

Development Of A Bedside Shift Report Policy And Guidelines To Assist Nurses With Patient Care, Cynthia Snedecor

Walden Dissertations and Doctoral Studies

In 2013, the Hospital Consumer Assessment of Healthcare Providers System (HCAHPS), a national, independent metric of patient satisfaction, revealed room for improvement at a teaching hospital in the southeastern section of the United States. This project reports the development and validation of a Bedside Shift Report (BSR) policy, practice guidelines, and associated documentation. Several initiatives, models, and theories informed thinking about this project. The work of Kurt Lewin and the Institute for Healthcare Improvement- Robert Wood Johnson Foundation's joint initiative, Transforming Care at the Bedside, both guided the project in terms of the process of institutional change. SBAR (Situation Background …

New Graduate Nurses: Evaluating An Innovative Mixed Method Orientation Program, Mary Josette Armendariz-Batiste

Walden Dissertations and Doctoral Studies

Institutions are recruiting new graduate nurses to fill their vacancies. The aim of this project was to create a new graduate nurse orientation program that consists of the Essentials of Critical Care Orientation (ECCO) program created by the American Association of Critical Care Nurses (2014), scenarios, and simulation that will result in an increase in nurses' sense of their ability to provide safe patient care, communicate effectively, perform skills, and increase their sense of institutional support. The theoretical framework for this mixed methods project was Benner's "From Novice to Expert." The convenience sample participants consisted of 17 baccalaureate-prepared new graduate …

Self-Efficacy And Select Characteristics In Nurses Who Respond To A Pediatric Emergency, Nancy Mcneill

Walden Dissertations and Doctoral Studies

Self-Efficacy and Select Characteristics in Nurses Who Respond to a Pediatric Emergency

by

Nancy McNeill

MA, New York University, 1996

BS, New York University, 1987

Doctoral Project Study Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Education

Walden University

June 2016

Nurses at a suburban northeastern U.S. community hospital reported that they felt unprepared to effectively respond to a pediatric emergency. Empirical data were not available to identify if this local problem was due to a lack of the nurses' self-confidence or if other factors were involved. The purpose of this study was to determine …

Transformational Leadership As A Means Of Improving Patient Care And Nursing Retention, Carla D. Thomas

Walden Dissertations and Doctoral Studies

The Joint Commission (TJC) sets standards to assist healthcare organizations in improving performance. The hospital for which this project was developed did not meet national TJC benchmarks for patient satisfaction and nurse retention. Based on direct observation, discussion with staff, and results of the Multifactorial Leadership Questionnaire given to 39 staff nurses before this project was chosen, evidence suggested that the leadership style of the charge nurses was transactional, which is less effective than transformational leadership (TFL). Framed within the Plan, Do, Study, Act model, the purpose of this quality improvement project was to design an educational curriculum including didactic …

Improving Pain Management For Hospitalized Patients, Ronda Sweet

Walden Dissertations and Doctoral Studies

Uncontrolled pain has proven effects on both physiological and psychological responses of hospitalized patients. These incapacitating sequelae most often negatively impact patient outcomes resulting in unnecessary suffering and prolong hospitalizations. First line nurses often have preconceived notions about a patient's pain without developing an individualized patient context that considers appropriate pain management knowledge translated from best practice standards. Guided by Bandura's social learning theory and Lippitt's change theory, the purpose of this quality improvement project was to determine if use of the Curriculum Outline on Pain for Nursing from the International Association for the Study of Pain (IASP) improved nursing …

Improved Satisfaction On Postpartum Unit By Implementing A Discharge Nurse Role, Nicole Ware Rn, Msn

Master's Projects and Capstones

A three-month time period was used to develop a postpartum education program change by designing a discharge nurse role on the postpartum unit at University of North Carolina Women’s Hospital. The goal of the education change is to increase patient satisfaction scores of discharged post-natal mothers on the postpartum unit by having HCAPS and Press Ganey to improve up to10% over the next 6 months.

An observational assessment revealed a fragmented and antiquated discharge process. This process was paper based and difficult to complete in light of the short stay and high volume patient population. Informal nurse feedback as well …

Nurses’ Perceptions Of Self As Role Models Of Health, Shelia Hurley

Electronic Theses and Dissertations

Given the sad state of obesity and lifestyle-related illnesses in the US, nurses, as the largest and most trusted health profession, must take the cause of health promotion seriously and personally. This study seeks to close the gap in knowledge of nurses’ perception of self as a role model of health and personal healthy lifestyle behaviors. This study focuses on four specific behaviors that lead to a healthy lifestyle: limit alcohol, avoid tobacco, improve nutrition, and engage in physical activity. The purpose of this study is to determine the relationship between nurses’ health practices and their perceptions of self as …

Impact Of Standardized Oral Health Assessment On Preventing Ventilator-Associated Events, Juana Ambriz De Williams

Evidence-Based Practice Project Reports

Ventilator-associated pneumonia (VAP) is a common but preventable health-care associated infection that affects up to 20% of mechanically ventilated adult patients, resulting in estimated mortality rates ranging from 13% to 55% (Chahoud, Semaan, Almoosa, 2015; Melsen et al., 2013). In an effort to reduce morbidity, mortality and related costs, the Centers for Disease Control and Prevention (CDC) and the National Healthcare Safety Network (NHSN), proposed ventilator-associated pneumonia prevention as a national patient safety goal. In 2014, amid growing concerns that the subjectivity of existing definitions had led to inconsistent reporting, thereby impeding efforts to reduce VAP, the CDC refocused surveillance …

Impact Of Hospice Nurse Education On After-Hours Calls And Visits, Cheryl Slack

Evidence-Based Practice Project Reports

Medicare-certified hospice home care agencies must provide a 24/7 on call system for after business hours patient concerns. An agency identified a problem with a high volume of after-hours hospice calls for symptom management. How these calls are handled impact patient and family outcomes and satisfaction. A literature review provided evidence that hospice nurse education and appropriate telephone support improves symptom management, enhances family support, provides a sense of security, reduces anxiety, and promotes comfort. Providing hospice nurse education on symptom management supported the goal of this evidence based practice (EBP) project to reduce the family/caregiver need for frequent on-call …

Using Education And A Prevention Protocol Tool To Decrease The Incidence Of Pressure Ulcers In A Nursing Home, Kristina L. Scalzitti

Evidence-Based Practice Project Reports

Over 1.3 million persons are residents in nursing homes (NHs); one in ten have pressure ulcers. The purpose of this evidence based practice project was to determine if implementation of a pressure ulcer prevention tool, along with staff education, decreases the incidence of pressure ulcers within the NH. Florence Nightingale’s Environmental Model and the Stetler Model were used to guide this project. The setting was a NH in northwest Indiana. Eleven nurses attended a 15 minute educational session on pressure ulcer prevention and implementation of the Pressure Ulcer Prevention Protocol Intervention (PUPPI) tool. PowerPoint slides were distributed and flyers about …

The Effects Of An Evidence-Based Food Allergy Management Plan To Keep Children With Food Allergies Safe At School, Scarlet R. Spain

Evidence-Based Practice Project Reports

The prevalence of food allergies in children has increased 18% between 1997 and 2007 (CDC, 2013). Furthermore, 84% of food allergic children will experience a reaction at school (Powers, Bergren, & Finnegan, 2007). An exposure in a sensitive child may progress quickly into potentially life threatening symptoms and death if not treated. The purpose of this evidence based practice (EBP) project was to determine if implementation of a food allergy management policy in a school setting reduced overall incidence rates of food allergy reactions in school children and to examine compliance to policy guidelines. The project encompassed implementation of a …

The Effect Of Education On Compassion Fatigue As Experienced By Staff Nurses, Kathryn L. Zehr

Evidence-Based Practice Project Reports

Historically, nursing has been perceived as a highly rewarding profession. Yet, due to the increasing complexity of today’s healthcare, nurses are faced with greater challenges in their work environments. Registered nurses who work in tertiary care settings are exposed to disturbing patient situations including trauma, death, abuse, or chronic disease. Joinson (1992) described this experience as compassion fatigue and symptoms include headaches, short attention span, or fatigue. A review of literature has identified that nurses should be educated about risk factors and coping strategies to combat compassion fatigue. Guided by the Model for Evidence-Based Practice Change and Jean Watson’s Theory …

Implementation Of An Advance Directive Protocol In A Primary Care Setting, Gloria Dillman

Evidence-Based Practice Project Reports

Despite the passage of the Patient Self-Determination Act in 1992, only 15% of the United States population has completed an advance directive (AD). This statistic will be exaggerated with the future growth of older adults in the year 2030, at which time this portion of the population is expected to double to 72.1 million people. Without an AD, patients lose their autonomy and may be subjected to costly, life prolonging treatments that they would never choose for themselves. The unnecessary costs and unwanted treatment are preventable with an AD, and primary care providers are in a prime position to initiate …

Inefficiency In The Post Anesthesia Care Unit: A Quality Improvement Initiative, Ashley St. Martin

Master's Theses and Capstones

Background: The post anesthesia care unit (PACU) is a busy environment in which nurses communicate with patients, family members, and a large team of perioperative professionals. PACU nurses were experiencing an unmanageable number of work interruptions due to a higher patient census which increased the daily surgical caseload.

Aim: The purpose of this project was to improve efficiency and nurses’ job satisfaction by making work interruptions manageable in the PACU.

Methods: Based on Kotter’s Change Theory, a quality improvement initiative was implemented using a change in the communication process. Qualitative and quantitative data was gathered in the PACU and on …

The Impact Of Relational Coordination And The Nurse On Patient Outcomes, Fanya Dejesus

Electronic Theses and Dissertations

Healthcare quality remains a significant issue due to fragmentation of care in our complex U.S. healthcare systems. While coordination of care is foundational to healthcare quality as well as identified as a National Priority, fragmentation and uncoordinated care continues to afflict our systems. The purpose of this study was to explore the relationship between relational coordination and adverse nurse sensitive patient outcomes, namely hospital acquired pressure ulcers, patient falls with injury, catheter- associated urinary tract infection, and central line-associated blood stream infection. A retrospective correlational survey design using cross sectional data was used to conduct this quantitative study. An electronic …

Leveraging The Power Of Shared Governance, Cynthia S. Cohen

Walden Dissertations and Doctoral Studies

Shared governance (SG) creates an evidence-based framework to support decision making in healthcare organizations by encouraging nursing staff ownership of nursing practice issues. This project assessed the current state of shared governance at a community hospital through: (a) deployment of Hess's Index of Professional Nursing Governance (IPNG) and the National Database of Nursing Quality Indicators (NDNQI) nursing satisfaction surveys which were open to nurses working in areas included in the SG framework at the project site, and (b) retrospective review of Unit Practice Council (UPC) and Nursing Senate (NS) minutes and agendas. Kotter's theory of change and the logic model …

Critical Care Nurses' Perceptions Of Their Knowledge And Self-Efficacy About Providing End-Of-Life Care, Mary Kathryn Gaffney

Walden Dissertations and Doctoral Studies

Most nurses receive limited formal education regarding end-of-life (EOL) care, which affects their ability to meet dying patients' needs. Guided by Bandura's social learning theory, this explanatory correlational study examined the relationships between critical care nurses' personal and professional characteristics and their perceived knowledge and self-efficacy when providing EOL care at an academic medical center. Convenience sampling was used to recruit participants from the eligible adult, pediatric, and neonatal critical care nurses for this study. The 67 participants completed the End-of-Life Professional Caregiver Survey (EPCS) to assess EOL care knowledge and self-confidence. Total EPCS scores revealed only moderate levels of …

Evaluating The Effectiveness Of Crucial Conversations® Training On Nurses’ Self-Efficacy, Deeanna R. Mccallie

DNP Projects

Background: The history of nurse/physician communication is well documented. Although there is no universal definition of nurse-physician communication, an increasing body of evidence identifies this factor as an important component of organizing and delivering safe, quality care to patients. Communication has been identified as the root cause in 65% of sentinel events and noted as having significant effect on patient outcomes; contributing significantly to increasing care coordination, decreasing length of stay, and decreasing mortality rates. Purpose: To examine whether Crucial Conversations® training improves nurses’ self-efficacy scores and assess whether clinical nurse report improved ability to communicate with physicians. Methods: A …

Just Sit For A Bit: A Moment Of Caring, Gabrielle M. Malouf

Master's Projects and Capstones

Background: Research shows that time spent sitting at the bedside promotes trust, which ultimately improves nurse satisfaction, patient satisfaction and patient outcomes. Patient satisfaction scores have been below benchmark for several months on an adult medical unit at an academic medical center.

Overview: The purpose of this project was to improve patient satisfaction in the areas of nursing courtesy, friendliness, and listening. Nurses were asked to sit down for at least 5 minutes per shift with each patient, engaging in a “moment of caring”. Nurse surveys were given and both pre and post implementation. These surveys assessed whether or not …

Improving Nurse Education On Research Informed Consent, Tina Rasooli

Master's Projects and Capstones

As the number of human participants in clinical trials continues to grow, it is increasingly imperative that research nurses are educated about valid research informed consent to improve patient outcomes. As patient advocates, nurses must be aware of the components and principles of valid informed consent in order to protect the rights, safety, and wellbeing of their patients as human subjects. The research nurse must also be aware of their available resources and who to contact if they suspect a problem or a lack of patient comprehension of the study. In order to address these needs, an evidence-based performance improvement …

Resilience In Nurses: An Integrative Review, Patricia L. Hart, Jane D. Brannan, Mary De Chesnay

Faculty Articles

Aim To describe nursing research that has been conducted to understand the phenomenon of resilience in nurses. Background Resilience is the ability to bounce back or cope successfully despite adverse circumstances. Nurses deal with modern-day problems that affect their abilities to remain resilient. Nursing administrators/managers need to look for solutions not only to recruit nurses, but to become knowledgeable about how to support and retain nurses. Evaluation A comprehensive search was undertaken for nursing research conducted between 1990 and 2011. Key search terms were nurse, resilience, resiliency and resilient. Whittemore and Knafl's integrative approach was used to conduct the methodological …

Effects Of An Apn-Led Amiodarone Clinic On Adherence To Recommended Monitoring Guidelines, Melissa Bartoszewicz

Evidence-Based Practice Project Reports

Evidence shows that patients receiving amiodarone therapy have not adhered to monitoring guidelines set forth by the Heart Rhythm Society. Uncertainty with responsibility for monitoring has led to the development of pharmacist-managed or multidisciplinary-managed outpatient amiodarone clinics. Some limitations have been identified in the pharmacist-managed outpatient clinics that may be overcome by advanced practice nurse (APN)-managed clinics. The purpose of this EBP project was to determine what effects an APN-led amiodarone clinic would have on adherence to amiodarone monitoring guidelines. Using the PICOT format, the clinical question was developed: Does enrollment in an amiodarone clinic compared with “usual care” change …

The Effect Of Telephone Follow-Up On Pain Experienced By Patients After Knee Replacement Surgery, Laurie J. Jones

Evidence-Based Practice Project Reports

Hospital length of stays are decreasing throughout the U.S. in an effort to contain healthcare costs, but these measures can be detrimental to patients. Those who get knee replacement surgery are finding their length of stay reduced from an average of 3 to 4 days to 24 to 48 hours, which can affect pain control and interfere with rehabilitation and recovery. This affects many people, as more than 632,000 knee replacements occur each year (American Academy of Orthopedic Surgeons, 2008). The purpose of this evidence-based project was to evaluate the effect of telephone follow-up on pain experienced by knee replacement …

The Effect Of Shared Medical Appointments And Education On Hemoglobin A1c Levels, Gina L. Moore

Evidence-Based Practice Project Reports

Type II diabetes affects millions of people worldwide. Approximately 25.8 million or 8.3 percent of the United States (U.S.) population has type II diabetes. The number of adults in the United States developing diabetes has been projected to double by the year 2030 (World Health Organization, 2013). Diabetes is the leading cause of kidney failure and blindness, as well as the major cause of heart disease and stroke which is the 7th leading cause of death in the U.S. The purpose of this evidence-based project was to determine the effects of education during shared medical appointments with type II diabetic …