Nursing Commons^™

Early Mobilization For Adult Mechanically Ventilated Patients, Stephanie Miller

MSN Capstone Projects

Approximately 13 million people worldwide receive treatment in intensive care units (ICUs) annually. Many patients admitted to the intensive care unit require mechanical ventilation for their survival and attempts to mobilize these critically ill patients is frequently restricted for their own safety. It has been suggested that this lack of mobility may have a significant negative impact on the recovery process and lengthen the time of the patient’s overall hospital stay and recovery. Additionally, survivors report significant physical impairments and deconditioning that present obstacles towards their recovery and well-being after prolonged ventilation.

Mandatory Child Abuse And Neglect Reporting Behaviors Among Registered Nurses In New Mexico: A Statewide Comparative Study, Ingrid Ann Wilson

Nursing ETDs

Child abuse and/or neglect (CAN) is a global problem. Although nurses are mandated CAN reporters, a lack of reporting has been an issue. New Mexico (NM) is faced with higher child poverty and CAN-related substance-abuse compared to other U.S. states. This quantitative study aimed to explore factors influencing intended/actual CAN reporting behaviors among NM registered nurses (RN)s, examine relationships of these factors, and compare differences in reporting behaviors between rural and urban locations. A survey to a sample of RNs (N=146) showed factors associated with CAN reporting intended behaviors were work status (r=.21, p < .05), cues to action (r=.20, …

Examining School Nurses' Knowledge And Confidence Related To Their Intention To Screen For And Report Child Sexual Abuse: A Descriptive Cross-Sectional Study, Suzanne Ackers

Electronic Theses and Dissertations

Background: Child sexual abuse (CSA) in a preventable national public health problem that results in adverse health consequences. Research suggests many victims are currently attending school. Screening for early detection of health issues is integral to school nurse (SN) practice but there is little evidence that screening for CSA is occurring in schools despite recommendations that it should be. Lack of confidence and knowledge related to screening for suspected CSA contribute to a SN’s missed opportunity for early intervention.

Purpose: To describe SNs knowledge and self-efficacy associated with screening for and reporting CSA in school settings.

Methods: A descriptive cross-sectional …

“One University’S Covid-19 Pandemic Mitigation Response And Anxiety Construct: A Summative Program Evaluation”, Ann Hodgin

Doctor of Nursing Practice (DNP) Manuscripts

Abstract

The effects of the COVID-19 pandemic continue to ripple through everyday life. In December 2019, an outbreak occurred in China. Subsequently, the World Health Organization identified SARS-CoV-2 as a new type of coronavirus that quickly spread around the globe (Nazario, 2022). As of May 31, 2023, there were 6,938,353 confirmed deaths worldwide from COVID-19 (WHO, 2023).

A needs assessment completed by the University identified that a program evaluation of the university’s COVID-19 response was warranted. Therefore, this program evaluation was conducted to assess the effectiveness of the policies and protocols implemented at a Catholic University in Southwestern Pennsylvania to …

Effectiveness Of A New Graduate Nurse Residency Program: A Program Evaluation, Christine Meyer

Doctor of Nursing Practice (DNP) Manuscripts

Healthcare organizations continue to face challenges in the retention of new graduate registered nurses (NGRNs) within the first year of hire. Accredited nurse residency programs are designed to provide support to NGRNs and help make the transition from student to graduate nurse by developing their knowledge and skills. This project evaluates a nurse residency program at a rural, community hospital. The project aims to analyze both qualitative and quantitative data to evaluate the program outcomes as it relates to nurse retention, turnover, and job satisfaction. The sample includes 94 new graduate registered nurses that were part of the yearlong residency …

Improving Ostomy Patient’S Self-Efficacy And Quality Of Living Through Prehabilitation And Prevention Of Complications Using Telehealth Visits: A Quality Improvement Project, Shabnam Pratik Bagh

Doctor of Nursing Practice (DNP) Manuscripts

Due to the rise in colorectal cancer and diverticular diseases in the United States, approximately 100,000 to 150,000 intestinal stomas (fecal diversions) are created annually. With approximately 80% of readmissions experiencing post-discharge complications (Agri et al., 2020), quality improvement (QI) initiatives to increase ostomy patient’s self-efficacy and quality of living (QOL) are needed. The purpose of this QI project was to enhance the current continuum of care for ostomy patients by adding a Prehabilitation Session prior to surgery followed up with 24-hour Telehealth visits after discharge from the hospital to support their living with an ostomy. The resulting Comprehensive Ostomy …

Evaluating Outcomes Of An Integrated Medical Care Model In An Acute Care Hospital: A Program Evaluation, Erin Flanagan

Doctor of Nursing Practice (DNP) Manuscripts

Background: Increased awareness of disparities for people with co-occurring medical and behavioral health disorders identified a gap in their individualized health care plan. This gap provides opportunities for hospitals and acute care centers to evaluate current care models for this specific patient population. Problem: Hospitals are challenged to meet the growing needs of patients while working to decrease operational costs. Patients with behavioral health disorders also have significantly greater spending for general medical conditions than patients without a behavioral health disorder (Chu et al., 2019). Methods: Hospitals are attempting to address this gap in care through interdisciplinary or collaborative care …

A Program Evaluation Of An Internship Program And Its Effectiveness On Retention During The First Year Of Professional Practice, Jamie Kilpatrick

Doctor of Nursing Practice (DNP) Manuscripts

Background and Significance: The registered nurse is an essential component of the healthcare team. Successful efforts have occurred worldwide for recruitment to the nursing profession. However, vacancy plagues the nursing profession through turnover, with the new graduate registered nurse remaining the most vulnerable with the highest rate of turnover. This program evaluation will review one organization’s retention project to support the senior nursing student with a paid clinical internship, and additional support through the vulnerable first year of practice within the chosen care setting. Methods: This summative program evaluation will utilize a systems-oriented approach and quasi-experimental methodology with quantitative data …

Implementation Of A Structured Hybrid Training Program To Improve Clinical Skills And Staff Confidence In The Care Of Maternal And Neonatal Patients In The Emergency Department: A Quality Improvement Project, Melissa Hewitt

Doctor of Nursing Practice (DNP) Manuscripts

Caring for a pregnant woman or compromised newborn is often a stressful situation for all healthcare workers regardless of their experience or expertise. This stress is only heightened when the patient presents to a unit that may not be comfortable with the situation such as the Emergency Department (ED). Often units such as the ED do not receive adequate training in caring for maternal and neonatal patients. The infrequency of patient interactions coupled with their lack of knowledge can leave staff with decreased levels of confidence. Various research articles recommend that hospitals provide interdisciplinary team training for high acuity low …

Implementation Of A Nursing Peer Mentorship Program To Improve Nursing Retention And Job Satisfaction In An Acute Care Hospital: A Quality Improvement Project, Rebecca Cassel

Doctor of Nursing Practice (DNP) Manuscripts

Background and Significance: Currently staffing shortages are impacting patients and communities nationwide. This problem has been on the rise since the before the pandemic. COVID-19 has certainly increased the rate of nursing turnover, and vacancy, especially in acute care (Krofft & Stewart, 2021). Many factors contribute to nursing turnover, including nursing satisfaction, interprofessional relationships, and organizational support, and it is apparent that swift and effective action is needed, to ensure that safe, skilled nursing professionals are available to provide the necessary treatment that those seeking healthcare need. Nursing Mentorship programs have been shown to improve retention of nursing staff, …

Mindfulness Meditation To Reduce Nurse Burnout: An Ebp Implementation Project, Lester Denson Jr

MSN Capstone Projects

Hospitals across the United States are suffering from poor staffing (American Nurses Foundation, 2021). A common thread throughout those facilities is that nurses are leaving their jobs due to self-reported burnout, contributing to the staffing shortage and low morale (Shah et al., 2021).

Mindfulness training plays a part in decreasing emotional exhaustion for staff nurses. A reduction of emotional exhaustion has been discovered after the implementation of mindfulness-based intervention programs, with continued improvement after completion of the program (Sarazine et al., 2021; Bianchini & Copeland, 2021). The benefit of this implementation would be a reduction of nurse burnout which ultimately …

Improving Nursing Provision Of Patient Care In High Acuity Medical Units And Fostering Their Wellbeing By Providing Education On End-Of-Life Care And Finding Joy And Meaning In Work: A Quality Improvement Project, Donna Durant

Doctor of Nursing Practice (DNP) Manuscripts

Abstract

Palliative care employs a multidisciplinary approach focusing on the quality of life for patients and their families experiencing the complexity of serious illness (Nelson, 2021). Due to shortages of palliative care specialists and a lack of nurse proficiency in caring for people with serious illnesses, integrating a palliative care approach is an ethical obligation for nursing (Parekh de Campos, 2022). Gaps in palliative care and end-of-life education for new nurses coming to the acute care setting in a large tertiary hospital in Southwestern Pennsylvania were identified.

Evidence-based education was delivered by advanced practice providers trained in this content area. …

"Reducing Heart Failure Readmission Rates Through Implementation Of Heart Failure Diuretic", Caley Tatrn, Yvonne Weideman, Venkatraman Srinivasan

Doctor of Nursing Practice (DNP) Manuscripts

Background and significance: heart disease was the number one cause of death in the United States in 2021, with 696, 962 deaths (Leading Causes of Death, 2022). There are about 6.2 million individuals in the U.S. total with heart failure (Kilgore et al., 2017). About one-quarter of patients with heart failure are readmitted within thirty days of discharge, while one-quarter of hospital readmissions are preventable. Between 2010-2017, over seven million patients were admitted for heart failure in the United States. Eighteen percent had a readmission within thirty days and thirty-one percent had a readmission within ninety days (Khan et …

Recognition Of And Response To Obstetric Emergencies: Developing A Virtual Competency-Based Orientation Program, Susan Morrison

Student Scholarly Projects

In order to improve outcomes in the perinatal setting, the development of a Virtual Competency-Based Orientation Program (CBO) toolkit is vital. Two toolkits, namely the Alliance for Innovation on Maternal Health (AIM) and the California Maternal Quality Care Collaborative (CMQCC), have been identified as effective in enhancing perinatal outcomes. AIM is a national initiative focused on improving maternal health outcomes, promoting safer birth practices, and saving lives through the implementation of best practices. CMQCC is a multi-stakeholder organization in California committed to eliminating preventable morbidity, mortality, and racial disparities in maternity care. Both AIM and CMQCC CBO toolkits incorporate research, …

Early Identification Of Postpartum Depression Symptoms During The Antenatal Period Through The Utilization Of The Edinburgh Postnatal Depression Scale, Cherie Didier

Doctor of Nursing Practice Projects

Postpartum depression (PPD) is a prevalent mental health disorder that negatively impacts maternal behavior and infant development. Despite a global incidence of around 12% (Ti & Curtis, 2019), current screening practices are inadequate. The American College of Obstetricians and Gynecologists (ACOG, 2018) recommends universal screening using the Edinburgh Postnatal Depression Scale (EPDS) at least once during pregnancy. However, the project site in an obstetrical clinic currently does not screen during pregnancy. This quantitative quality improvement project in a Memphis, TN, obstetrical clinic used systematic data collection of EPDS scores of pregnant women and analysis to investigate the effectiveness of implementing …

Improving Timeliness Of Nursing Documentation, Anthony S. Morgan

Doctor of Nursing Practice Projects

Nursing documentation is a critical element of the patient's medical record and contains essential information relied upon to create and implement the plan of care. Despite the understood importance of timely documentation, nurses in this community hospital inpatient medical/surgical unit still struggle to complete data entry promptly. This quality improvement project aimed to improve the efficiency and timeliness of nursing documentation in this unit by deploying the EMR on a mobile application as an adjunct to desktop and laptop PC devices. EMR reporting tools were used to collect timestamps of flowsheet documentation observation time and observation entry time. Time in …

Impact Of Anxiety In School Aged Children And Adolescents In Rural Settings, Jasmine Smith

Doctor of Nursing Practice Projects

The widespread prevalence of youth anxiety has a strain on rural communities lacking screening access. The Screen for Child Anxiety Related Emotional Disorders (SCARED) Tool is widely validated to assess anxiety. The project’s purpose analyzed clinician’s adherence to screening youth with a chief complaint of anxiety or as a behavioral referral at Shaw Medical. The principal investigator implemented a SCARED educational protocol which consisted of SCARED handouts, mock training interviews, a post-educational survey, and chart audits. A descriptive research design using a retrospective chart review examined SCARED screenings in 100 youth aged 8-18 listing sociodemographic statuses of gender, race, and …

Rounding With A Purpose: Reducing Falls In Geriatrics Residing In A Community Living Center, Ashley Wesson

Student Scholarly Projects

Practice Problem: Falls among geriatrics continue to be a significant concern for healthcare organizations and one of the costliest healthcare problems attributed to increased morbidity and mortality rates. Falls rates in residential dwellings such as nursing homes and community living centers (CLCs) continue to rise despite fall prevention efforts.

PICOT: The PICOT question that guided this project was In geriatrics, age 65 or older, who reside in the Community Living Center (P), how does one-hour purposeful rounding (I), compared to rounding without structured set time intervals (C), affect fall reduction rates (O), within eight weeks (T)?

Evidence: In fifteen high-quality …

Evidenced-Based Practice Competency Assessment For Competency-Based Orientation Protocol To Improve Competency Level Among Medical-Surgical Nurses, Maryann Ornelas

Student Scholarly Projects

Practice Problem: Within a 12-month period, high incidences of severe post-spinal surgical complications resulted in a host of concerns in this clinical site when patients either returned to the operating room for spine revision or increased the length of stay.

PICOT: The PICOT question that guided this project was: "In Medical Surgical (Med-Surg) nurses (P), how would a Competency-Based Orientation (CBO) protocol with the inclusions of four critical elements of postoperative spinal care [POSC] (I) compared to the usual postoperative practice (C) enhance competency level in Med-Surg nurses when delivering postoperative practice at an inpatient setting (O) over 10 weeks …

The African American Dream Deferred: Exploring The Relationship Between The “American Dream” And The Black American Millennial Reality, Simonleigh P. Miller

Seton Hall University Dissertations and Theses (ETDs)

The purpose of this qualitative study is to highlight and bring understanding to the lived experiences of Black American millennials. This study was conducted from the constructivist and critical research paradigms and utilized Reflexive Thematic Analysis methods to analyze qualitative data. The study places specific focus on Black or African American millennials’ associated thoughts and feelings regarding their current reality and positionality within the American context, and its relation to the idealized reality of the American Dream. The influence of the American Dream on the African American millennial reality was explored to gain a better understanding of how, or if …

My Happy Baby Is Back: Zero Balancing, Craniosacral Therapy And A Baby’S Journey To Becoming Mobile, Veronica Quarry

Journal of Transformative Touch

Alison began receiving ZB and CST at 13 months of age due to gross motor delays: at that age she was only able to sit somewhat rigidly. After the first session, Alison changed` from being very unhappy and seemingly frustrated to being happy and more calm. Within one month of weekly sessions, Alison was able to be on her tummy, began to crawl, became more agile in seated play, was squatting and standing and took her first steps.

A Multi-Stakeholder Perspective On Quality Of Care Among Residents, Family Members And Nursing Staff In Nursing Homes: A Balanced Centricity Approach, Sil Aarts, Erica De Vries, Hilde Verbeek, Gaby Odekerken, Katya Y. J. Sion

Patient Experience Journal

The objective of this study was to use a Balanced Centricity (BC) approach to describe how personal values related to experienced quality of care are defined for residents, family and nursing staff in nursing homes. Capturing the values from a multi-stakeholder perspective, a qualitative approach was conducted in which the stakeholders’ (e.g., residents, family members of residents and nursing staff; a triad) experiences, opinions and values were explored. Participants were recruited from ten nursing homes within the Living Lab in Ageing & Long-Term Care Limburg, the Netherlands. The audio recording of every interview was transcribed verbatim. The analysis made use …

Identifying Sources Of Patient Dissatisfaction When Seeking Care For A Chronic And Complex Disease, Katharine J. Head, Anna K. Forster, Amanda Harsin, Rebecca J. Bartlett Ellis

Patient Experience Journal

Patients’ evaluations of healthcare often rely on patient satisfaction and encounter-specific approaches. Instead, valuable information can be gained by focusing on patient dissatisfaction with healthcare over time. This study examined patients’ sources of care dissatisfaction when seeking healthcare for a long-term chronic and complex disease (CCD). Participants with a CCD called polycystic kidney disease (N=387) completed an online questionnaire with an open-ended question about dissatisfying experiences. Content analysis was used to analyze responses. The coded data resulted in conceptual codes related to dissatisfaction with information, support, and care management. Analysis revealed the type of healthcare provider is often …

Standardizing Congestive Heart Failure Education To Decrease Readmissions, Cyntia Boter

Master's Projects and Capstones

Background: The setting of this project took place in a small 100-bed community hospital that is a part of a larger healthcare organization in Northern California. The focus of the project was the implementation of standardized education for patients with congestive heart failure (CHF) to lead to an outcome of decreased readmissions. Readmissions to hospitals are costly and effective discharge planning can impact and decrease readmissions.

Problem: The facility in which this project took place has 35 readmissions a year for CHF. It is the third highest DRG and reason for readmissions in 2022. Although there is work in place …

Transformational Leadership Training For Middle Management To Reduce Turnover And Improve Job Satisfaction, Andrea Huntsinger, Andrea Huntsinger

Master's Projects and Capstones

Reduce Turnover and Improve Job Satisfaction

Abstract

Background: The medical center’s Maternal Child Health Department comprises 10 labor and delivery beds, 22 postpartum beds, and a 16-bed Level II NICU. The unit is overseen by six ANMs, a manager, and a director. The unit comprises approximately 160 employees, most being bedside registered nurses (RNs). The hospital prioritizes achieving Magnet status, where nurse job satisfaction is prioritized. The concern is that the department’s culture is not aligning with Magnet guidelines due to a lack of leadership within the unit.

Problem: A review of the department’s ANM team showed an unstable turnover …

Use Of Electronic Health Record Reminders To Improve Primary Care Providers’ Colorectal Cancer Screening Recommendations., Terra Renee Schrembs

Doctor of Nursing Practice Papers

Background: Colorectal cancer (CRC) is the third most common worldwide cause of cancer morbidity and mortality. CRC mortality is preventable through regular screening. Electronic health record (EHR) reminders for providers can increase providers’ CRC screening recommendations and lead to earlier CRC diagnosis. According to the National Cancer Institute’s Screening and Risk Factors Report for Kentucky by County 2008-2010, 62.7% of adults in a rural Kentucky county aged 50-75 had completed a home based FOBT in the past two years or have ever had a colorectal endoscopy.

Purpose: The purpose of this DNP project was to implement and evaluate an …

Evaluation Of Sensory Room Education To Promote Usage In An Inpatient Psychiatric Setting: A Quality Improvement Project., Breanna M. Coulardot

Doctor of Nursing Practice Papers

Seclusion and restraints are intended to be used as a last resort intervention if a patient presents as harmful to themself or others. However, the use of seclusion and restraints in mental health practice has been questioned for several decades. A 26-year study that researched restraint-related fatalities among children and adolescents in the United States from 1993 to 2018 disclosed 79 deaths (Nunno et al., 2022). Seclusion and restraints also restrict autonomy which can cause retraumatization if a patient was previously neglected or abused (Hammer et al., 2011). Many patients presenting to the project site are survivors of neglect and …

A Program Evaluation Of Domestic Violence Screening At A Large Urban Hospital., Taylor L'Heureux

Doctor of Nursing Practice Papers

Domestic violence has been deemed a direct invasion and violation of human rights by the World Health Organization (2021). Due to the continuous rise in cases of domestic violence, national organizations like the United States Preventative Services Task Force (USPSTF) have recommended that healthcare providers screen patients for this abuse. The purpose of this study was to reinforce the current screening procedure and protocol to ensure that each patient was screened for domestic violence before being discharged from the hospital. This study evaluated a quality improvement project formed to promote the completion of a preexisting domestic violence screening form that …

Implementation Of A Mindfulness Intervention To Increase Adolescent Resilience In An After-School Program: A Quality Improvement Project., Katie Thomas

Doctor of Nursing Practice Papers

Background: Globally, fourteen percent of adolescents ages 10 to 19 years old suffer from mental health problems (World Health Organization, 2021). Resilience is a fundamental concept of the mental health promotion framework (CAMH, 2022).The WHO (2020) “Guidelines on Mental Health Promotive and Preventive Interventions for Adolescents” includes the recommendation that universal interventions to promote mental health and reduce mental disorders should include social and emotional learning (SEL), such as emotional regulation, mindfulness, stress management, problem solving, and interpersonal skills. Mindfulness-based interventions (MBIs) are one evidence-based method of accomplishing this goal (Sapthiang et al., 2018). Purpose: The purpose of …

Implementation Of An Initiative To Standardize Abdominal Binder Use In Postoperative Cesarean Section Patients: A Program Evaluation., Sarah Cohron

Doctor of Nursing Practice Papers

A cesarean section is a major abdominal surgery with a unique recovery profile. The patient must recover from surgery while simultaneously coping with a major life event: the birth of a new baby. The utilization of pain management techniques with as few side effects as possible is paramount to ensure optimal maternal and newborn outcomes (Karlström et. al., 2007; Eisenach et. al., 2008). On an inpatient mother/baby unit at a high-risk urban hospital in Louisville, Kentucky approximately 66 babies are born via cesarean section every month (Mattingly, 2021). However, in the fall of 2021, it was discovered that there was …