Other Nursing Commons^™

Perceptions Of Adult Patients Accessing Telehealth In An Urban Medical Group, Katharine Shepherd West

Doctoral Projects

Problem: Although implementation of in-patient electronic healthcare records is nearly complete in the United States, this achievement has not translated into consumer-to-business telehealth in the primary care setting. Because there are few studies that describe how and why patients select telehealth, the aim of this study was to learn about perceptions of adult patients in an urban setting when telehealth options are available. Research questions included a) How do patients select any type of appointment? b) How do patients perceive and use telehealth options? c) How and when might telehealth be useful in the future?

Methods: A qualitative study design …

The Effect Of Basal Bolus Insulin Administration Vs. Sliding Scale Insulin On Glycemic Control In Patients With Type 2 Diabetes Mellitus At A Community Hospital, Meriam Signo

Doctoral Projects

Evidence of effective insulin delivery by nurses can help prevent fluctuating plasma glucose levels of Type 2 diabetes mellitus (T2DM) in the hospital setting. Information leading to better diabetes care using either basal bolus insulin administration (BBI) or sliding scale insulin (SSI) is essential for safe blood sugar values. The purpose of this project was to measure patient glycemic control after the implementation of BBI vs. SSI during a patients’ stay in the hospital. This study was a quantitative, retrospective exploratory chart review of T2DM in medical-surgical units at a Northern California community hospital. The data were collected from routine …

Understanding The Skills Necessary For Advanced Practice Nurses In Oncology To Deliver Bad News To Patients With Cancer: The Results Of A Delphi Analysis, Matthew Michael Burke

Doctoral Projects

Overcoming the dichotomy of providing bad news in a compassionate, empathetic manner that strengthens dialogue and enhances a caring environment is the ultimate challenge advanced practice nurses (APN) face in oncology. This study aims to understand the skills necessary for APNs in oncology to deliver bad news to patients with cancer.

Using a Delphi analysis, an established method of developing a consensus, a novel, patient-centered survey tool has been developed designed to extract as much information as possible about the present issue from an expert panel. Oncology APNs were recruited via Facebook. The survey tool was administered using a web-based …

Barriers In Health Care In Hmong Men And Women With Cardiac Diseases, Ying Thao

Doctoral Projects

Lauver’s theory of care seeking behaviors is applied to identify perceived barriers to accessing healthcare in Hmong men and women that may influence care seeking behaviors. The purpose of this study is to identify barriers in accessing health care among Hmong men and women ages 50 to 80 with cardiovascular heart disease (CHD) and risk factors for CHD (e.g., diabetes, hyperlipidemia, and hypertension). A quantitative descriptive analysis was used to look at demographic characteristics while a multiple regression analysis was used to statistically compare correlations between barriers to care, risk factors for CHD, sex, and access to health care. The …

Promoting Self-Efficacy Among Head And Neck Cancer Patients, Lily Lam

Doctoral Projects

Current survivorship visits at the Stanford head and neck oncology program are not standardized to address ongoing post-treatment sequelae. The objectives of this study help to address whether current non-standardized visits actually help to empower patients to self-manage their chronic diagnosis of head and neck cancer by measuring their self-efficacy levels before and after their post-treatment survivorship visit.

Given the convenience sampling method, 17 patients were enrolled in this quasi-experimental pilot study. Demographic information was collected for each patient: gender, ethnicity, smoker status, and age. Head and neck cancer patients would first be surveyed before and after their follow up …

Complete Care Model Impact On Glycemic Control In California State Prisons, Diane M. O’Laughlin

Doctoral Projects

The Complete Care Model (CCM) is a health care delivery model based on the well-studied and internationally validated chronic care theory. Since the integration of the chronic care theory into California Department of Corrections and Rehabilitation (CDCR) patient care in 2008, steady improvement in health care related mortality has been seen, and there have been no unavoidable health care related deaths in CDCR since 2012 (Gransee, 2018). However glycemic control in CDCR diabetic patients has made no statistically significant change since the implementation of the CCM in 2015 when comparing the two years before and the two years after implementation …

Does Preoperative Ostomy Education Decrease Anxiety In The New Ostomy Patient?, Michelle Suzann Harris

Doctoral Projects

Background: There are approximately 100,000 patients with new ileostomies and colostomies created in the United States each year. These patients have specialized needs that include acceptance of altered body image, psychological stress, learning of difficult tasks, and occasionally an ominous diagnosis leading to the need for surgery. In addition to pre-surgical stoma site marking on the abdomen, ostomy nurses have identified early education to be an important factor in long-term success and management of the patient . Early education and stoma site marking may assist with a better-situated stoma leading to fewer complications related to appliance adherence and leakage. …

Is There A Relationship Between Limited English Proficiency (Lep), Medication Adherence Behaviors, And Adverse Asthma Outcomes In Hispanic Adults With Moderate To Severe Persistent Asthma?, Archana Kartik Chandra

Doctoral Projects

The effects of LEP are well documented in the literature. LEP decreases medication adherence, causes ineffective communication between patients and providers, and reduces health outcomes. Asthma is known to be misdiagnosed and under-treated in Hispanic adults. There are discrepancies in the literature about the effects of LEP in Hispanic adults with persistent asthma.

The purpose of this study was to determine if the presence of LEP is associated with medication adherence behaviors and adverse asthma outcomes in Hispanic adults with moderate to severe persistent asthma. Hispanic adults with LEP were assessed for asthma outcomes and medication adherence behaviors.

The results …

Outcomes Of Communication, Workflow Efficiency, & Patient Care Quality Resulting From A Hands-Free, Wireless Communication Device, Hyacinth Flores Carreon

Doctoral Projects

Purpose: Failures in communication have long been identified as one of the root causes of preventable medical errors. The purpose of this quality improvement project was to assess staff perceptions on the outcomes of communication, workflow efficiency, and patient care quality after the implementation of a hands-free, wireless communication device in a federal acute care setting.

Methodology: Replicating the quantitative component of a 2012 study by De Grood et al., a 10-item survey using a 5-point Likert scale was administered within a 4-week period to healthcare team members from two inpatient units composed of monitor technicians, nurses, nursing assistants, and …

Tools To Increase Compliance And Decrease Mortality Due To Sepsis, Cody F. Carr

Doctoral Projects

Severe sepsis is a leading cause of death in the United States and is the most common cause of death among critically ill patients in non-coronary intensive care units (Mayr, Yende, & Angus, 2014). The incidence of severe sepsis is estimated to be 300 cases per 100,000 population and cost an estimated $14 billion in the United States (Mayr et al., 2014). This Doctor of Nursing Practice (DNP) project focused on identifying an early-assessment tool to identify sepsis and increase compliance when using the tool. Identifying sepsis early is important in starting a treatment plan to prevent morbidity and mortality. …

Developing Cultural Competency In Anesthesia Through Student Registered Nurse Anesthetists, Emma To

Doctoral Projects

Certified Registered Nurse Anesthetists (CRNAs) are the main anesthesia providers in over 70% of rural hospitals providing anesthesia. Each year, over 2,000 student registered nurse anesthetists (SRNAs) graduate and continue as licensed CRNAs. This Doctor of Nurse Practice (DNP) project emphasizes the importance of developing culturally competent providers in anesthesia by promoting early outreach in cultural competence education of SRNAs. Cultural competence is described as possessing characteristics of congruent attitudes, awareness, and conduct that provides and enables effective skills in cross-cultural encounters. Encompassing cultural competency education early in the SRNAs profession may provide valuable lifelong cultural skills that will benefit …

Analysis Of Current Practices For Measuring Endotracheal Cuff Pressures, Myisha Jessie Dixon

Doctoral Projects

The current practice for the measurement of endotracheal tube (ETT) cuff pressure intraoperatively is subjective, potentially leading to negative consequences for patients. The purpose of this best practice project was to examine and synthesize the current evidence-based literature on measuring ETT cuff pressure and developed a policy recommendation for measuring ETT cuff pressure in the intraoperative setting by anesthesia providers. The ACE star model of knowledge transformation guided this best practice project. An extensive literature review was performed to evaluate and synthesize the current evidence-based research that can be used to develop the policy on measuring endotracheal tube cuff pressure. …

Laryngeal Mask Airway: A Postoperative Sore Throat Clinical Practice Guideline, Logan Williams

Doctoral Projects

One of the most common and preventable complications experienced by patients undergoing general anesthesia is a postoperative sore throat (POST). Up to 70% of patients who receive a laryngeal mask airway (LMA) during anesthesia suffer from POST. Despite its regular occurrence and designation as a minor complication, POST has proven to be a distressing complication for patients afflicted. Consequently, a perceived minor complication can, in fact, play a major role in a patient’s perception of their care, the skill of their anesthesia provider, and their overall satisfaction with their experience.

Evidence shows that inflation of LMA cuffs beyond the recommended …

Utilizing The Stop-Bang Questionnaire As A Preoperative Assessment Tool In Patients Undergoing Endoscopic Procedures, Emily Randle

Doctoral Projects

In the world of anesthesia, obstructive sleep apnea (OSA) can cause a conglomeration of post-operative complications. One of the best ways to avoid these complications is to alter one’s anesthetic to accommodate the needs of a patient with OSA. The current issue with altering one’s anesthetic is that a majority of patients with OSA still remain undiagnosed. My project that will showcase just how many patients have undiagnosed OSA.

The goal of this project was to recognize how many patients were at moderate to high risk for OSA. I did this by providing an in-service on OSA and the STOP-Bang …

Best Practice Policy: Utilizing A Standardized Handoff Tool Postoperatively In An Intensive Care Unit For Patients Undergoing Cardiac Surgery, Alexandra Bradley

Doctoral Projects

Communication is a key aspect of care in the health care setting. Handoff communication occurs between medical provider’s numerous times a day. Each patient handoff performed has the potential for ineffective communication, leading to poor patient outcomes. The Joint Commission has recognized handoff communication as one of the main causes of sentinel events, or unexpected events that results in patient harm or death, in the health care setting (Joint Commission on Accreditation of Health care Organizations [JCAHO], 2012). The Joint Commissions National Patient Safety Goal requires “a standardized approach” for provider handoffs. The introduction of a checklist or handoff tool …

Can Using A Smartphone Application Improve The Ability Of Law Enforcement Officers To Recognize Commercially Sexually Exploited Children And Report Them To Child Welfare Authorities?, Sheree Goldman

Doctoral Projects

The commercial sexual exploitation of children (CSEC) is a crime of abuse that is frequently unrecognized because mandated reporters may be unfamiliar with the indicators. Commercially sexually exploited minors participate in sex acts in exchange for money, goods, or services. At least 200,000 American children are believed to be victims of this crime each year (County Welfare Director Association of California, 2015). Victims often go undiscovered and experience significant health issues. A public health model is used to explain the context of victimization and the need for interdisciplinary collaboration to discover victims and connect them with needed services. A randomized …

Patient Perceptions Of Google Glass In The Outpatient Dermatology Setting, Sandra Odenheimer

Doctoral Projects

Background: The ubiquitous use of electronic health record (EHRs) during medical office visits using a computer monitor and keyboard can be distracting and disrupt patient-healthcare provider (HCP) non-verbal eye contact cues, which are integral to effective communication. Provider use of a remote medical scribe with face-mounted eyeglass technology, such as Google Glass (GG), may preserve patient-HCP communication in the healthcare setting by allowing providers to access other parts of the patient’s EHR (e.g. laboratory results, current medications, immunization records) all while maintaining direct eye contact with their patients. The medical scribe is able to chart patient encounters in real-time working …

Sexually Transmitted Infection Risk Reduction For College Students, Mary Kathryn Dowling

Doctoral Projects

University students have been assessed through many sexual health lenses, but there is a paucity of research on the sexual health of community college students. This population may provide good access to at-risk youth, and opportunity to reverse steep climbs in sexually transmitted infection (STI) rates. This research project pilot tests a theory-based intervention employing social facilitation to reduce STI risk among college students. Fifty students were recruited from Human Sexuality courses to participate in a 60-minute workshop. Pre- and post-testing measured for change in STI knowledge, attitude towards safer sex, and self-efficacy for engaging in safer sex practices.

A …

A Pediatric Respiratory Care Curriculum For Emergency Department Nurses, Luzmaria Alcala-Van Houten

Doctoral Projects

As pediatric visits to community hospitals increase, the Institute of Medicine (IOM) and the Pediatric Emergency Care Network (PECARN) recommend that staff be provided improved education, protocols, and resources to improve patient outcomes (Emergency Medical Services for Children, n.d.). Acute respiratory disorders are the most commonly seen complaints in children aged 0–24 months, with an average of 2–4 visits a year. The purpose of this Doctor of Nursing Practice (DNP) project is to create a pediatric respiratory care curriculum for emergency department nurses in the Kaiser Permanente Central Valley Area (CVA) and to have it evaluated by a group of …

Clinical Practice Update On A Temperature Guideline To Decrease Intraoperative Hypothermia In Patients Undergoing General Anesthesia, Ashley Rigdon

Doctoral Projects

Intraoperative hypothermia is a common problem within the operating room. Anesthesia inhibits the body’s normal thermoregulatory response to hypothermia, redistributing heat from the core to the periphery (Brandt et al., 2009). In the event of hypothermia, the incidence of infection triples as there is an increased risk for blood loss, increased risk for cardiac complications, and the thermal discomfort of patients (Brandt et al., 2009). Following a recent clinical practice guideline can help prevent hypothermia.

A descriptive project was organized utilizing current literature. The sample for this study is 45 CRNAs practicing at a multiple system healthcare facility in the …

Implementing Nerve Blocks For Patients Undergoing A Bilateral Mastectomy With Immediate Reconstruction: A Practice Change, Corey Beene Auerswald

Doctoral Projects

Breast cancer is one of the most commonly diagnosed cancers in women. A mastectomy is one of the first line treatments for breast cancer, but it is associated with considerable postoperative pain. Literature suggests current methods of pain management are ineffective and regional anesthesia can help reduce postoperative complications following a bilateral mastectomy with immediate reconstruction. Information from the literature review was used to inform five anesthesia providers at a rural hospital in Mississippi about the benefits of regional anesthesia for patients having a mastectomy. A presentation was given to anesthesia providers regarding the benefits of paravertebral blocks (PVB) for …

The Effects Of In-Service Education On Workplace Incivility For Crnas, Tran King

Doctoral Projects

Workplace incivility (WPI) affects many healthcare providers, including Certified Registered Nurse Anesthetists. This project was an exploration of the prevalence, nature, and sources of WPI affecting CRNAs. The project’s intervention was an in-service education on WPI for CRNAs. The purposes of the project were to measure the effectiveness of the in-service education in increasing awareness of CRNAs about WPI; and to offer a practice change proposal in terms of a policy against WPI in the anesthesia department.

A Needs Assessment Survey and Demographic Data Information form were distributed from Survey Monkey to participants’ email by way of blind copy. Data …

Implementing The Use Of Intracuff Alkalinized Lidocaine Among Certified Registered Nurse Anesthetists: A Practice Change Proposal, Shawn Taylor

Doctoral Projects

Patients today are experiencing comorbidities predisposing them to increased risk under general anesthesia. Emergence cough reflex is a response that can lead to hemodynamic alterations occurring during emergence and the postoperative period for many patients requiring general endotracheal tube anesthesia (GETA). It is proposed that 38% to 96% of patients receiving GETA will experience coughing during emergence (As, Iqbal, & Ali, 2009; Watkins, Lee, White Jr, & Mundy, 2012).

The use of intracuff alkalinized lidocaine is an intervention shown to be effective in previous studies at blunting this response during anesthesia emergence. Through verbal communication with CRNAs, it was discovered …

A Clinical Practice Change Initiative To Incorporate Animal Assisted Therapy In Advanced Practice Registered Nurses' Clinical Practice For Children And Adolescents, Donna Rae Cowell

Doctoral Projects

Background: Children and adolescents mental healthcare needs is vital for the future of our nation’s welfare (American Psychology Association, 2014). Research has indicated AAT may be a considerable choice to help with pediatrics mental healthcare and may be utilized as an adjunct to enhance the care within the psychiatric healthcare field (Chandler, 2012). AAT has become popular within the healthcare realm (Friesen, 2009; Uyemura, 2016) and is a unique method for providing “patients” health care, which may improve patient outcomes (Chandler, 2012; Cowell, 2013; McCullough, 2016; McQuarrie & Urichuk, 2008). Research supports that “providers” in the health care field may …

Curriculum Development Of California Correctional Institution (Cci) Nursing Staff Performance During Simulation Training Related To Cardiac Emergency Response, Dina Wang

Doctoral Projects

The Cycle 4 OIG medical reports published in January 2016 for California Correctional Institution (CCI) noted emergency medical response (EMR) inadequacies. Nursing was specifically called out for EMR care deficits. Chest pain and respiratory distress were amongst the top signs and symptoms identified as having substandard nursing care issues within the report. The cycle 4 OIG medical inspection report gives specific incidences of patient care inadequacies.

As a result of the EMR portion results of the cycle 4 OIG reports, there was a need for improvement planned interventions. The Doctor in Nurse Practice (DNP) project is a quantitative quasi-experimental study …

Implementing Evidence Based Practices For Preventing Cardiac Implantable Electronic Device (Cied) Infection And The Role Of Post-Operative Oral Antibiotics, Ingrid Mitchell

Doctoral Projects

Cardiac pacemakers and implantable cardioverter defibrillators (ICD) are standard therapy for patients with a bradyarrhythmia, tachyarrhythmia or heart failure (HF) with a left bundle branch block (LBBB) (Wilkoff, et al., 2008). Millions of cardiac implantable electronic devices (CIED) have been implanted worldwide and this clinical practice has improved the quality of life for millions (Epstein, DiMarco, & Ellenbogen, 2008). With the increase of implants there has been an increase in the infection rates (Klug et al., 2007). Research studies have evaluated pre-procedure, during procedure and after procedure risk and protocols. Studies have also evaluated operative factors, procedural related factors, intravenous …

The Perceptions Of Registered Nurse To Bachelor Of Science In Nursing Students Of Motivational Interviewing, Christie M. Smart

Doctoral Projects

Purpose: The purpose of this study was to collect information on the perceptions of motivational interviewing (MI) among Registered Nurse (RN) to Bachelor of Science in Nursing (BSN) students and whether or not the students felt it could increase holistic practice. Methodology: A qualitative descriptive study was used to collect data through semi-structured one on one interviews from six RN-BSN students post a module taught on MI. Qualitative content analysis was utilized to process the data. Findings: The students felt that MI was a useful tool for practice in improving patient communication and would contribute to holistic practice.

An Assessment Of The Associate Degree Nursing Students’ Understanding Of Health Literacy Concepts When Providing Health Promotion For The Diabetic Patient, Donna L. Lebaron

Doctoral Projects

Health literacy (HL) concept deficiencies exist in undergraduate nursing curricula (Smith and Zsohar, 2011; Cornett, 2009; Jukkala, Deupree, Graham, 2009). As future nurses who will have a significant impact on client health literacy assessment, it is essential that health literacy-related content be integrated into undergraduate nursing educational curricula (Sand-Jecklin, Murray, Summers, Watson, 2010; McCleary-Jones, 2012). The prevalence of Type 2 diabetes (T2D) has significantly increased resulting in greater morbidity and mortality risks to the general public; therefore, programs for diabetes prevention, education, and health literacy assessments have become a national priority (Whittemore, Rosenberg, Gilmore, Withey, and Breault, 2013; Hemingway, Stephenson, …

Efficacy Of Continuous Passive Motion After Total Knee Arthroplasty In Veteran Patients, Jaimee Riza B. Hare

Doctoral Projects

Since the early 1980s, continuous passive motion has been used as adjunct therapy in patients’ rehabilitation following total knee arthroplasty. Although existing literature challenged the benefits of continuous passive motion claiming it had no added short-term or long-term benefits after knee arthroplasty (Boese et al., 2014; Chen et al., 2012; Herbold et al., 2014; Leach et al., 2006; Maniar et al., 2012), the existing literature is difficult to generalize and apply to the veteran population at San Francisco Veterans Affairs Medical Center. This study was undertaken to determine the efficacy of continuous passive motion in helping veteran patients at San …

Stress In New Graduate Nurses: Can They Sweat It? A Correlational Study Of Exercise And Stress In New Graduate Nurses, Kathleen Helgesen

Doctoral Projects

Stress in new graduate nurses has been a known issue in nursing for decades. The number of new graduate nurse turnover rates has reached up to 50% within the first three years of practice, according to some studies. Most new graduate nurses who choose to leave their job, or even the profession, cite stress as a major factor.

Methods: Single point correlation survey of new graduate BSN students in Southern California (n=32).

Results: Initial results showed a statistically significant difference between those who exercised three to five hours per week, versus though who exercised more than five hours per week. …