Nursing Students\u27 Self-Efficacy and Attitude: Examining the Influence ofthe Omaha System In Nurse Managed Centers

Self-efficacy, or confidence, as an outcome behavior has been identified as influencing nursing job satisfaction and retention. Clinical learning environments and teaching strategies that build and support perceived self-efficacy are critical aspects of preparing new nurses for their entry and continuing role as professional nurses in today\u27s information-intensive data-management healthcare environment. The purpose of this pre-test post-test study is to measure, using the C-scale (Grundy, 1992), nursing students\u27 self-efficacy to perform patient assessment in Nurse Managed Centers (NMC) after one semester of using the Omaha System documentation framework. Nursing students\u27 attitudes of preparation for using Standardized Nursing Languages (SNL) in the future was also examined. Bandura\u27s (1977, 19986) theoretical model of self-efficacy provided the conceptual framework. Students\u27 overall self-efficacy scores increased significantly over the 12 week study. Use of the Omaha System \u27prepared a little\u27 to \u27very prepared\u27 90% of student nurses for future use of SNL. Continued use of the Omaha System documentation framework in Nurse Managed Center clinicals as a tool for understanding SNL is recommended.

Telehealth Wound Applications: Barriers, Solutions, and Future Use by Nurse Practitioners

Telehealth applications are an emerging technology in a new era of health care system technologies. Although telehealth technologies, including a number of different applications, are used by various members of the health care team, nurse practitioners (NPs) utilize them for a variety of patient issues across healthcare settings. The Indiana University-Purdue University Fort Wayne Computer Science Department has recently developed a wound scanning application, WoundView for nurse practitioners to utilize in different healthcare settings. Such telehealth mobile applications are used in clinics, home health, rural, and remote settings where a physician may not be readily available. However, there are obstacles with the current practice of using telehealth technologies such as a dire need for evidence-based research that supports attainable solutions for these barriers. Extensive, ongoing research will allow NPs to anticipate an immense mainstream implementation of telehealth applications in the very near future

Transitional Care Interventions as Implemented By Faith Community Nurses

Hospitals are seeking innovative and efficient methods of decreasing avoidable readmissions. Despite the volume of nursing literature exploring the use of advanced practices nurses in providing transitional care, only one study mentions the use of a faith community nurse. The faith community nurse operates in the community and has the skills to provide transitional care. The purpose of this study was to describe transitional care as implemented by faith community nurses using a standardized nursing language: the Nursing Intervention Classification (NIC). A mixed method descriptive design was selected to facilitate a thorough exploration of the interventions implemented by faith community nurses. The findings suggested that the majority of interventions are in the coping assistance, communication enhancement, and patient education Classes of the Behavioral Domain. The most frequently selected nursing interventions in NIC (n=26) were found and validated by the faith community nurse focus group. Results were compared to evidenced-based priority transitional care interventions described in research. In addition, results were compared to previous faith community nursing research describing the practice. Results were also described using the Faith Community Nursing conceptual framework. The results may provide the underpinnings for further testing of transitional care interventions

Single Point of Entry Long-Term Living Resource System Team Report

Pursuant to House File 451 the Single Point of Entry Long-Term Living Resources System Team, involving several state agencies as well as interested associations, submitted a report to the legislature on recommendations to establish a single point of entry system

Nonpharmacological Interventions for Behavior Management in Dementia

Since 2011, the Centers for Medicare and Medicaid (CMS) have been monitoring antipsychotic usage in residents with dementia in nursing homes. Increased monitoring has led to a decrease in use of these medications in long-term care settings. At the project site, a skilled nursing facility in Western North Carolina, residents with dementia are ordered to have all antipsychotic medications discontinued on admission. Unfortunately, medications typically are not useful in treating disruptive behaviors in residents with dementia. Nonpharmacological interventions (NPIs) are considered best practice; however, when nonpharmacological interventions are appropriately utilized at the facility, there was no standard for documenting their usage. A newly created standardized nonpharmacological checklist was implemented in order to guide staff members in utilizing nonpharmacological interventions prior to the administration of PRN (as needed) behavior medications. The primary objective of the project was to increase compliance with the implementation of nonpharmacological interventions in the management of disruptive behaviors in residents with dementia. The project implementation resulted in a 70% staff compliance rate in utilizing the standardized checklist. Staff reported a much better understanding of how to utilize NPIs in their interactions with residents with dementia. While the outcome of the project was positive, many barriers and limitations were encountered throughout the process.D.N.P

Postpartum Depression Screening of Women Veterans in Alaska Quality Improvement Project

A Project Submitted in Partial Fulfillment of the Requirements for the Degree of MASTER OF SCIENCE in Nursing SciencePostpartum depression screening guidelines were updated by the American College of Obstetricians and Gynecologists and the United States Preventive Services Task Force in 2015 and 2016, respectively. Universal postpartum depression screening is recommended where previously it was not. Postpartum depression screening is relevant to the rapidly growing population of women Veterans served by the Veterans Health Administration (VA) as part of their comprehensive health care benefits. Little information was available on the postpartum depression screening practices within the Alaska VA Healthcare System. Using a quality improvement methodology, the author identified postpartum depression screening as a topic of interest. Current practice was assessed through a retrospective chart audit of all maternity consults placed during the fiscal year 2014. The chart audit revealed an 81% postpartum depression screening rate. Incomplete data limited a full statistical analysis; however, all women who returned to an Alaska VA clinic, received screening and treatment. An informational brochure was developed for women and their health care providers highlighting postpartum depression screening and treatment resources.Title Page / Abstract / Table of Contents / List of Tables / List of Appendices / Introduction / Purpose / Literature Review / Implications for Nursing Practice / Methods / Results / Discussion / Conclusion / References / Appendice

An interprofessional nurse-led mental health promotion intervention for older home care clients with depressive symptoms.

BackgroundDepressive symptoms in older home care clients are common but poorly recognized and treated, resulting in adverse health outcomes, premature institutionalization, and costly use of health services. The objectives of this study were to examine the feasibility and acceptability of a new six-month interprofessional (IP) nurse-led mental health promotion intervention, and to explore its effects on reducing depressive symptoms in older home care clients (≥ 70 years) using personal support services.MethodsA prospective one-group pre-test/post-test study design was used. The intervention was a six-month evidence-based depression care management strategy led by a registered nurse that used an IP approach. Of 142 eligible consenting participants, 98 (69%) completed the six-month and 87 (61%) completed the one-year follow-up. Outcomes included depressive symptoms, anxiety, health-related quality of life (HRQoL), and the costs of use of all types of health services at baseline and six-month and one-year follow-up. An interpretive descriptive design was used to explore clients', nurses', and personal support workers' perceptions about the intervention's appropriateness, benefits, and barriers and facilitators to implementation.ResultsOf the 142 participants, 56% had clinically significant depressive symptoms, with 38% having moderate to severe symptoms. The intervention was feasible and acceptable to older home care clients with depressive symptoms. It was effective in reducing depressive symptoms and improving HRQoL at six-month follow-up, with small additional improvements six months after the intervention. The intervention also reduced anxiety at one year follow-up. Significant reductions were observed in the use of hospitalization, ambulance services, and emergency room visits over the study period.ConclusionsOur findings provide initial evidence for the feasibility, acceptability, and sustained effects of the nurse-led mental health promotion intervention in improving client outcomes, reducing use of expensive health services, and improving clinical practice behaviours of home care providers. Future research should evaluate its efficacy using a randomized clinical trial design, in different settings, with an adequate sample of older home care recipients with depressive symptoms.Trial registrationClinicaltrials.gov identifier: NCT01407926

Doctor of Philosophy

dissertationPeristomal skin lesions are common following stoma surgery. However, there is wide variability in how those lesions are documented. The purpose of this study was to evaluate psychometric properties and feasibility of use for the Studio Alterazioni Cutanee Stomali (SACS™) instrument. Content validity was previously evaluated. This study extends that work by examining use in pediatrics, use by parents and bedside nurses, and by evaluating reliability and validity. The study was guided by the Donabedian Structure-Process-Outcome framework and psychometric theory. Data collection included questionnaire, direct observation, and rating of lesion photographs. Participants were 64 parents of children who had undergone stoma surgery, 64 bedside nurses, and 10 wound nurses, who simultaneously assessed the child's skin lesion. There were 73 lesions in 65 children, with 292 direct observations and 40 photographs. Findings supported use of the SACS™ instrument in pediatrics. The instrument was feasible for parent and nurse use. Most parents (98%) were willing to use the instrument at home. Intrarater reliability was acceptable when ratings were grouped into clinically relevant categories (78-85% agreement for lesion severity). There was strong evidence of interrater reliability, with intraclass correlation > 0.91. The contrasted groups approach supported construct validity, demonstrating that the instrument could distinguish between lesions of known severity, and that parents and bedside nurses, who have less stoma experience, rate lesions in a similar manner to each other, and differently than wound experts. Most important clinically, there was strong evidence of decision validity; the instrument was able to discriminate between lesions that needed to be seen in clinic and those that could be safely treated at home. When there was disagreement, raters consistently erred on the side of safety, rating lesions as more severe than the expert, which would have resulted in the child being assessed by a clinician. Limitations included a single setting with limited number of wound nurses, convenience sampling, and predominantly Caucasian population. Strengths included standardized methodology and strong basis in the theoretical framework. The study demonstrated that the instrument can be used in the pediatric population to document peristomal skin lesions, which should facilitate clinical decisions and communication