Dysphagia is a leading complication of a stroke. A nurse-driven bedside swallow screen can identify dysphagia and decrease the risk for complications such as aspiration pneumonia. At the project site, the use of the bedside swallow screen was at 33%; there was noncompliance with the use of the bedside swallow screen by the emergency department nurses. The purpose of the doctoral project was to increase the use of the bedside swallow screen. Published outcomes, research, and reports generated from archived data were the sources of evidence. The six sigma methodology was used to inform the quality improvement doctoral project. At the end of the quality improvement project, the posttest scores were statistically significantly higher than the pretest scores mean. The nurses' scores demonstrating level of confidence before the training (M = 68.39, SD = 10.86) were lower than scores indicating their level of confidence after the training (M = 79.55, SD = 10.56), and the paired t test showed statistical significance p < .001. The training made a statistically significant difference in the emergency department nurses' knowledge and confidence in performing the dysphagia screen. After the causes of low compliance were identified, strategies developed and implementation of the swallow screen in the emergency department increased. The quality improvement project improved the use of the dysphagia screen at the project site from 33% to 60%. The project made a positive impact on social change by reducing stroke patients' risk for complications.

Nurses are often promoted or hired into leadership positions without the benefit of a formal orientation to their new leadership positions. The challenge of navigating the various expectations of the role of clinical nurse leader (CNL) such as fiscal ownership, staffing patterns, payroll, and disciplinary action process can be overwhelming. The lack of a formalized orientation process and an identified nurse leader to function as a mentor can contribute to the novice CNL feeling unsupported and overwhelmed. The purpose of this project was to identify, develop, and evaluate a CNL orientation manual, outline, and program for newly appointed CNLs. The desired outcome for this doctor of nursing practice project was the education and preparation of CNLs who will navigate the various facets of the role and retain their positions longterm. The Association of Nurse Executives nurse leader model was used to guide the project. A panel of 5 CNL experts evaluated the manual outline and content using a 5-question Likert scale survey. Findings indicated 100% of the participants agreed or strongly agreed with the importance of the topics covered and 80% agreed with the content covered in the manual outline. The project is expected to promote positive social change by preparing new CNLs to meet the requirements of leadership positions.

In 2014, Louisiana experienced substantive issues with quality of care in nursing homes. The state had the lowest nurse staffing level among all states, and 7,666 deficiencies for immediate jeopardy violations were recorded from 2011 to 2013. Despite ample research on nurse staffing and quality of care, there is no consensus on how higher nurse staffing relates to quality. The purpose of this quantitative, correlational research was to determine the relationship between nurse staffing levels and quality measures in Louisiana. Donabedian's category structure, process, and outcome was the conceptual framework used to develop the research questions. The data included the quality of care deficiency score and the quality measures found in the Centers for Medicare and Medicaid datasets. The quality measures were the deficiencies and the prevalence of nursing home residents with pressure ulcers, urinary tract infections, and physical restraints. Generalized linear models were used to analyze the relationship between nurse staffing levels and the quality measures. The findings suggested that RNs, nonprofits, chain-affiliated nursing homes, and smaller facilities are important to improve the quality of care in Louisiana nursing homes. These variables were associated with fewer quality of care deficiencies and fewer pressure ulcers. These findings have implications for social change. This information may help inform and direct policy makers in the development and implementation of Medicaid-managed long-term services and supports programs in order to improve the quality of care of a vulnerable population: the elderly and disabled.

Staff nurses are frequently placed in charge nurse positions without the necessary formal training. The long-term goal of this project was to develop a curriculum for a formal institutional leadership workshop for the charge nurses at the practicum site. The Johns Hopkins Nursing Evidence-Based Practice model and Lewin's change theory were used to guide the development and implementation of the workshop. Data were collected using a focus group approach with 4 novice and 5 expert medical-surgical charge nurses. The short-term goal of the project was to understand the charge nurses' perceptions of leadership and the challenges as a front-line leader. Participating nurses were recruited from staff meetings and from a hospital flyer. Each participant answered the 3 leadership questions. The charge nurses' statements were categorized and color-coded to identify emerging themes from repetitions of words and patterns; themes were subsequently prioritized from the most to the least occurring. Member checking with participants as well as preceptor verification and validation of 10 themes that were utilized to develop the curriculum: communication, patient safety, roles, teamwork, conflict management, generational diversity, mentoring, cheerleader, prioritization, and delegation. Implementing the workshop 4 hours per month over a 3-month period and formal mentoring was recommended for optimal sustainability based on the proposed theoretical framework. Implications for positive social change include the potential for enhancing the quality of patient care delivered and improving patient safety as a result of charge nurse leadership being modeled.

Health care providers gather and track quality patient indicator scores to monitor patients' safety and outcomes and decrease the number of adverse events. Nursing leaders implemented a Quality Workbook Committee (QWC) within a hospital setting to improve patient outcomes and the facility's reported scores for nurse-sensitive patient indicators. The practice-focused question for this quality improvement evaluation project examined whether the implementation of the QWC improved nurse-sensitive patient indicator scores. Watson's theory of human caring was used to evaluate the gap in practice, and Rosswurm and Larabee's model for evidence-based practice change provided guidance for planning the project. Sources of evidence were 2017 end-of-year organization report cards. The 4 specific areas chosen for evaluation were: patient falls, hospital-acquired pressure ulcers, pain reassessment scores, and medication scanning rates. Results from an analysis of variance showed improvements in 3 of the 4-nurse-sensitive patient indicator scores. Hospital-acquired pressure ulcers decreased by 13 pressure ulcers, pain reassessment rates increased by 18.42%, and medication scanning scores increased by 4.03%. However, patient falls increased by 15, suggesting the need for further evaluation measures. Project findings may help nursing leaders to improve nurse-sensitive patient indicator scores and promote social change by reducing hospital adverse events, length of hospitalization stays, and wasted healthcare resources.

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 informed interventions aimed at creating an effective SG. IPNG data were analyzed using Hess' scoring guidelines to establish total governance and subscale scores. Mean IPNG scores of nurse leaders, clinical nurse managers, and staff nurses were compared using a 1-way ANOVA based on job title, education, employment status, and shift. NDNQI results were analyzed based on benchmarked Magnet objectives and comparison to previous year's surveys. Meeting agendas and minutes were analyzed for attendance and initiation of interventions. Outcomes of this project included successful creation of a UPC on a medical telemetry unit; alignment of meeting times to promote attendance; paid access to remote meeting attendance; standardization of meeting minutes and agendas; and unit-specific, outcomes-data dashboards. Implementation of this model to improve the effectiveness of SG can lead to positive social change through improvement in the decision-making process in the nation's healthcare institutions. Inclusion of all members of the healthcare team in the decisions that impact practice helps ensure comprehensive, evidence-based, and patient-centric care.

Patients experiencing nonfatal strangulation during intimate partner violence (IPV) are suffering the consequences of unrecognized injuries and delayed life-threatening medical sequela. Forensic nurses offer expertise in the physical assessment and documentation to a variety of assault victims including those impacted by IPV. This project addressed whether an educational program on nonfatal strangulation increased the knowledge and assessment skills of forensic nurse examiners. The purpose of this doctoral project was to develop a continuing education program on the topic of nonfatal strangulation for forensic nurse examiners. The project design was created using Knowles's adult learning theory principles. The content outline was guided by the International Association of Forensic Nurses Nonfatal Strangulation Toolkit as well as input from content experts on nonfatal strangulation. The evaluation of the project was through pre- and posttest scores. The nonfatal strangulation continuing education training resulted in a statistically significant increase in participants' posttest scores (z-value= -3.064; p value =.002) indicating that the training material and teaching modality positively affected the participants test scores. This continuing education program on nonfatal strangulation increased knowledge of forensic nurse examiners and its application in the field might contribute to positive social change by increasing the identification of IPV and providing appropriate intervention.

Using a staff development approach, this doctor of nursing practice project addressed the preparation of nurses who serve in the role of mentors. Developed and carried out in an American Nurses Credentialing Center Magnet-designated hospital, the primary aim of the project was to develop and implement a staff education program for mentors focusing on best-practice strategies for mentoring new nurses. The secondary purpose was to conduct a literature review on evidence-based practice strategies for mentoring new nurses. This project was guided by Knowles' adult learning theory and Benner's novice to expert model. A 2-hour education program was attended by 16 registered nurses, including 2 assistant nurse managers, 12 clinical nurses, and 2 unit-educators. A program evaluation was completed showing 2 RNs indicating interest in initiating a unit-based mentorship program. Two nursing units reported current mentorship programs already in place. Evaluation results were summarized and reported to the education council chair. Improvements in knowledge scores on mentorship was ascertained from the results of a posttest that were higher (average score of 83.125%) than the scores noted on the pretest (average score of 70%). Potential implications of the project include improving the morale of mentors who would be well equipped through organized mentorship education programs with tools for preparing, training, and developing new nurses. The findings of this project have the potential to positively influence social change by assisting in achieving higher nurse retention rates leading to improved patient outcomes.

Magister Curationis - MCur / The frequent readmission of patients in psychiatric hospitals is caused by the relapse in their different psychiatric conditions. With a shortage of professional nurses, lack of resources, and an ever-increasing workload, the frequent readmission of psychiatric patients further worsens the situation.

Vulnerability is a phenomenon that with life changing events becomes more apparent. The nurse’s approach to their own and the patient’s vulnerability affects the caring relationship where all the feelings the patient is experiencing is considered. For the patient to dare express the feelings that vulnerability induces it is important not to disregard it. Caring tradition implies a deeper emotional connection between the patient and nurse, it fills an important and central part in caring for vulnerable patients. The aim of the study was to illuminate what vulnerability is within caring. The method was a literature study where systematical searches in different databases with care focus resulted in ten scientific result articles. With inspiration from content analysis the result articles were processed and analysed. The result clarifies experiences of vulnerability within caring through the categories: feelings, courage, alleviation, and burden-resource. It emerged that vulnerability occurs because of different reasons for the patient and nurse and how vulnerability is considered has impact on the emotional connection that is needed in a caring relationship. The conclusion from the literature study is that vulnerability is an important phenomenon to have knowledge of. It is relatively unexplored and demands further research with the purpose of exploring vulnerability in a caring context and thereby give the nurse better tools to be able to give best possible care based in scientific evidence. / Sårbarhetär ett fenomen som i samband med livsomställningar blir mer framträdande. Sjuksköterskans inställning till sin egen och patientens sårbarhet påverkar huruvida en omsorgsfull relation skapas där alla känslor patienten upplever beaktas. För att patienten ska våga uttrycka känslorna sårbarheten framkallar är det viktigt att sårbarhet inte förbises. Vårdande medcaringtraditionen i fokus som innebär en djupareemotionell anknytning mellan patient och sjuksköterskafyller därfören viktig och central del i omvårdnaden av sårbara patienter.Syftetvar att belysa vad sårbarhet är inomcaring.Metodför studien varallmän litteraturstudie där systematiska sökningar i databaser med omvårdnadfokus resulterade i tio vetenskapliga resultatartiklar. Med inspiration från innehållsanalys bearbetades samt analyserades de vetenskapliga resultatartiklarna.Resultatettydliggör upplevelser av sårbarhet inomcaringgenom kategorierna:känslor,mod,lindrandeochbörda-resurs. Det framkom att sårbarhet uppkommer av olika skäl för patienten och sjuksköterskan och hur sårbarheten beaktas har inverkan påden emotionella anknytningen som behövs i en vårdande relation.Slutsatsenfrån litteraturstudiens resultat är att sårbarhet är ett viktigt fenomen att ha kunskap om. Det är relativt obeforskat, därför rekommenderas fortsatt forskning med syfte att undersöka sårbarhet i en caring kontext för att ge sjuksköterskan bättre redskap att geen patientsäker och evidensbaserad omvårdnad.