Dissertations / Theses on the topic 'Nursing practice and evidence'

The purpose of this project was to develop and test a pilot competency assessment tool for sexual assault nurses. The content for the competency assessment was based on available evidence, primarily targeting current standards of sexual assault nurse examiner (SANE) practice. Descriptive statistics from a regional crime lab allowed the researcher to identify areas for improvement in the evidence-collection technique. This information was then used to develop the content of the competency assessment. A team of experts helped inform the development of an online competency assessment using a web-based platform. The competency assessment was tested on a small sample of sexual-assault nurse examiners. The instrument demonstrated a reasonable level of consistency and reliability (KR20 was 0.66) for an initial assessment. The aim of developing and testing an online instrument to serve as a baseline for establishing a valid and reliable competency assessment for sexual assault nurse examiners was achieved.

Evidence-based practice (EBP) ensures excellent nursing care; however, limited literature exists for implementing EBP within schools. This mixed method study, using the Promoting Action on Research Implementation in Health Services (PARIHS) framework, explained EBP implementation within three school districts. Quantitative results identified the level of implementation and nursing characteristics predictive of EBP implementation. The mean EBP Implementation score (n = 64) was 8.36 (SD 9.75), indicating a low level of EBP implementation. EBP Belief scores was the only nursing characteristic that explained 34% of the variance. Qualitative results explained survey results, using a multiple case study design with interviews with six school nurses with high or low EBP Implementation scores. Analysis included pattern matching to propositional statements derived from PARIHS evidence, context, and facilitation concepts. Individual case stories varied and demonstrated both positive and negative patterns. Data synthesis examining propositions and themes indicated all cases supported four evidence propositions. No cases supported the evidence proposition about collecting and using routine student data. Three cases (n =3) with high EBP Implementation scores supported six evidence and context propositions. Three cases (n = 3) with low EBP Implementation scores supported thirteen propositions for the evidence, contest, and facilitation concepts. Common themes across cases were using evidence, cultural influences, structural supports, and impeding implementation. When integrating findings only three EBP Implementation scale items indicated routine implementation of evidence, which matched with evidence propositions supported across cases and the theme using evidence. Context and facilitation propositions and themes primarily explained low EBP Implementation items.

The purpose of this project was to decrease of the rate of unnecessary antibiotic prescribing for pharyngitis by implementing an evidence-based training session for physicians in an outpatient pediatric setting. The PICOT question explored was, "For health providers treating children aged 4–15 presenting with sore throat, will the use of a power point training session presenting the rapid antigen detection test (RADT) with reflexive culture, combined with the ICE (ideas, concern and expectations) method, improve knowledge and reduce antibiotic prescribing compared to RADT alone in a 20 day period?"

The provider study group consisted of four pediatricians and one family practice physician ranging from 32–72 years old. Their pre-test (34.63%) and post-test (53.75%) knowledge scores were significantly different ( t = –2.3822, df = 6, p < 0.05). A total of 125 cases were sampled, 64 pre-intervention and 61 post-intervention. Pearson’s Chi Square analysis revealed homogeneity between both the groups in age (X² = 0.94, df = 1, p = 0.33), gender (X2 = 0.64, df = 1, p = 0.42), and ethnicity (X2 = 1.29, df = 2, p = 0.53) and a decrease in overall antibiotic prescribing rates from 40.6% (n = 26) to 27.9% (n = 17). Although this was not a significant statistical reduction (p = .13), further analysis using a binomial test revealed statistically different rates of success in the accuracy of diagnosis and associated antibiotic prescribing pre-intervention (79.7%) compared to 96.7% post-intervention (p = .00; 95% CI [88.7, 99.6]). Unnecessary antibiotic exposure was reduced by 17.2%.

The most common ICE elements were thought of possible strep infection (39), viral or other infection (26), concern for pain (24), infecting other family members (14), fever (14), expectation to get better (32), test for strep (18), and pain relief (9). Only 2 of the 5 cases in the post-intervention group (n = 61) who expressed desire for antibiotics received them.

The purpose of this study was to examine the effects of an educational intervention on nurses’ knowledge of, beliefs about, and attitudes toward EBP, and their perceived ability to implement EBP. Also, the study was focused on examining the correlation between nurses’ knowledge of, beliefs about, and attitudes toward EBP and nurses’ perceived ability to implement EBP. A pretest/posttest quasi-experimental randomized design was used. Nineteen nurses employed in a county hospital in California participated in the study. Data were collected via a web-based survey. The knowledge and attitude subscales of the Evidence Based Practice Questionnaire, the Evidence Based Practice Beliefs Scale, and the Evidence Based Practice Implementation Scale were used to measure nurses’ knowledge of EBP, attitudes toward EBP, beliefs about EBP, and their perceived ability to implement EBP respectively. Data analysis included descriptive statistics, Wilcoxon’s signed rank test, and Pearson’s correlation coefficient test. Within subject data analysis indicated that the EBP educational intervention significantly improved nurses’ beliefs about EBP, knowledge of EBP, and their perceived ability to implement EBP (p < .05). Pearson’s r test analysis indicated that there is no relationship between nurses’ knowledge of EBP, beliefs about and attitudes toward EBP, and their perceived ability to implement EBP ( p > .05). The study results could encourage nurse leaders to promote teaching EBP in clinical settings and remove barriers to the application of evidence into nursing practice. The study served as a foundation for future studies on an educational intervention to help nurses adopt EBP.

The old practice of separating the mother-baby-dyad was without measurable benefits to mothers or their infants. Evidence has shown that skin-to-skin care (SSC) prevents hypothermia and hypoglycemia, decreases crying during painful procedures in newborns, and reduces maternal anxiety, stress, and postpartum depression. Rooming-in care (RIC) has been linked to an increase in the rate of breastfeeding and mother-infant interaction, as well as a decrease in the infant morbidity rate. This project assessed the effect of an educational intervention to increase rates of SSC and RIC in an obstetric unit, in addition to measuring nurses’ attitudes and barriers in relation to SSC and RIC. The obstetric nurses received educational content related to SSC and RIC based on Kotter’s model of change. A pre and postintervention evaluation showed a significant increase in the rates of SSC and RIC from pretest of 10%, to posttest of 96%; and RIC from pretest of 10% to posttest of 92%. Using a Wilcoxon test, a significant difference was found from pretest to posttest for every subscale score of the Mother-Newborn Skin-to-Skin Contact Questionnaire and Nurse Attitudes and Barriers to nonseparation Scale (p < 0.001), with the exception of belief about obstacles for SSC, which yielded a nonsignificant change (p = 0.57). This DNP project led to changes in the organization’s culture, including the closure of the well-baby nursery. This project promoted social change across the organization, in that the team health care providers delivered evidence-based, standardized, unbiased, and family-centered care to the mother-baby dyad.

The United States has set a 90% benchmark for influenza vaccinations for healthcare personnel. Unfortunately, healthcare personnel fall far short of that mark with current rates as low as 62%. Low vaccination rates are responsible for influenza, nosocomial influenza, influenza-like illness, and mortality during influenza season. The purpose of this quantitative correlational study was to understand the relationship between leadership styles, attitudes towards evidence-based practice, and vaccination intention among New Jersey registered nurses (RNs). Diffusion of innovations theory was the theoretical foundation. The 3 instruments used were the Multifactor Leadership Questionnaire, Evidence Based Practice Attitude Scale, and Behavioral Intention Scales, which measured independent variables such as transformational leadership and attitudes toward evidence-based practice. Vaccination intent was the dependent variable. The results showed that transformational leadership was positively related to vaccination intent r(353) = .16, p < .01. There was no relationship between transactional leadership and vaccination intent r(353) = .01, p > .05 nor between attitudes toward evidence-based practice and vaccination intent r(353) = .09, p > .05. The implication of the study is that the effects of transformational leadership constitute a predictive tool to identify how an organization can increase vaccination rates among RNs. Implementing the recommendations of the study could promote social change by providing nursing leadership with tools to facilitate increased vaccination rates among health care personnel. Increasing vaccination rates for healthcare personnel will decrease vaccine-preventable illnesses and improve outcomes for hospitalized patients.