This evidence-based project assessed and compared the KSAs of the QSEN core competencies in two groups of RNs at a tertiary healthcare facility using the Quality Improvement Skills, Knowledge, and Attitudes (QulSKA) questionnaire (Dycus & McKeon, 2009). In this quality improvement project RNs in staff leadership roles demonstrated a greater understanding of the QSEN core competencies for informatics when compared to newly hired RNs. Overall, on average, participants scored 69.2% on the knowledge portion of the QulSKA with newly hired RNs scoring 67.6% and RNs in staff leadership roles scoring 72.1%. These scores were not significantly different.

The mean self-rating of skill proficiency on the QSEN core competencies was 2.91 on a six-point Likert-type scale for both groups (1 = novice; 6 = expert). The nurse’s role was perceived as important to highly important for each of the QSEN core competencies.

The results of this project will be used to inform the development of an organization specific evidence-based interventional strategy that is strategically aligned and enhances the institution’s culture of safety initiatives. If the QSEN core competencies are used as an assessment tool, organizations could align their findings to inform and develop ongoing flexible educational interventions that address areas of need in the practice setting and contribute to enhanced quality and safety outcomes.

Eighteen nurse residents hired for the July nurse residency program participated in this program evaluation. The Health Sciences Reasoning Test (HSRT) was used to measure critical thinking. A paired samples t-test revealed a statistically significant increase (t = -2.219, p = .041) on the overall HSRT score, indicating the participants’ critical thinking did improve after using case studies and videotaped vignettes as an educational strategy for their orientation program. No relationships were found between critical thinking and the variables: age; previous health care experience; location of health care experience; and previous experience with case studies and videotaped vignettes.

It is impossible to prepare new graduate nurses for every situation they could encounter in the clinical practice environment, which is why it is so important for individuals to develop critical thinking skills. Using multiple strategies and embracing technology are options that should be considered when selecting a strategy. The results of this scholarly project are site specific, which precludes the generalizability to other organizations.

The purpose of this practice dissertation project was to evaluate the impact of a nurse-facilitator led quality improvement initiative in one acute care hospital using the End of Life Nursing Education Consortium (ELNEC) communication Module 6. Specifically, nurse attitudes regarding death anxiety (using the Revised Death Anxiety Scale [DAS-R]) and communication apprehension (using the Communication Apprehension with Dying [CA-Dying] scale) were evaluated pre and post education. A multi-faceted evaluation approach was utilized, the Promoting Action on Research Implementation in Health Services (PARiHS) framework for assessment of organizational readiness for change, and the Donabedian Quality Model to evaluate efficacy of the ELNEC Module 6 education on nurse death anxiety and communication apprehension.

Preliminary evaluation of the ELNEC Module 6 intervention indicated that, controlling for the DAS-R pre-score, nurses with an ADN or Diploma degree had a significantly lower post-test death anxiety score than nurses with a BSN or MSN degree. Nurses who cared for more dying patients per year, controlling for the CA-Dying prescore, had a statistically significant lower CA-Dying score. Experiential learning and reflection are central to creating a culture of innovation, improvement and effectiveness.

The ELNEC curriculum promotes personal reflection about death. By embedding nurses skilled in advanced communication techniques at the frontline, a sustainable model for peer consultation and support regarding difficult conversations is possible. Providing effective palliative care across an organization is a complex endeavor. A doctorally prepared nurse can have an integral role in transforming EOL care.

The purpose of this practice dissertation project was to work in collaboration with a community hospital on the BFHI designation pathway by specifically implementing breastfeeding education (Step three of the guidelines). Program goals included improving breastfeeding knowledge, self-efficacy, and intent among the targeted population. Using the conceptual frameworks of both Donabedian and Breastfeeding Self-Efficacy Theory, a multi-faceted approach was implemented targeting all pregnant women in this organization‟s affiliated prenatal clinic. Helping to create transformational change in organizational culture at the system level resulted in the development of the prenatal educational program (PEP). Healthcare providers and office staff delivered breastfeeding education and support to patients as a component of their routine care.

Preliminary evaluation of the PEP did not indicate that there was a difference in the short-term outcomes of breastfeeding knowledge, self-efficacy, and intent. However, significant differences in breastfeeding knowledge and self-efficacy were found between women who planned to breastfeed when compared to women who were undecided or did not intend to breastfeed. These significant differences in breastfeeding knowledge and 7 self-efficacy were found in both the pre-intervention and post-intervention assessments. Practice implications exist related to implementation science, systems change and addressing breastfeeding barriers. Healthcare providers must have the necessary skills to provide breastfeeding education and support, and to improve health outcomes at the community level. A doctorally prepared nurse can have an integral role in achieving these outcomes.

The HCV carries an estimated financial burden of $10.7 billion nationally, and $377 million in Michigan alone. Barriers to treatment include the lack of qualified healthcare providers and treatment programs; rigorous treatment regimens and significant medication side effects; psychosocial challenges include mental illness; addiction; stigmatization; and insufficient healthcare coverage. The purpose of this project was improve access and care for individuals with hepatitis C in an undeserved area.

The purpose of this dissertation was to evaluate care received in a free clinic for patient satisfaction and perceived increased access to health care services. The clinic population was the medically underserved residents of a western Michigan lakeshore community.

A community coalition was formed to address the lack of access to health care for medically underserved adults in this area. With the help of the local community hospital and a large charity organization, a pilot clinic was opened in the local health department one evening per week, managed solely by volunteer providers, nurses, and social workers. A literature review was completed and the evidence showed that the best model of providing care to this population needs to be one that incorporates community collaboration and financial sustainability.

Data collection tools included a utilization of health care services tool and patient satisfaction survey. The data were analyzed and presented to stakeholders.

Overall patient satisfaction was high. Additional observations of the clinic were addressed and recommendations to improve the effectiveness of the clinic were presented to the clinic director. The evaluation also revealed many other unmet needs of this population and community.