Digital Commons Network^™

Lost In Interpretation: The Lived Experience Of Nurse Interpreters In The Clinical Setting, Byron Batz

Dissertations

The use of language interpreters in the health care setting constitutes a vital part of provider-patient communication but remains a relatively unexplored phenomenon. Registered nurses (RNs) are often called upon to serve as interpreters when linguistically diverse patients constitute a large segment of the patient population. That RNs serve simultaneously in an interpreter role – in addition to clinical and advocacy roles – is a complex facet of contemporary nursing practice in a diverse U.S. culture. The purpose of this qualitative descriptive study was to examine the lived experience of RNs serving as interpreters in health care institutions in Southern …

Implementation Of Clinical Institute Withdrawal Assessment: Alcohol Revised (Ciwa-Ar) Education Program In A Crisis Stabilization Unit, Amanda Dehart

Doctor of Nursing Practice Final Manuscripts

Background: At this time the crisis stabilization Units do not currently utilize the Clinical Institute Withdrawal Assessment: Alcohol Revised tool with patients who may experience Alcohol Withdrawal Syndrome. Patients with alcohol use disorders have a high comorbidity rate with psychiatric disorders (Butterfield, et al, 2020). The Clinical Institute Withdrawal Assessment: Alcohol Revised or CIWA-Ar is currently the most widely used assessment tool in the psychiatric setting when assessing patients who may be experiencing Alcohol Withdrawal Syndrome (Pribék, et al, 2021) .

Purpose of Project: The purpose of this project is to measure pre and post -education knowledge of the registered …

When "First, Do No Harm" Fails: A Restorative Justice Approach To Workgroup Harms In Healthcare, Pedro L. Flores

Dissertations

In healthcare, workgroup mistreatment is a pervasive problem that begins during medical education (medical and nursing school) and becomes embedded in the “hidden curriculum of professionalism,” which dissuades and even punishes learners for talking about abuse they witness. Furthermore, the mistreatment of healthcare providers (HCPs) pervades all disciplines in the healthcare delivery chain due to a combination of cultural factors, systemic pressures, dysfunctional hierarchies, and leadership’s tolerance of intimidating and disruptive behaviors. Not surprisingly, 18% of U.S. HCPs have left the medical field since the start of the COVID-19 pandemic, and burnout, stress, anxiety, and increased workloads have been identified …

Utilization Of Peer-Led Education To Enhance Advance Care Planning And Advance Directive Completion, Jenna Juenger

Doctor of Nursing Practice Final Manuscripts

Background: The integration of advance care planning (ACP) and palliative care (PC) into oncology plays a critical role in symptom management and quality of life. Studies reveal a large subset of oncology patients with unmet needs regarding ACP and advance directive (AD) completion. Successful ACP helps to promote congruent medical treatment with patients’ values and preferences and motivates patients to complete ADs.

Objective: An evidence-based practice project was conducted to assess the effectiveness of peer-led education to nursing staff to improve ACP and AD completion among inpatient oncology and PC patients

Design: A standardized survey created from the …

Older Adults’ Implementation Of Discharge Instructions Following An Acute Care Hospital Stay, Brenda Miller

Dissertations

Discharge instructions are a self-care guide for patients after discharge from an acute care hospitalization. The discharge process starts on admission to the hospital and continues until discharged. Many patients rely on informal caregivers to provide support after a discharge. However, it is often unclear whether the patients or caregivers completely understand instructions provided during the discharge process. Key concepts related to how discharge instructions were implemented following discharge to home have been understudied from the patient’s and informal caregivers’ perspectives. Developing effective discharge instructions based on study findings may assist in reducing 30-day hospital readmission rates.
This study was …

The Use Of Clinical Decision Support To Improve Nursing Practice, Kathleen Klimpel

Dissertations

Healthcare information technology is solidly entrenched in most acute care hospitals but the need to demonstrate its positive impact on patient outcomes persists. Clinical decision support (CDS) is an informatics tool that is highly customizable to promote patient improvement activities. Despite its high potential, studies have had mixed results regarding the impact of CDS and it has not been widely studied in the realm of nursing practice. One aim of this dissertation was to analyze the concept of CDS in order to inform the examination of the relationships between CDS implementation and nursing interventions. The determining factors of nurses use …

Onsite Integrative Clinics: Acupuncture, Positive Patient Outcomes, And Frequency Of Provider Office Visits, Sherry Shoemaker Phd

Dissertations

Purpose and Aims. There is limited information about outcomes of care, resource utilization, and associated costs for patients who receive acupuncture in integrative health settings. The purpose of this study was to address this gap through the following aims: To examine: (1) changes in patient pain levels pre/post acupuncture treatments; (2) relationships between receiving acupuncture treatments (number of treatments, length of time, select demographic factors, (age, gender), pain level pre and post acupuncture treatments; (3) relationships between number of treatments, length of time, age, gender, pain level (pre/post acupuncture treatments) and provider visits (pre/post acupuncture treatments); and (4) relationship between …

Exploring A Diabetic Registry For Cardiovascular Risk Factors, Mary C. Anziano Phd

Dissertations

Background: Cardiovascular disease is the leading cause of death in the United States. There were over 18 million people diagnosed with diabetes in 2002. These disease processes together combine for significant health burden on society (American Diabetes Association, 2008). The purpose of the study was to describe the relationship between select demographics, and clinical characteristics to determine risk factors for cardiovascular disease in a diabetic population. Methods: A retrospective descriptive study was conducted using a diabetic registry database containing patients diagnosed with diabetes from January 1, 2011 to December 31, 2012. Study variables included age, gender, socio-economic status, glycosylated hemoglobin …

The Case Of Reintegration Of Women Post Incarceration, Deana Raley Noble Phd

Dissertations

Women released from prison or jail face particular obstacles and challenges on reentry to the community, many of which are related to their childhood and to gender roles as women and mothers. This study relates the lived experience of one woman's successful transition to economic and mainstream societal reintegration and family reconnection after release from prison and the insights gained by the researcher. Case study methodology congruent with Miller's Relational-Cultural Theory philosophical framework was utilized in this in-depth, single case design and represents a unique case. The overall purpose of this descriptive and explanatory research was to explore precursors to …

Relationship Between Age And Pre-End Stage Renal Disease Care In Elderly Hemodialysis Patients, Rubette Harford Phd, Msn, Rn

Dissertations

Purpose: The primary purpose of this dissertation was to examine the relationship between age and receipt of three components of pre-end stage renal disease care prior to first initiation of hemodialysis, and to explore the implications of differences in interpretation of funding policies for dialysis services in Puerto Rico and the U.S. mainland. Background: The growing burden of chronic kidney disease (CKD) is a national public health concern, particularly within the aged population. It is estimated that more than 25 million Americans are living with some level of kidney disease, with an increasing prevalence noted with increasing age (Coresh et …

Patient Care Technology And The Nurse-Patient Relationship, Belinda M. Toole Phd, Msn, Rn

Dissertations

Background: Technological devices are increasingly used in healthcare and their proliferation has providers questioning the impact on the patient-provider relationship. Technological device integration has been studied in the primary care setting, less extensively in the acute care setting. The impact of device use on the nurse-patient relationship in acute care setting required further study, particularly with nursing's history of holistic practice incorporating caring and presence. Objectives: The study purpose was to explore the patient's perceptions of nurse caring and presence when technological devices were used in care delivery in the acute care setting. Specific aims were: 1) to describe the …

Patients With Advanced Lung Cancer: Quality Of Life And Perception Of Dyspnea, Barbara A. Roces Phd, Msn, Np, Rn

Dissertations

Background: Dyspnea perception can be defined as a multidimensional experience of breathing discomfort, influenced by physiological, psychological, social, and environmental factors, that includes secondary psychological and behavioral responses and cannot be defined only by physical objective abnormalities (Mularski et al., 2010). Dyspnea is the most common and distressing symptom in patients with advanced lung cancer and decreases one's quality of life (QOL) (Smith et al., 2001). Furthermore, dyspnea has been found to interfere with physical activities such as walking, work, and psychological activities such as disposition, taking pleasure in life, relationship with others, and sleep (Tanaka, Akechi, Okuyama, Nishiwaki, & …

Depressive Symptomatology And Perceived Social Support In Adolescents With Type 2 Diabetes, Kristiana Gay Huffman Cullum Phd, Cpnp

Dissertations

Type 2 diabetes has increased dramatically in the pediatric population in the last decade. One of the comorbidities of diabetes is depression. In the presence of depression, diabetes may be mismanaged by patients and lead to a decline in health. Diabetes with comorbid depression may have better disease management outcomes in the presence of higher levels of social support. Defining childhood depression, which encompasses adolescence, and the subtleties of this disorder compared to the adult counterpart, was needed to better delineate important variables for this research study. There are several instruments that evaluate adolescents' perceived social support, but a fairly …

Symptom Burden And Healthcare Utilization In Pulmonary Arterial Hypertension, Catherina Anne Madani Phd

Dissertations

Background: Pulmonary arterial hypertension (PAH) is a rapidly progressive disease. There is currently no cure; thus treatment is aimed at prolonging survival, improving functional status (FS), and symptom mitigation. Symptom burden (SB) can impact quality of life (QOL), and lead to increased healthcare utilization. Palliative care (PC) has been associated with higher QOL, decreased depression, aggressive care, and mortality. The Institute of Medicine's (IOM) recent report supports earlier integration of PC for people living with serious illness. Detection of patients at high risk for heavy SB may help to identify patients who could benefit from earlier integration of PC into …

Skin Cancer Risk Perception And Sunscreen Use In Adolescent Female Soccer Athletes, Cheryl L. Butera Phd, Msn, Aprn, Fnp-Bc, Np-C, Phn

Dissertations

Over 3.5 million cases of skin cancer are diagnosed annually in the United States. In adolescent females ages 15-19, melanoma is the second most common form of cancer. The greatest risk factor for skin cancer is ultraviolet rays from the sun. Research has shown that sunscreen use is protective of all skin cancers, especially melanoma. The purpose of this study was to obtain perceptions about risk of skin cancer and sunscreen use among 13- to 18-year-old adolescent female club soccer athletes as a basis for effective interventions to improve sunscreen use in this population. The Health Belief Model was employed …

Nurse Practice Environment And Peripheral Intravenous Infiltrations In A Pediatric Hospital On The Magnet Journey, Jannise Topacio Baclig Phd

Dissertations

Background: Characteristics such as quality patient care, excellence in nursing, and innovations in professional nursing practice shape a health care organization into a "magnet" organization. Magnet designation is a key aspect of nursing, which places pressure on healthcare organizations to commit to nursing excellence and patient care should they take the challenge of attaining this prestige. With growing focus on quality and safety, nursing needs to remain diligent in ensuring a healthy work environment that not only supports the profession, but also sustains exceptional patient outcomes. The purpose of this research study was to describe the relationship of the nurse …

Delirium Rate And Risk Factors In Palliative Care Outpatients And Caregiver Coping Strategies, Sarah Deur Livermore Phd, Fnp

Dissertations

Background: Delirium causes suffering and in terminal illness undermines important goals to die at home. Improved knowledge about delirium among palliative outpatients can lead to improved patient outcomes through early identification and treatment in the home. Conversely, a missed diagnosis leads to costly hospital admissions, and is the most common reason to seek long-term care placement (Breitbart & Alici, 2008). Medicare stresses the importance by listing it as a common cause of falls among non-reimbursed hospital events. Prior evaluation of outpatient delirium rate was 14% among demented community dwelling elders (Steis, Evans, et al., 2012a). It is hypothesized that frail, …

A Phenomenological Study Of Acceptability Of Preexposure Prophylaxis Therapy Within The Lived Experiences Of Hiv Negative Male-To-Female Transgender Young Adults, Gloria N. Nwagwu Phd

Dissertations

The male-to-female transgender (MtF-TG) are individuals assigned a male gender at birth but self identify as female. MtF-TG young adults experience discrimination, stigmatization, isolation, and homelessness as a result of gender identity and gender expression. The transgender populations are linked to high rate of new HIV infection. The use of Preexposure prophylaxis (PrEP) therapy demonstrated a decrease in HIV infection risk ranging from 42% to 73% among sexual minority individuals. The goal of this three-part study was achieved through concept analysis, data collection, and analysis. The following aims were addressed; analyze the concept of transgender, explore currently used HIV prevention …

Hospital Fall Prevention Using Interactive Patient Care Technology, Verna A. Sitzer Phd, Mn, Rn, Cns

Dissertations

The impact of patient engagement in hospital fall prevention using interactive patient care technology is not known. The purpose of this investigation was to examine the engagement of hospitalized patients in a computer-based, interactive patient care fall prevention pathway, comprised of a self-assessment of fall risk questionnaire and a fall prevention video, and hospital fall outcomes. The aims were to 1) formulate an interactive patient care technology conceptual framework to guide the study, 2) provide reliability and validity evidence for a patient self-assessment of fall risk questionnaire, and 3) explore the relationship between the fall prevention pathway engagement characteristics and …

Identification Of Posttraumatic Stress Disorder Symptoms In Post-Icu Patients, Heather Warlan Phd, Rn, Ccrn

Dissertations

Background: Patients receiving critical care are experiencing post-traumatic stress syndrome (PTSS) as a result of life-saving interventions received in the intensive care unit (ICU). PTSS is associated with poor patient outcomes and decreased quality of life compared to post-ICU patients without PTSS. Personal and clinical characteristics that place patients at higher risk for PTSS are still being examined. It is also unknown to what extent patients are being screened for ICU-induced PTSS. Objectives: This body of work aims to examine the risk factors associated with ICU-related PTSS and describe the screening experiences of patients who recently received care in an …

Professional Quality Of Life And Emergency Department Nurses' Communication Patterns, Elvira Dominguez-Gomez Phd

Dissertations

The purpose of this mixed methods embedded design study was to examine relationships between compassion satisfaction, burnout, compassion fatigue/secondary trauma, and perceived levels of communication difficulty in emergency room nurses employed at a health care system. Quantitative data was collected from a purposive sample of 43 emergency room nurses using the Professional Quality of Life Scale (ProQOL), the Silencing Response Scale, and a demographic form. The study's embedded qualitative component was participants' experiences with traumatic cases in the emergency room. Qualitative data was collected via telephone interview with 10 emergency room nurses obtained from a subset of the original sample …

Relationship Between Horizontal Violence Among Registered Nurses And Falls, Elizabeth Densford Rocha Phd

Dissertations

Background: Horizontal violence is a manifestation of oppressed group behavior leading to low self-esteem and feelings of worthlessness among nurses. Horizontal violence leads to the creation of a hostile, unsafe work environment preventing nurses from performing at their highest potentials. A hostile work environment leads to a culture of unsafe patient care which may result in increased harm to patients. An understanding of why horizontal violence occurs and the implications of this phenomenon are the first steps in addressing this destructive behavior as well as protecting patients from harm. Health care environments must support nurses to perform at their best …

Relationship Between Participation In Nurse Externship Program And Rn Retention And Quality Care, Lourdes C. Salandanan Phd

Dissertations

Study Background. Nurse externship programs were initially developed by healthcare institutions as a recruitment tool for new nurses. Literature has demonstrated the positive outcomes of the program on the participants and healthcare institutions but during times of economic difficulties, health care institutions discontinue the program. The studies that demonstrate the value of the program are limited to the recruitment phase and the 2-year retention of the newly graduated nurses. There is a need to demonstrate the value of the program in terms quality of care and long term RN retention. Research Questions. The three research questions this study addressed include: …

Factors Affecting Health Promotion Lifestyle Behaviors Among Arab American Women, Kholoud Khalil Phd

Dissertations

Guided by Pender and colleagues' (2006) revised health promotion model (HPM), this descriptive correlational study was designed to explore the relationships between personal factors (comprised of sociodemographic factors, degree of acculturation, and perceived stress), perceived health self-efficacy, perceived social support, and health promotion lifestyle behaviors (HPLBs) among a group of Arab American women (AAW) living in Southern California. A second purpose was to explore the psychometric properties of the translated version of the perceived health competence scale (PHCS). A convenience sample of 267 AAW were administered a paper copy of a self-reported survey. Four of the study's five standardized measures …

Does Participation In A Multi-Modal Activity-Based Program Impacts On Functional Recovery, And Quality Of Life In Adults With Spinal Cord Injury?, Carolyn S. Gerber Phd, Msn, Rn

Dissertations

The purpose of this study was to explore the relationships between relevant personal factors, participation in a multi-modal activity-based training program, and the program's impact on an individual's level of functional recovery, and overall quality of life in adults with Spinal Cord Injury (SCI). A descriptive, correlational design was performed on a secondary analysis dataset to conduct this study. Inferential statistics were performed with mixed ANOVA's on measures of ASIA UEM and LEM scores, EuroQol, and SWLS to compare their means. The study proposed that participation in a multi-modal activity-based training program would be associated with greater functional recovery, less …

Determinants Of Physical Activity In Arab American Children, Wearn Alkhatib Phd

Dissertations

Physical activity is an integral part of preventing and managing childhood and adolescent obesity. Lack of regular physical activity has negative impact on physical and psychosocial health. Arab Americans (AAs), one of the most rapidly growing minorities in United States, tend to have a high prevalence of obesity and low participation in physical activity. The purpose of this study was to describe determinants of physical activity, including self-efficacy, social support, physical environment, and selected demographics among AA children in Southern California. A descriptive correlational study using a cross sectional design was conducted. Self-administered questionnaires were completed by children (N=206) recruited …

Quality Of Life Among Southwest American Indians And Alaska Natives Living With The Hepatitis C Virus, Rydell Todicheeney-Mannes Phd, Rn, Acns-Bc

Dissertations

Background: Hepatitis C Virus is considered to be a global public health threat because seventy-five percent of infected persons have no symptoms and are unaware of their infection. It is significant to note that AI/ANs commonly contend with issues that prevent them from receiving or seeking medical care. Objectives: The purpose of this study was to: (a) Characterize the level of depression, alcohol consumption, stigma, and quality of life; (b) Examine the relationship among the variables of age, gender, residing on an AI/AN reservation, current partner status, depression, alcohol consumption, and stigma with quality of life in a sample of …

Acupuncture For Sleep Disturbances In Veterans With Post Traumatic Stress Disorder, Heather C. King Phd

Dissertations

Post Traumatic Stress Disorder (PTSD) has emerged as a significant problem among Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans. Disturbed sleep is one of the most frequently reported symptoms among OEF/OIF veterans with PTSD. PTSD itself is impairing, but the burden of this disorder is likely heightened when accompanied by sleep disturbances. Sleep disturbances have been associated with a 75-90% increased risk of co-morbid conditions, increased levels of depression and anxiety, daytime sleepiness and fatigue, reduced psychomotor performance, diminished work productivity, and decreased quality of life. These consequences of disturbed sleep emphasize the critical need for additional evidence based therapies …

A Descriptive Exploratory Study Of The Experience Of Gay Partners Of Hiv-Positive Men, Jon Christensen Phd, Msn, Rn

Dissertations

HIV disease/AIDS has been the focus of much research since its introduction in 1981 and continues to have profound implications for those living with the disease and for those who are in close social relationships with them. One group that has received minimal attention in the HIV/AIDS literature is gay partners of HIV infected men. The aim of this study was to explore and describe the experiences of gay men living with a life partner who has HIV disease/AIDS who were not primary caregivers. A qualitative study using an interpretive descriptive approach was employed to study the experiences of ten …

Psychometric Properties Of Standardized Patient And Faculty Rater's Evaluations Of Pre-Licensure Nursing Student Competencies, Karen A. Macauley Phd, Dnp, Fnp-Bc, Gnp, Bc

Dissertations

The use of simulation as a teaching modality has been rooted in the military, aviation, space, and engineering for centuries (Bradley, 2006). Clinical simulation allows for training of healthcare providers that might be too costly, risky, or hazardous in the clinical setting (Bradley, 2006). A variety of simulation modalities are used including virtual learning, task trainers, mannequins, and standardized patients (SPs). External demands for improved accountability of clinical performance is requiring nursing educators to reevaluate methods of teaching and how we measure nursing competence (Nehring & Lashley, 2010). Standardized patients have been used in medical school curricula to teach and …