Digital Commons Network^™

The Role Of The Nurse Practitioner In The Patient-Centered Medical Home, Patricia M. Sohn

Dissertations

The Patient Centered Medical Home (PCMH) was established to improve patient access to high quality, cost-effective primary care. Critical to this new model of care is the optimal utilization of nurse practitioners (NPs) in performing services traditionally offered by physicians. This study compared the roles of NPs and physicians in providing primary care in two PCMHs in a local health care system. During the calendar year 2011, a total of 50,471 patient visits occurred in the two PCMHs. Each PCMH consisted of a Traditional Clinic that saw patients on a scheduled basis and a Convenient Care Clinic that accepted walk-in …

Identification And Management Of Vertebral Column Fractures In Primary Care, Christopher Richard Hemmer

Dissertations

The purpose of this project is to perform a program evaluation of current treatment patterns of primary care providers for osteoporotic vertebral compression fractures (VCF). VCF’s result in significant morbidity and long term sequelae following a VCF is not uncommon. Additionally, there is controversy regarding the diagnosis and management of this disorder, especially as these relate to the clinical practice guidelines. This practice evaluation project included a pre and post-test survey and a continuing education offering. Thirty-nine physicians and nurse practitioners completed the survey instruments and attended the continuing education sessions. The educational session resulted in improvement of the provider’s …

Vertical Violence And The Student Nurse: Is This Toxic For Professional Identity Development?, Sherri Williams Cantey

Dissertations

This narrative inquiry centers on student nurses’ stories of vertical violence perpetuated by clinical registered nursing staff and the meaning that students associate with this phenomenon. Student nurses are the very young and potentially impressionable members of our profession; therefore, a concern of this study was if vertical violence affects professional identity development for the student nurse. Additionally through stories revealed by these participants, this study attempted to explore whether perceptions of violence are believed to be a rite of passage into the profession. Students are the future of our profession, and it is important that this phenomenon be understood …

Using Box-Jenkins Modeling Techniques To Forecast Future Disease Burden And Identify Disease Aberrations In Public Health Surveillance Report, Larry C. Garrett

Dissertations

The analysis of public health surveillance data to identify departures from historical patterns of disease is required to facilitate the timely identification of potential outbreaks. Using the Box-Jenkins forecasting model, this study examines the potential to predict future disease burden based upon the historical record within local public health jurisdictions. Box-Jenkins forecasting was developed as a direct result of forecast problems in the business, economic, and control-engineering applications, yet it has not been systematically examined for use with public heath surveillance data.

Box-Jenkins forecast models are constructed by stratifying 84,029 disease reports from the State of Utah by year (n …

Health Literacy, Cognitive Impairment, And Medication Adherence In Veterans With Heart Failure, Lee Ann Hawkins Phd

Dissertations

Background: Heart failure (HF) affects 5.8 million people in the United States, costly in terms of patient mortality and morbidity as well as healthcare dollars. One important manifestation of poor HF outcomes is the excessive admission-readmission cycle. Non-adherence to medication is responsible for the majority of HF readmissions. Identification and intervention for key factors contributing to poor medication adherence is critical to improving outcomes. Two such factors prevalent in persons with HF are cognitive impairment (CI) and poor health literacy (HL). There is a paucity of tested interventions designed to improve medication adherence by addressing underlying CI or HL. A …

Obstructive Sleep Apnea And The Effects Of Co-Existing Factors On Pacu Stay Time, Shari F. Jones Phd, Crna

Dissertations

Significance/Background: Obstructive Sleep Apnea (OSA) is the most common disturbance during sleep affecting 30% of the population. The occurrence of moderate/severe OSA is 11.4% in men and 4.7% in women. OSA is caused by repetitive partial or complete obstruction of the upper airway with apnea episodes. OSA is prevalent in western society, yet is frequently undiagnosed due to lack of knowledge of the disorder. This population presents a challenge during the peri-operative period due to increased risk for several complications. Of particular interest to Nurse Anesthetists, are respiratory complications that result in delayed emergence from anesthesia, delayed post-operative recovery, increased …

Does Psychopathy Predict Future Risky Sexual Behavior?, Jessica Jade Fulton

Dissertations

Risky sexual behavior (RSB), such as having sex with an unknown partner, is associated with a variety of negative consequences including sexually transmitted diseases and unplanned pregnancy. Previous research (e.g., Fulton, Marcus, & Payne, 2010) suggests that psychopathic personality traits as assessed by the Psychopathic Personality Inventory (Lilienfeld & Andrews, 1996) are associated with RSB. Self-Centered Impulsivity (SCI), which is characterized by impulsivity, irresponsibility, and reckless behavior, was positively associated with RSB among men and women. In contrast, Fearless Dominance (FD), which is characterized by fearlessness, manipulativeness, and social dominance, was positively associated with RSB among men but not women. …

Assessing The Feasibility And Perceptions Of Health Services For Refugees Of Resettlement Organizations, Heidi Jean Worabo

Dissertations

Background: Since 1975 the U.S. has resettled 2.6 million refugees who had to flee from their home countries. Many refugee resettlement organizations have developed different models of innovation to promote a smooth transition between previous foreign refugee camps to U.S. communities so that refugees swiftly become economically and socially self-sufficient. Providing refugees with health benefits and resources has been foremost priority upon arrival as they try to overcome health care barriers. Yet there is a lack of literature examining the impact of these health services and how they are perceived by the program recipients. Purpose: This scholarly project aimed to …

Lesbian/Queer/Same-Gender-Loving Women Graduate Students In Mental Health Related Fields: A Grounded Theory Of Attitudes Toward Transgender Individuals, Bonnie M. Benson

Dissertations

Transgender (trans) issues are an emerging area of research within counseling psychology. As such, little is known about how individuals form their attitudes toward trans people. Despite evidence that lesbian women are one group that has held biased views of the trans population, the literature has not addressed the perceptions that lesbian women have of trans individuals. Furthermore, the campus climate literature has attended to how LGBT students experience campus discrimination, but this literature has not addressed within-group differences, that is, attitudes and interactions among LGBT members of a university community, such as those between lesbians and trans people. The …

Pain Management In Triage And Reducing Percentage Of Left Without Being Seen In An Overcrowded Ed, Christina Ballejos-Campos Phd

Dissertations

Although in most emergency rooms, the patient is seen first by a highly trained triage nurse, the ED physician is trained to determine if the patient can safely leave the ED prior to in-depth exam, treatment and diagnosis. The goal is to keep the left without being seen by a physician percentage low, since a high number would indicate poor quality, additionally patients who present with pain, and then leave the ED prior to being seen can pose a greater risk. This study examined the association of nurse-initiated triage pain protocol on the LWOBS percentage rate of patients who present …

Inpatient Glycemic Management: Glucose Control Relationship With Hospital Variables, Discharge Planning And Education, Crisamar Javellana-Anunciado Phd, Fnp-Bc, Rn

Dissertations

This dissertation study examined the relationship of glucose control with clinical outcomes, costs, discharge planning and education. Extant studies showed that hyperglycemia, in the presence or absence of a diabetes diagnosis, is prevalent in hospitalized patients. Hyperglycemia is found in one-third of all hospital admissions and is linked to poor clinical outcomes and increased healthcare costs. Furthermore, clinical evidence suggests that lack of discharge coordination associated with medical errors and readmission. This entire body of work contains three distinct sections: Two manuscripts and a grant proposal. The two manuscripts in this study were based on more current retrospective data at …

The Impact Of A Direct Care Training Program On The Self-Efficacy Of Newly Hired Direct Care Employees At State Mental Health Facilities, Marcus Wayne Lewis

Dissertations

Self-efficacy has been shown to be an important element in the success of individuals in a variety of different settings. This research examined the impact of a two week new employee orientation training program on the general and social self-efficacy of newly hired direct care employees at state mental health facilities. The research showed that the training program did not have a statistically significant impact on the social self-efficacy of the new employees after the training or after one month on the job. The research also showed that the two week new employee orientation program did not have a statistically …

Tobacco-Use Promotional Environment And Intrapersonal Environment: Predictors Of Smoking Intention Among Young Southern California Thai-American Adolescents, Arpakorn Magkunthod Phd, Msn, Rn

Dissertations

This study explores tobacco-use related environment, intrapersonal factors, and smoking initiation in Thai-American adolescents aged 10 to 16 living in Southern California. A purposive sample of 217 youth was recruited from seven Thai-community centers located in four counties of Southern California: The sample was fairly evenly distributed by gender with female (54.5%) and almost three quarters (70.9%) were born in the United States (70.9%). Age ranged from 10 to 16 years, with the mean age 12.71 years old (SD =1.835); 27% reported age of 11. Data were collected using the 97 item Teen Tobacco-Use Questionnaire. Findings indicated 12 participants (6.3%) …

Relationship Between Delirium And Night-Time Interruptions In Icu, Amy R. Stuck Phd, Rn

Dissertations

Background: This dissertation examined the phenomenon of delirium in the intensive care unit (ICU) setting. Delirium is a form of cognitive disturbance with a physiologic etiology and complex, multifactorial mechanisms of causation and risk. Delirium in the ICU patient presents a significant risk for adverse outcomes including increased mortality, length of stay, falls, and restraint use. ICU delirium can lead to persistent cognitive impairment beyond discharge and frequent skilled nursing placement. Identifying delirium requires accurate diagnosis that is optimized when validated instruments are used. Sleep deprivation has been linked to adverse health consequences including delirium. Previous studies investigating the relationship …

Documentation: Delirium In The Hospitalized Older Adult, Jacqueline Fitzgerald Close Phd

Dissertations

Background: Delirium is a common, life threatening and preventable geriatric syndrome. Because this condition is frequently addressed by administering dangerous antipsychotic drugs, it is imperative that accurate systematic assessments are charted to determine the actual need for these medications. The purpose of the study was to describe medical record documentation of a systematic assessment of delirium in older adults who had been administered an antipsychotic medication. Methods: A descriptive correlational retrospective design was used for this medical record data based study. The setting was a 107 bed acute care community hospital located in southern California. Inclusion criteria were medical records …

Instituting An Oral Health Preventive Service Program, Including Fluoride Varnish, For Preschool Children Birth To Five Years In A Rural Health Clinic: A Clinical Scholarship Project, Carol Ann Berger

Dissertations

Abstract This project was designed to institute an oral health preventive program in a rural health clinic, in a dental provider shortage area, promoting oral health in preschool children birth to five years by: (a) instituting a program that supports the Missouri preventive service program in oral health, (b) promoting oral screenings and fluoride varnish twice yearly, (c) assessing the risk of caries, (d) referring to appropriate dental services and (e) educating parents or guardian about the importance of oral health and how to maintain oral health at home with children birth to five years. This project sought to answer …

Oncology Nurses' Cultural Competence, Knowledge, And Attitudes Toward Cancer Pain, Ayman Alnems Phd, Msn, Rn

Dissertations

Effective pain management requires appropriate knowledge, attitudes, and assessment skills. The purposes of this study were to obtain information about the knowledge and attitudes of oncology nurses related to cancer pain and its management, to evaluate oncology nurses' cultural competence, and to investigate relationships between oncology nurses' cultural competence and their pain management knowledge and attitudes. Ferrell and McCaffery's (2008) Nurses' Knowledge and Attitude Survey Regarding Pain (NKASRP), the Cultural Competence Assessment Survey (CCA) (Doorenbos, Schim, Benkert, & Borse, 2005; Schim, Doorenbos, Miller, & Benkert, 2003), and a demographic questionnaire were used to measure oncology registered nurses' cultural competence and …

California School Nurses' Knowledge, Attitude, And Intention To Participate In Sexuality Education, Maria G. Matza Phd, Msn, Rnc

Dissertations

A critical need exists to provide adolescents with sexual health education as demonstrated by our nation's position in having the highest adolescent pregnancy rates among all the developed nations. The critical need is further pronounced by California's changing demographic profile of young Latinos who are projected to be the majority in 2042 and continue to demonstrate higher pregnancy and birth rates than other racial and ethnic groups. Currently, there is limited evidence to confirm if California's students are receiving sexual and reproductive health as required by law, nor is there evidence to link school nurses as teachers or consultants in …

Coping Mechanisms Among Lebanese First-Time College Students, Rita Doumit

Dissertations

No abstract provided.

Risk Perception, Psychological Well-Being, And Health-Promoting Behaviors In Persons Informed Of A Coronary Artery Calcium Score, Jennie Elizabeth Johnson

Dissertations

Background: Cardiovascular disease (CVD) remains the leading cause of adult deaths because individuals continue to engage in behaviors that exacerbate CVD. New technologies such as coronary artery calcium (CAC) screening detect atherosclerosis before clinical disease is manifested. Awareness of an abnormal finding should enhance motivation for change.

Objective: To examine how awareness of a CAC score affects risk perception and health-promoting behaviors in persons at high risk for CVD.

Methods: This study used a descriptive prospective design with 174 high risk adults (3 or more major risk factors) recruited at a radiology center offering CAC scans in a Chicago suburb. …