Digital Commons Network^™

Parametric Characteristics Of The B6omsi-Re, Sarahelizabeth Janemarie Baguhn

Dissertations

Orientation and mobility specialists for young children who are blind or visually impaired have relied on informal assessments or commercially available tools designed for sighted children to track developmental progress. When Bradley-Johnson (1994) literally wrote the book on assessment in blindness, the sharing and refinement of common tools led to professionals working in teams to sift and winnow the checklists, and move the best available tools into wider circulation. This has led to the evolution of the practitioner made tools becoming the published tools, although they have not yet had statistical evidence to support their efficacy. This three-paper dissertation aims …

The Role Of Youth Characteristics, Home Ecology, And Child Maltreatment In The Severity Of Problematic Sexual Behaviors And Conduct Problems, Ariel K. Berman

Dissertations

A multitude of individual, familial, and environmental variables have previously been identified as contributing to the development of problematic sexual behaviors (PSB) and general conduct problems (CP) in youth. The majority of these studies have focused either on individual youth characteristics or parenting behaviors such as child maltreatment. Although researchers examining contributions to PSB and CP generally acknowledge the importance of the impact of the home environment on youth behavior, few researchers have included family characteristics of both parents and siblings in their analyses. Additionally, some factors that have been identified as having great importance in general juvenile delinquency, such …

Blood Pressure Management And Factors Affecting Adherence To Antihypertensive Medications In The United Arab Emirates, Akshaya Srikanth Bhagavathula

Dissertations

Hypertension is a significant public health problem worldwide and is a major modifiable risk factor for cardiovascular disease. The dynamics of guidelines-recommended blood pressure (BP) control and adherence to antihypertensive medications in incident hypertensives remain unclear. This dissertation aims to assess guidelines-recommended BP management, adherence to antihypertensive medications, and factors associated with poor BP control among newly diagnosed hypertensive patients in the UAE. A retrospective chart review of 5308 newly treated hypertensives across the emirate of Abu Dhabi, UAE, in 2017 was conducted. These patients were diagnosed by the treating physician according to ambulatory (ABPM), or home-based BP monitoring (HBPM) …

Mental Health Treatment In Juvenile Correctional Facilities: Utilizing Assessment To Inform Treatment, Sarah Riccio

Dissertations

Youth in juvenile correctional facilities face a wide range of mental health difficulties. Over the years, the juvenile justice system has prioritized the need for providing appropriate and effective treatment services to youth throughout their detainment. Despite these ongoing efforts, treatment practices in juvenile correctional facilities continue to fall short. This study will first focus on assessment practices within these facilities and the impact current practices have on diagnosis and subsequent treatment. Emphasis will be placed on the importance of comprehensive evaluations for informing diagnosis and determining the individual treatment needs of detained youth. An integrated approach to assessment will …

Informing Cognitive Screening In The Young Adult Population, Samantha L. Mcdaniel

Dissertations

The clock drawing test (CDT) is a cognitive screening measure with sound psychometric properties which has been well researched over the past century. The CDT is a popular tool for many healthcare professionals to administer independently or as part of a more thorough cognitive evaluation. Given the drastic technological and social developments over the years since the CDT was developed as well as the persistent research focus on older adult populations, a gap in the CDT literature presented for young adults, who may have difficulty drawing an analog clock. Identifying cognitive impairment can improve health outcomes. The young adult population …

Resuscitation Quality Improvement Mortality Rates, Jordan Priest

Dissertations

This paper explores and answers the question: What is the impact of Resuscitation Quality Improvement on survival at discharge rates after suffering an IHCA when compared to every two-year BLS/ACLS training? Articles are explored that identify positive patients’ outcomes when resuscitation training is repetitively learned. The design consists of a BLS/ACLS and RQI evaluation of quarterly survival to discharge rates prior to the initiation of the new RQI program and after the initiation of the new RQI program. The setting of the study is the east region of a midwestern faith-based health care system, that includes four hospitals in one …

Standardized Screening For Peripheral Artery Disease In Primary Setting, Tamara Tomlin

Dissertations

Problem: Peripheral artery disease (PAD) affects eight million Americans and is the third leading cause of death in the U.S. in people 60-85 years of age. Veterans are at a 45% greater risk to develop PAD than non-veterans. Left untreated, PAD can progress to hospitalization for revascularization, amputation, or death. The American Heart Association (AHA) recommends using a standardized screening tool for the diagnosis of PAD; however, a lack of standardized screening is problematic in veterans receiving proper intervention.

Methods: This quality improvement (QI) project utilized a descriptive, observational design. The American Heart Association (AHA) screening tool was administered by …

The Alexander House Apostolate Marital Relationship Education Results: A Quantitative Study, Angel Estrada

Dissertations

According to existing literature, 27 components contribute to the concept of couple’s relationship satisfaction. Some of these components are included in non-religious and religious marital relationship education (MRE) programs. Research on nonreligious MREs spans decades; however, research on Catholic MRE programs is limited and not widely published. The purpose of this research was to evaluate the effectiveness of one Catholic, faith-based, couples’ MRE on impacting relationship satisfaction, and determine if specific religious and behavioral practices contributed to relationship satisfaction. The study was conducted with archival data collected from a population of mostly Catholic Latino and White couples in south central …

How Domestic Violence Counselors With Personal Histories Of Trauma Experience Their Clients Who Were Victims Of Domestic Violence: A Heuristic Study, Janis Edralin

Dissertations

The heuristic inquiry-based phenomenological approach values focusing on a question or problem that has been a personal challenge in one’s quest to understand oneself and the phenomenon. Previous research has shown that counselors with a personal history of trauma who provide services to victims with a similar history report a range of negative consequences. The researcher utilized a heuristic research design to answer the following question: How do domestic violence counselors who have personal histories of trauma experience their clients who were victims of domestic violence? The methodology involved interviewing eight counselors, from whom four themes were identified: awareness of …

Benzodiazepine Reduction Program In A Psychiatric Mental Health Setting, Tracy Pacini

Dissertations

Benzodiazepine Reduction Program in a Psychiatric Mental Health Setting

The purpose of this pilot project was to reduce side effects and adverse effects of long-term benzodiazepines (BZDs) use in a non-profit community health center. This was a quality improvement project. The evidence-based practice (EBP) framework identified for the project was from the Institute for Healthcare Improvement (IHI) Plan-Do-Study-Act (PDSA) framework to decrease BZD use in a non-profit community health center. This model is focused on four stages: 1) gathering a proactive healthcare team to examine and identify solutions to reduce BZD usage, 2) testing the pilot program that the team …

Implementing The Richmond Agitation-Sedation Scale To Assess Delirium In A Pediatric Icu, Leigh Paridy

Dissertations

Purpose: The purpose of this quality improvement project was to establish early identification of delirium in the intensive care setting to reduce the impact of long-term patient outcomes. Description of project: A retrospective-prospective medical chart review was completed. The retrospective chart review looked at fifty-two patients admitted to the pediatric intensive care unit (PICU) between October 1, 2020 and December 1, 2020 for patient demographics and State Behavior Scale (SBS) and the Cornell Assessment for Pediatric Delirium (CAPD) charting compliance especially with children with developmental delay and those with a high susceptibility to delirium. The prospective chart review looked at …

Telework Intensity, Work-Family Conflict, And Work-Family Balance, During The Covid-19 Pandemic, Timir Jayesh Bharucha

Dissertations

The COVID-19 pandemic has led to increased popularity, application, and utilization of telework. To vastly reduce the spread of COVID-19, governmental agencies worldwide have implemented lockdowns and emphasized businesses and corporations should implement telework wherever possible (Anderson & Kelliher, 2020; Belzunegui- Eraso & Erro-Garces, 2020; Buomprisco et al., 2021; Chong et al., 2020; Contreras et al., 2020; Mouratidis & Papagiannakis, 2021; Nguyen, 2021; Oz & Crooks, 2020; Raišienė et al., 2020; Tavares et al., 2020). States of emergency can disturb employees’ workflow and lead to financial difficulties; thus, telework presents an option to reduce that disruption. In such unprecedented times, …

Evaluating Loneliness In An Older Adult Population, Kelli Rowland

Dissertations

Problem: Loneliness and social isolation are severe burdens on global public health and can impair overall health outcomes. Unfortunately, both loneliness and social isolation are prevalent in the older adult population. The purpose of this quality improvement project was to evaluate loneliness in older adults enrolled in a weekly socialization program and its impact on loneliness.

Methods: A descriptive cohort design was utilized to analyze surveys completed three months apart. A convenience sample was used with older adults already enrolled in a weekly socialization program. The Iowa Model of Evidence-Based Practice was applied to evaluate and promote quality …

Exploring Fused Deposition Modeling (Fdm) Three-Dimensional Printing Tablet Design Options For Pharmaceutical Dosage Forms, Guluzar Gorkem Buyukgoz

Dissertations

This dissertation examines the use of Fused Deposition Modeling (FDM) based three-dimensional (3D) printing approach for developing patient-specific dosage forms and addressing related technical challenges in such drug delivery systems. The first main objective is to explore pharmaceutical tablet design options using novel FDM 3D printing technology as the drug delivery platform such that drug form and tablet properties are tailored by considering patient age-specific formulations and dissolution control. Of the five different design options, two proposed options meet the main objective of providing similar drug release, whereas the popular option of fixed drug concentration but differing tablet size could …

Mobbing And Job Satisfaction Among Registered Nurses In Mississippi, Brenda Collins

Dissertations

The incidences of mobbing or workplace bullying are a common occurrence among nurses. The practice has been associated with overwhelming and long-standing comprising emotional, psychosomatic, and psychosocial distress. Mobbing (workplace bullying) impacts the target, those close to them, and the organization in which they work. The experience of mobbing produces affective reactions in the target. Affective experiences on the job can impact job satisfaction within organizations. Job satisfaction plays an essential role in sustaining an adequate nursing workforce. Subsequently, some nurses become frustrated and opt for resigning or early retirement when they are no longer satisfied with the culture or …

Exploration Of Patient Variables And Characteristics Best Suited For Medical Marijuana Treatment For Anxiety And Depressive Disorders, Corey Gazoo

Dissertations

Individuals with posttraumatic stress, anxiety and depressive disorders are currently being prescribed medical marijuana as a treatment in many states across the United States. However, marijuana is still considered a schedule one narcotic by the Drug Enforcement Administration and federal government, which provides several barriers and challenges to conduct research such as approval from the U.S. Food and Drug Administration and following guidelines from the National Institute on Drug Abuse issued by the DEA. Additionally, individuals prescribed medical marijuana for mental health disorders are not always thoroughly instructed on the type of medical marijuana, the dosage, and how frequently to …

A Qualitative Exploration Of The Patient Care Experience As Perceived By Hispanic Patients Receiving Care At A Safety-Net Facility, Silvinia Cuizon

Dissertations

Purpose: The purpose of this study was to understand how English- and Spanish-speaking Hispanic patients seeking kidney and liver transplant care at a safety-net facility perceive and interpret the care experience with the goal of generating a grounded theory model to guide care delivery and improve perception of care for this population.

Background/Rationale: The patient experience is the current federally mandated hospital quality indicator that measures the range of interactions patients have with their hospital admission, which has fiscal and clinical implications for the delivery of care. Many safety-net health care delivery systems, which primarily serve traditionally underserved populations, and …

Veteran Social Network: Peer Support Impact On Mental Health Service Utilization, Stacy A. Harris

Dissertations

Of the 20 million US Veterans, approximately 30% receive health care benefits from the Veterans Affairs system. Research confirms that these Veterans are less likely to seek professional mental health services as a result of a belief that mental illness equates with weakness. Research on peer support with Veterans suggests that Veteran social networks reduce stigma and facilitate help seeking behavior. Most studies on Veteran help seeking for mental health services use subjects who receive health care from the Veterans Health Administration or Department of Defense. The purpose of the current study is to gain an understanding of Veterans who …

Bringing Hospital And Community Together: Interventions To Bridge The Transitional Care Gap, Jeremy Yates

Dissertations

Abstract

Problem

As healthcare spending continues to increase and overall quality lags in comparison to other developed countries, hospital readmission has been targeted to increase quality while decreasing cost. Components of the Affordable Care Act (ACA) have placed an emphasis on preventative and transitional care which has created programs aimed at reducing readmission, including the Community Health Access Programs (CHAP). One program in St. Louis, Missouri consisted of advanced practice paramedics and an occupational therapy assistant that performed discharge follow-up through in-home, in-office, and telephone visits. An in-depth program evaluation can create a foundation to build other programs in communities …

The Role Of Counseling Trainee Adversity, Attachment Style, And Trauma-Informed Principles In Clinical Supervision, Nicole Hurless

Dissertations

Current supervision literature suggests that supervisees with insecure attachment styles may perceive a poorer relationship with their supervisor and feel less satisfied with supervision. Studies across disciplines indicate a relationship between traumatic and/or adverse experiences and insecure attachment; however, this association has not been studied within the context of supervision. This dissertation explores a structural equation model assessing the associations between student’s adverse experiences, insecure attachment, and quality of the supervision relationship. It was hypothesized that greater prevalence of adverse experiences would negatively relate to supervision relationship quality, and this relationship would be mediated by insecure attachment. The results of …

Enhancing Communication Between Nurses And Physicians On Patients With Sepsis, Jayne Ehirim

Dissertations

Abstract

Problem: The condition of sepsis is life-threatening, and its severity increases when there are delays in interventions. Communication challenges exist on medical-surgical units and are major contributors to poor management of patients with sepsis. Ineffective communication among health care team members continues to threaten patients` health outcomes. The purpose of this project was to implement a standardized form of communication between nurses and physicians of patients with sepsis.

Methods: An observational descriptive design with a retrospective chart review. A quality improvement PDSA cycle was used to implement an SBAR communication instrument.

Results: A total of 16 …

County Youth Athletics Response To Covid-19 Pandemic, Elise Schaller

Dissertations

Problem: To ensure safe participation in youth athletics and prevent COVID-19 transmission during the COVID-19 pandemic, St. Louis County Department of Public Health (DPH) implemented Youth Sports Guidelines on October 14, 2020. This project aimed to identify level of adherence to precautions listed in the guidelines at six county public high school athletic events.

Methods: An observational descriptive study design was used to monitor guideline adherence at high school athletic events. Two observers tallied violations by participants and spectators to Youth Sports Guidelines at St. Louis County public high school athletic events. Six high-frequency contact (basketball and wrestling) events …

Impact Of Social Isolation In Hiv-Positive Individuals During A Pandemic, Corina Jane Bakoylis

Dissertations

Problem: The global pandemic of COVID-19 caused concern for immunocompromised individuals. The purpose of this quality improvement initiative was to assess the impact of social isolation on feelings of loneliness, depression, and social isolation experiences in HIV-positive individuals residing in a long-term care facility.

Methods: A mixed-method convergent design with a purposeful sample of HIV-positive adult residents residing in a long-term care facility was utilized. An evaluation of loneliness using the University of California Los Angeles (UCLA) Loneliness Scale (Version 3) and depression using the Patient Health Questionnaire-8 (PHQ-8) were completed. Personal experiences were also assessed with five predetermined open-ended …

Evaluation Of Depression, Anxiety And Stress In Graduate Nursing Students, Rachel Dunston

Dissertations

Mental health issues are growing in the United States. Postgraduate school is widely known to increase the level of psychological difficulties (Dyrbye et al., 2006) experienced by students. There is a need to address mental health care in graduate nursing students. This project was a descriptive observational comparison pre-post-intervention design used to see if online modes of delivery would aid in decreasing mental health issues for nursing graduate students. Participants were provided with access to three podcasts and encouraged to use the Sanvello mobile application provided to all students at this university. The first podcast focused on using the Sanvello …

Antibiotic Administration Time During A Code Sepsis, Shemekia Ford

Dissertations

Problem: Sepsis is the leading cause of morbidity and mortality and antibiotic administration within 60-minutes is a priority. The purpose of this quality improvement project was to improve sepsis patient’s outcomes by administering parenteral antibiotics within 60-minutes of a code sepsis (CS) activation.

Method: Observational descriptive design utilizing a retrospective medical record review over a three-month period in 2020 and 2021. A purposive sampling of adult patients from a Midwestern, metropolitan, Level II trauma and medical center emergency department (ED) were selected.

Results: The administration of parental antibiotics once a sepsis bundle was activated was essentially 28-minutes in 2020 …

The Effect Of Pre-Procedural Opioid Video Education On Pediatric Patients Undergoing Orthopedic Surgery, Amy Pham

Dissertations

Problem The opioid epidemic is a continuing public health threat, growing amongst the pediatric population. Contributing to the issue are their accessibility within the community, and lack of education on safe storage and disposal of opioids.

Methods For this quality improvement (QI) project, a descriptive observational study design was used to identify the opioid storage and disposal habits of patients and their caregivers at home. The participant and caregiver dyads were shown a brief opioid educational video pre-operatively and were followed up with via emailed survey two weeks post-operatively. The survey contained questions pertaining to disposal and storage habits of …

Primary Care Screening For Adverse Childhood Experiences (Aces) In The Adult Population, Carrie Plisco

Dissertations

Problem: Exposure to Adverse Childhood Experiences (ACEs) is associated with chronic diseases in adulthood. Several studies found over 60% of adults have had exposure to one or more ACEs. While guidelines for ACEs screening exist, most primary care practices do not perform screening at this time. This results in a lack of referrals for adults with history of ACEs for proper behavioral health (BH) intervention.

Methods: This quality improvement (QI) initiative utilized a descriptive observational design. The Centers for Disease Control and Prevention (CDC) ACEs screening tool was administered to a convenience sample of adult patients aged 18 years and …

Implementation Of Pediatric Adverse Childhood Experiences Screening In Primary Care, Alexzandra Hillyer

Dissertations

Implementation of Pediatric Adverse Childhood Experiences Screening in Primary Care

Problem: Over half of children worldwide have experienced abuse in the past year. In 2012, The American Academy of Pediatrics released a policy statement emphasizing the importance of primary care providers implementing Adverse Childhood Experience (ACE) screening into all well-child examinations.

Methods: This quality improvement project was a descriptive, observational pilot study in which Center for Youth-Well ACE Questionnaire (CYW-ACE-Q) was implemented into a large, metropolitan pediatric primary care clinic. A convenience sample was utilized composed of pediatric patients between the ages of 5 and 18 being seen for a …

Evaluation Of A Dirfloortime® Program For Autism Spectrum Disorder, Jennifer L. Pipitone

Dissertations

Problem. Parents with children who have neurodevelopmental disorders, such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) experience high levels of parenting stress. The prevalence of ASD is on the rise in the United States. As a result, there has been an increase in the use of treatment modalities, in effort to better understand which modalities have the most positive impact on children and their parents. DIRFloortime® is a developmental treatment modality used to help strengthen the parent-child bond and used to decrease parental-child stress. The Autism Parenting Stress Index (APSI) measures the impact of an intervention …

Standardizing Genomic Testing Of Pancreatic Cancer In A Community Oncology Practice, Julie Marie Scott

Dissertations

Problem. Ordering genomic testing for patients with pancreatic cancer can discover germline or somatic mutations that may allow for targeted therapy. There are some difficulties in obtaining genomic tests, such as which test to order, and optimal timing of ordering. In addition, interpreting results and maintaining easy access to the report in the electronic medical record can be difficult. Delays in ordering genomic testing can delay the discovery of an actionable mutation for treatment.

Methods. A descriptive comparison project was developed comparing rates and timing of ordering of genomic testing for patients with pancreatic cancer who established care with a …