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Acknowledgment Of Culture And Stereotypes: Black Participants’ Perceptions Of Specific Therapist Behaviors, Tsotso T. Ablorh

Graduate Masters Theses

Mental health disparities for Black people of diverse ethnicities compared to people of other racial identities has been well-documented (Alegría et al., 2008; Maura & Weisman de Mamani, 2017). Research addressing this pervasive systemic and interpersonal problem often focuses on client-related factors that create or intensify barriers to care. However clinician-related factors (i.e., racial identity, multicultural training, implicit biases, behavior, etc.) also have a significant impact on barriers to care, retention in therapy, and clinical outcomes for people of African descent (Larrison & Schoppelrey, 2011; Owen, Imel, Adelson, & Rodolfa, 2012). Researchers suggest that the favoring of historically white perspectives, …

Spontaneous Coronary Artery Dissection, Amy N. Wagner

Graduate Dissertations and Theses

Spontaneous coronary artery dissection (SCAD) causes 35% of myocardial infarctions in women under the age of 50 years old. Typically, these are healthy, active women without risk factors for atherosclerotic coronary artery syndromes. SCAD is a myocardial infarction caused by a coronary arterial dissection and not atherosclerotic plaques. Because of this, those effected do not present with the typical risk factors associated with acute atherosclerotic coronary syndromes. Therefore, clinicians must maintain a high level of suspicion for SCAD in young, healthy, women presenting with chest pain. Observation and pharmacological therapies are the preferred methods of treatment for a SCAD event. …

Identifying Micrornas Panel Associated With Hepatocellular Carcinoma In Serum Of Chronic Hepatitis C Patients, Areeg Dabbish

Theses and Dissertations

Introduction: early detection of hepatocellular carcinoma (HCC) will reduce morbidity and mortality rates of this poorly diagnosed widely-spread disease. Dysregulation in microRNA (miRNAs) expression is associated with HCC progression. Objective: Is to identify a panel of differentially expressed miRNAs (DE-miRNAs) to enhance HCC early prediction in hepatitis C virus (HCV) infected patients. Methodology: Candidate miRNAs were selected using bioinformatic analysis of microarray and RNA-sequencing datasets, resulting in nine DE- miRNAs (miR-142, miR-150, miR-183, miR-199a, miR-215, miR-217, miR-224, miR-424 and miR-3607). Their expressions were validated in the serum of 44 healthy individuals, 62 non-cirrhotic HCV patients, 67 cirrhotic-HCV and 72 HCV-associated …

Infusing Evidence-Based Practice Into The Cayman Islands Health Services Authority Nursing Culture, Melissa Ring

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Background: James Madison University and Cayman Islands Health Services Authority (HSA) entered into a collaborative agreement the summer of 2020. There was a lack of organizational structure surrounding implementation and systemization of evidence-based practice (EBP) models and a disconnect between nurse manager knowledge and EBP implementation within HSA.

Methods: The population for this evidence-based project was 21 HSA nurse managers from the inpatient setting. Pre-intervention survey results informed organizational readiness, nurse manager knowledge and ability to implement, and guided the intervention that included the creation and implementation of a website toolkit for EBP. An EBP model was selected for nursing. …

An Evidence-Based Project: Exploring Nurse Manager Communication Competencies And Skill Development, Micaela Ross

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Abstract

Evidence supports effective communication skills as essential for patient safety and organizational success. Evidence is also clear regarding ineffective communication and its negative impact. The purpose of this project was to determine an area of communication skill development needed among nurse managers of the participating island hospital and support positive change in knowledge, understanding, and ability to use effective communication skills. The aim was to improve communication skills among these nurse managers.The objectives were to determine a specific skill need, provide a focused educational intervention, and evaluate skill improvement. Pre-intervention survey results revealed a self-identified priority of effective communication …

Loneliness, Interpersonal Goals, Life Satisfaction, And Subjective Well-Being In Older Adults, Francesca C. Ezeokonkwo

Electronic Theses and Dissertations

Background: Loneliness is detrimental to health and is linked to numerous physiological and psychological problems. People across the age spectrum can be affected by loneliness at one point or another in their lives; however, older adults are disproportionally affected.

Aims: This study investigated the effect of interpersonal goals (compassionate and self-image goals), life satisfaction, and subjective well-being on loneliness in older adults and the influence of demographics and social support. The Ecosystem-Egosystem Theory of Social Motivation served as the theoretical framework.

Design and Method: This descriptive cross-sectional correlational study used the 2016 Health and Retirement Study. Participants were 65 years …

Implementation Of An Agitation Scale In Three Emergency Departments In An Urban Area Of Northern California, Adam Pelzl

Doctor of Nursing Practice (DNP) Projects

Background. Behavioral health patients in the emergency department are customarily treated without an objective assessment of agitation at presentation and throughout their hospital stay.

Local Problem. Behavioral health patients presenting with agitation in three emergency departments in Northern California are customarily treated with activation of a Code Grey emergency alert, use of physical restraints, or emergent sedation medication administration to manage the situation, prevent escalation, and protect the staff.

Context. Agitation in patients that is not recognized can lead to emergent sedation medication administration, physical restraints placed, and Code Greys activated to support the clinical staff.

Interventions. An evidenced-based agitation …

Implementation Of A Mental Health Environmental Risk Assessment Tool, Alan Le

Doctor of Nursing Practice (DNP) Projects

Background: Patient suicide is a serious safety issue, especially in mental health settings since suicides disproportionately affect psychiatric patients. Environmental hazards are a primary contributing factor in patient suicide cases.

Problem: Mental health staff may lack tools and training to perform proper environmental risk assessments, which is the case at a psychiatric crisis residential center in northern California that utilized no environmental risk assessment tool.

Methods: An environmental risk assessment tool was implemented at the site for four months to increase staff confidence, ability to identify hazards and decrease risk of patient suicides.

Interventions: The Suicide and …

Implementation Of An Acute Care For The Elderly (Ace) Unit In A Community Hospital, Kimberly A. Colonnelli

Doctor of Nursing Practice (DNP) Projects

Background: “Baby boomers” (born between 1946 and 1964) represent 15% of the total population of the United States (Population Reference Bureau, 2019), but 50% of its total healthcare expenses (Mattison, 2021). Growth of this population will have a corresponding rise in demand on healthcare resources. Replication of a geriatric inpatient care model (Palmer et al., 1994) was introduced in a large geographically and ethnically diverse integrated care delivery system.

Problem: The demographic for this small community hospital located in Northern California has a larger percentage of patients over the age of 65 compared to other facilities within this …

The Effects Of Naloxone Education Among Adults In Alameda County, Patricia Ronnica Tinglin

Doctor of Nursing Practice (DNP) Projects

Fatal opioid overdose is a growing concern in the United States (U.S.). The pharmaceutical companies assured the medical community that opioid pain relievers were not addictive. As a result, providers prescribed them at a significantly higher rate, which led to more extensive use of authorized and unauthorized opioid use before it was realized that they could be highly habit-forming (The U.S. Department of Health and Human Services [HHS], 2019). A growing body of evidence supports providing naloxone education as a means of harm reduction. The quality improvement project aims to implement educational sessions for adult patients seen at East Bay …

Assessing Moral Distress And Substance Use Among Nurses In The Time Of Covid-19 To Improve Patient Safety, Lauren Childers

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

The COVID-19 pandemic has brought rapid changes, increased stress, and ethical challenges to nurses across the globe. These factors may place nurses at increased risk for developing moral distress and substance use disorder. This stress can also increase nurse vulnerability to substance use. Previously there was little evidence about the rates of moral distress and substance use disorder among nurses during the COVID-19 pandemic. The primary objective of this evidence-based project was to describe levels of moral distress and substance use among nurses in a community hospital during the COVID-19 pandemic and to make recommendations for interventions to improve nurse …

A Public Health Ethics Approach To Substance Use Disorder, Adele Flaherty

Electronic Theses and Dissertations

The goal of the dissertation is to undertake an analysis of substance use disorders that focuses on a public health ethics perspective. The ethical argument focuses upon justifying the use of harm reduction and is primarily concerned with the current opioid crisis. While substance abuse/misuse over the course of history has been identified as a public health concern, this dissertation presents substance use disorders over the course of the lifespan, examining various contexts in which it can affect daily living and health outcomes. It achieves this by analyzing substance use disorders through the lens of the socioecological model of public …

Factors Associated With Omani’S Schoolteachers’ Reporting Behavior Of Suspected Cases Of Child Abuse And Neglect, Zeinab N. Alazri

Theses & Dissertations

Child abuse and neglect is a global problem that can result in severe negative consequences for victims and their societies. Numerous initiatives have been launched by the United Nations Children's Fund (UNICEF) to combat this problem. Recently, Sultanate Oman, an Arab country, has mandated schoolteachers to report suspected abuse and neglect cases to comply with UNICEF's recommendations. As schoolteachers spend a great deal of their time with children, they are in a good position to recognize and report suspected abuse and neglect cases so the victims can get the needed help and treatment. There is a dearth of information about …

Behavioral Health Patients And Agitation In The Emergency Department: A Synthesis Of Literature, Adam Pelzl

Doctor of Nursing Practice (DNP) Projects

Abstract

Introduction: Patient agitation is a phenomenon that presents itself to the emergency department (ED) on a daily basis. Agitation can manifest from an array of physical or psychological complaints. Behavioral health patients presenting with agitation is a growing subset of the total agitation population within EDs. A better understanding of behavioral health patient agitation in the ED setting is needed to guide best practices in treating this fragile population with therapeutic, patient-centered care.

Methods: A review of literature was conducted on agitation and behavioral health in ED settings, using the search terms emergency department, agitation, restraints, sedation, and behavioral …

Increase Access To Community-Based Health Care For Underserved Individuals: A Quality Improvement Project, Piper Oneal

Doctor of Nursing Practice (DNP) Manuscripts

Abstract

Background: Health care access disproportionately affects certain populations. Health care opportunities for uninsured adult members of a rural community can be limited. Suwannee County is a rural community with a population of 43,814 of which 40.8 % live below the 200% poverty income level (WellFlorida Council, 2020). Problem: In 2016, 23.8% of adults in Suwannee County were unable to see a doctor in the past year due to the inability to pay and lack of insurance (Florida Department of Health, 2020). Community-based health care initiatives can address such issues by targeting underserved individuals, reducing barriers, and making health services …

Improving Lymphedema Self-Management And Screening In Newly Diagnosed Breast Cancer Clients Through The Use Of A Self-Management Lymphedema Toolkit, Kescia Gray

Doctor of Nursing Practice (DNP) Manuscripts

Background and Significance: With breast cancer effecting women at much younger ages and modern treatments prolonging the life span, survivors are at increased risk of developing breast cancer-related lymphedema (BCRL), a chronic, progressive condition that can cause disability.

Purpose: The purpose of the project was to determine the level of knowledge and awareness of BCRL in newly diagnosed breast cancer clients; and to provided education on self-care after treatment, using of a self-management lymphedema toolkit (SMLT), to decrease risks of treatment-related lymphedema, improve self-efficacy, and enhance quality of life (QOL).

Methods: Newly diagnosed breast cancer clients (N=10) from the Breast …

Purposeful Nurse Hourly Rounding: Plan To Decrease Patient Falls During A Pandemic, Robbie Masangkay

Doctor of Nursing Practice (DNP) Projects

Problem: Patient falls remain a critical and persistent safety problem in healthcare today. The prolonged impact of the COVID-19 pandemic raises leadership concerns regarding the safe care of high-risk COVID patients and mitigating the increased stress and potential risks of infection to clinical staff.

Context: This Doctor of Nursing Practice (DNP) scholarly project details implementation of an evidence-based purposeful nurse hourly rounding (PNHR) pilot project designed to decrease the incidence of patient falls on a designated COVID-19 unit.

Measure: A modified PNHR rounding tool was implemented to guide focused elements for key nurse/patient interactions.

Interventions: …

Evaluating The Impact Of Nursing Assistant Employment On New Graduate Nurse Practice In The Acute Care Setting, Amy Bliemeister

Doctor of Nursing Practice Projects: College of Nursing

Background: New graduate nurses (NGNs) are expected to enter the acute care setting ready to provide safe and quality care in a fast-paced environment filled with high acuity patients, shortened lengths of stay, and difficult nurse to patient ratios (Clark & Springer, 2012). Employers, nursing students, and consumers are setting high expectations all nursing graduates will possess specific skills, knowledge, and competencies upon entry into practice (American Association of Colleges of Nursing, 2020).

Purpose: The purpose of this project was to determine the impact of NA program completion and employment on the NGN during the first year of nursing practice. …

Barriers To Discharge: A Retrospective Medical Record Review Examining Potential Barriers To Patient Discharge At The End-Of-Life, Pauline Felker, Kelly Purdy

Doctor of Nursing Practice Projects: College of Nursing

It is estimated that 70% of Americans would prefer to die at home, but less than one-quarter do so. Patients near the end of life often face several barriers that prevent them from successfully transitioning from an acute care setting to their preferred place of death. These barriers include but are not limited to a lack of trust between facilities and community care providers, ineffective communication, delayed discharge planning, difficulty accessing medications and supplies, lack of control, feelings of uncertainty, and feelings of burden. This study utilized a survey of 102 medical records of patients who died in the hospital …

Intention To Breastfeed: Breastfeeding Attitudes, Norms, Self-Efficacy, Social Support Network And Community Resources Of African American, Low-Income, Emerging Adult Women, Pregnant For The First Time, Sara E. Brown

Theses & Dissertations

African American (AA) women continue to have the lowest rates of breastfeeding. This continues to create a health disparity even though breastfeeding is extensively recognized in the scientific and health care communities as the optimal feeding choice for infants. This study examined the relationship between the external variables (social support network and community resources) and the explanatory variables (attitudes, norms, and perceived self-efficacy) and intention to breastfeed, for the AA, first time, low-income, emerging adult pregnant woman. The Integrated Behavior Model (IBM) was used as the theoretical framework to guide this study in better understanding the variables influencing breastfeeding intention. …

Streamlining Care For Children With Autism Spectrum Disorder, Siavash Rostami Jafarabad

Doctor of Nursing Practice (DNP) Projects

Background: Autism spectrum disorder (ASD) is a chronic and developmental disorder that affects about one out of every 65 children in California, and one in 59 children in the United States. Children with ASD have difficulty communicating and interacting with others, and experience oversensitivity to new stimuli and environments.

Problem: In healthcare settings, children with ASD experience numerous challenges related to lack of adequate knowledge and education of staff regarding ASD, and lack of appropriate environmental and sensory resources which reduce quality of care provided to this population.

Methods: The project took place in a Psychiatric Emergency Services (PES) Unit …

The Ecology Of Mental Health And The Impact Of Barriers On Mental Health Service Utilization, Alisha Aggarwal

Theses & Dissertations

Mental health has emerged as a major public health concern in recent times with several disparities and barriers related to adequate health service utilization. Different age groups experience diverse symptoms and face distinct barriers in accessing and utilizing healthcare. Policies like Mental Health Parity and Addiction Equity Act and the Patient Protection and Affordable Care Act were launched to improve insurance coverage and delivery of mental health services. However, a large gap of unmet needs exists for adequate mental health service utilization in the country. This dissertation aims to describe the financial and non-financial barriers to mental health service utilization …

Giving Birth At A Critical Time: Assessing Perinatal Depression Among Syrian Refugees In Low Resource Settings, Nada Alnaji

Theses & Dissertations

Refugee mothers are at an increased risk of suffering from stress and mental health conditions during the first year after giving birth to a child. The objective of this study is to enhance the early identification of treatable mental health conditions among perinatal women living within humanitarian settings. The central hypothesis is that a culturally specific approach can be helpful for the long-term success of mental health efforts. In this study, we use qualitative interview methods to understand the cultural paradigms and predisposing factors for perinatal depression related to being a Syrian refugee in Lebanon during the COVID-19 pandemic. In …

Post-Transplant Hepatic Graft Fibrosis In Pediatric Liver-Inclusive Transplant Recipients, Hanh D. Vo

Theses & Dissertations

Hepatic graft fibrosis is a common histologic finding following pediatric liver transplant (LT) that may affect the long-term graft outcome. Hence, it is essential to identify hepatic graft fibrosis at a stage where fibrosis is not yet clinically apparent but has the potential for progression to initiate appropriate intervention and prevent its progression. Liver biopsy is the gold standard for fibrosis staging, but it is invasive, requires general anesthesia in children, and has potential complications. Our long-term goal is to implement non-invasive tests to assess and monitor the progression of hepatic graft fibrosis in liver-inclusive transplant children. The work presented …

The Contribution Of Bioethics To Home Healthcare (Hhc) In Saudi Arabia, Saeed Alghamdi

Electronic Theses and Dissertations

This dissertation examines the contribution of bioethics to Home Healthcare (HHC) In Saudi Arabia (SA). Through exploring the critical bioethical issues that have influenced the implementation of home health care, the dissertation highlights the significance of incorporating bioethics in home health care. Organizational ethics has led to the regulation of healthcare professionals, patients, and the stakeholders within clinical care settings. Healthcare organizations and other stakeholders, such as global health bodies, should formulate laws and policies that promote bioethics in contemporary healthcare. The Kingdom of Saudi Arabia, through the Ministry of Health, should promote the adoption of home health care services …

Living Positive, Cheyann Harris, Emani King Mack

Capstones

A short documentary by Emani King Mack & Cheyann Harris, that focuses on Black men who are living with HIV. This film features the stories of Malik Davon, Jah Love, and Melchizedek Roberson to destigmatize, empower, and set a new precedent in media on how to cover people living with HIV.

Link to capstone: https://cheyannharris.wixsite.com/livingpositive

Improving Developing Countries’ Health Information Systems Capacity For Infectious Disease Pandemic Responses: A Case Study Of The Ebola Virus Disease And The Coronavirus Disease Pandemics, Uche Ikenyei

Electronic Thesis and Dissertation Repository

There is increasing evidence to demonstrate that current information system theoretical models meant to assess the success of the health information systems (HIS) lack the applicable theoretical underpinning suitable for developing countries. This stems partly from a theory-evidence gap where theoretical models developed in the West are applied in developing country contexts but lack tailoring to localized, contextual realities. Therefore, this study addresses this gap by enhancing the DeLeon and McLean's information system success model with six contextual factors peculiar to the infectious disease HISs in a developing country context.

This study took place in two developing countries, Liberia and …

The Influence Of Comorbid Gad On Er Utilization In Urban Youth With Asthma, David A. Karpe

Theses and Dissertations

Current literature indicates a strong association between asthma and the early onset of comorbid generalized anxiety disorder (GAD) in minors and their primary caregivers. Studies show that asthma prevalence increases with certain demographic factors, such as ethnicity, socioeconomic status, and housing quality. Evidence also suggests that GAD influences decision-making, especially when deciding to utilize emergency room (ER) services for asthma-related concerns. This study analyzed the effect of comorbid GAD on minors with asthma and ER utilization. The data were provided by an earlier Stress & Justice Study (S&J) baseline survey, an investigation aimed at understanding the impact of parental criminal …

A Peer Feedback Process To Improve Assistant Nurse Manager Job Satisfaction, Juanita A. Jularbal-Walton

Doctor of Nursing Practice (DNP) Projects

Problem

Healthcare organizations offer different methods of training for emerging and newly hired Assistant Nurse Managers (ANM). Without sufficient orientation to what the role requires, new ANMs receive many requests without adequate guidance on how to respond to patient, staff, and leadership requests. This experience creates unhealthy work environments with low job satisfaction and high turnover rates.

Context

Peer feedback provides an opportunity to reflect on the purpose of the Assistant Nurse Manager role. With sufficient orientation and peer feedback, front-line assistant nurse managers develop competency and role satisfaction, as evidenced by reduced turnover and improved retention.

Intervention

This project …

Antipsychotic Medication Administration In Oregon Assisted Living/Residential Care Settings: Analyzing An Action Situation, Sarah Dys

Dissertations and Theses

Antipsychotic medication use (APU) in assisted living and residential care (AL/RC) settings is an under-studied and controversial health policy issue. APU in older adults with dementia is associated with an increased risk of falls, hospitalizations, and early mortality. I operationalize the Institutional Analysis and Development Framework using a situational analysis approach, an extension of grounded theory methods, to explore the APU in Oregon AL/RC settings. Regulatory deficiency citations, Oregon AL/RC population data, and semi-structured interviews suggest that staff role clarity, organizational characteristics, and perceived agency influence decision-making around APU. AL/RC providers and caregivers are forced to simultaneously balance and prioritize …