Digital Commons Network^™

Factors Related To 30-Day Readmission Among Hispanics With Type 2 Diabetes, Athena Mohebbi

Dissertations

Background: Medicare spends $17 billion yearly on 30-day readmissions. Hispanic adults have a higher prevalence of diabetes (12.6%) compared to non-Hispanic whites (9.4%). Those with a diagnosis of diabetes have the 17% higher rate (14-23%) for 30-day readmission. Little research has been conducted on Hispanics with diabetes relative to 30-day readmissions. Aims: Among Hispanics with type 2 diabetes: 1) measure the incidence of 30-day readmission by sociodemographic, behavioral and clinical factors;2) identify independent factors associated with 30-day readmission among Hispanic adults with type 2 diabetes accounting for potential covariates; 3) compare the ability of the Hispanic Diabetic Study Model plus …

The Replication Of The Globe Study In Turkey: Understanding The Effects Of Social, Economical, And Political Changes On Cultural Dimensions And Leadership Ideals: A Mixed Methods Study, Zeki Pagda

Dissertations

Starting in 1995, the GLOBE (Global Leadership and Organizational Behavior Effectiveness) project has conducted a comprehensive study of cultural values and leadership ideals of 62 countries. GLOBE has identified nine cultural and six leadership dimensions, examined the relationship between cultural values and leadership ideals, grouped countries into clusters, and presented culturally derived leadership ideals. According to the 1995 GLOBE findings, Turkey fits in the Middle Eastern cluster with its corresponding expectations regarding leadership ideals. However, in the past thirty years, Turkey has undergone dramatic social, economic and political changes that may have affected ideals of leadership. The goal of this …

Delirium In Long Term Care Rehabilitation Residents: A Correlational Retrospective Study, Rebecca Lerma-Kjonegaard

Dissertations

Abstract Background: Delirium is associated with devastating outcomes, cognitive loss,

decreased function and an increase risk of mortality which affects patients and places a heavy burden on family and the healthcare system. The purpose of this study was to describe the relationship between select demographics, clinical characteristics, CHART- DEL-derived delirium diagnosis and ICD-10 coded discharge delirium diagnoses among Long Term Care (LTC) rehabilitation residents.

Method: A retrospective correlational design from174 LTC rehabilitation residents age 65 years or older using EMR and hard copy charts. The setting was a Southern California community hospital-based 100-bed LTC. Abstracted data included demographic characteristics (age, …

Patient Perception Of Fall Risk And High Fall Risk Screening Scores, Nicole D. Pena

Dissertations

Purpose: The purpose of the study was to describe the relationship between patient

perception of fall risk and high fall risk screening scores.

Background: Despite mandated government regulations and multiple hospital

interventions, falls are the most prevalent adverse event among hospitalized patients and

are the leading driver of health care costs, amounting to over $30 billion each year with

projections to double by 2030. Recently, perception was identified as a major component

in preventing falls. A dearth of research examines the relationship between a patient’s

perceived risk for falls and standardized fall screening scores.

Methods: A descriptive correlational design with …

Adult Postoperative Open-Heart Patients: Anemia And 30-Day Hospital Readmission, Lindsey Ryan

Dissertations

Background. In 2013 alone, more than 4% (3.9 million) of patients discharged from a hospital were readmitted. Anemia following a surgical procedure is associated with early hospital readmission.

Purpose/Aims. The following were specific aims of this dissertation:

• Aim 1. To develop an operational definition of the term condition-based maintenance as applied to health care and discuss the applicability and effectiveness of condition-based maintenance within health care.
• Aim 2. To identify the number of adult patients undergoing elective open-heart surgery with preoperative anemia.
• Aim 3. To examine the relationship between preoperative anemia, sociodemographics, and 30-day hospital readmission rates among postoperative open-heart …

The Lived Experience Of Discharged And Readmitted African Americans With Chronic Obstructive Pulmonary Disease To A Safety-Net Hospital, Kiiyonna Jones

Dissertations

Background:Chronic Obstructive Pulmonary Disease (COPD) is a debilitating respiratory disease that negatively affects the quality of life of those affected and has been a major contributor to the continuous rise in healthcare cost in the Unites States (Guarascio, Ray, Finch, & Self, 2013; National Heart Lung and Blood Institute, 2009; Shavelle, Paculdo, Kush, Mannino, & Straus, 2009; Scott, Smith, Sullivan, & Mahajan, 2001). In 2014, Centers for Medicare & Medicaid Services (CMS) identified COPD as an applicable condition to the Hospital Readmissions Reduction Program, which penalizes healthcare organizations having readmissions higher than the national average. COPD is the second …

Patient’S Utilization Of Health Information Technologies For Disease Self-Management, Mahmoud Hamzeh Altawalbih

Dissertations

Background: The rapid growth of Health Information Technologies (HITs) provides

patients with greater opportunity to take control over their health. HITs utilization has

been proven to be a critical component of disease self-management and can result in

positive outcomes. Its widespread adoption and utilization is still relatively low among

patients with chronic disease. It is important to understand the factors that may impact

HITs utilization, such as the perceived Task-Technology Fit (TTF). A very limited

number of studies have examined the relationship between HITs utilization and the

perceived fit between task and technology in the context of TTF theory.

Aims/ …

Nurse Family Member Perceptions Of Patient Death And Nursing Care After Withdrawal Of Life-Sustaining Treatment, Deena Drake

Dissertations

Purpose/Aims: This pilot study explored nurse family member perceptions of nursing care and patient quality of death and dying during and after withdrawal of life-sustaining treatment within Intensive Care Units (ICU).

Rationale: Past research that examined physician, nurse, and family member experiences of End-of-Life (EOL) care within the ICU found significant differences between the three groups.

Background: Approximately 500,000 people die within an ICU each year in the United States. End-of-Life and Palliative Care programs focused primarily on physician interventions to improve quality of EOL care have had little impact on family member perceptions of quality of care or patient …

Perinatal Mood And Anxiety Disorders, Stigma, And Social Support Among Postpartum Women, Ellen K. Fleischman

Dissertations

Purpose/Aims: The purpose of this descriptive, correlational, cross-sectional study was to examine the relationships among perinatal mood and anxiety disorder (PMAD) symptomatology, select demographics, stigma of mental illness, and social support, among inpatient postpartum women. Rationale: PMADs affect as many as 21% of childbearing women, yet these disorders are identified and treated less than half the time. There is a gap in the literature regarding the relationships among stigma, social support, and PMADs in postpartum women.

Conceptual Basis/Background: Despite recommendations from professional organizations, screening for PMADs is not consistently completed using a valid, reliable instrument. Stigma contributes to the low …

Legal Accountability And Nonprofit Governance: An Exploratory Quantitative Study Of Board Member And Executive Knowledge Of Fiduciary Duties, Crystal Trull

Dissertations

United States nonprofits are governed by boards of directors who have legal responsibilities based on the fiduciary duties of care, loyalty, and obedience. Boards, along with the chief executive, are held responsible to fulfill these standards which are designed to hold nonprofits legally accountable to carry out their tax exempt purpose by using organizational resources for the intended purpose, avoid conflict of interest, and ensure compliance. However, despite this weighty responsibility and the voluntary nature of nonprofits, no standardized process exists to educate nonprofit leaders about their legal responsibilities.

While governance is a key area of nonprofit research, there is …

Examining Inter-Relationships Between Supervisor Full-Range Leadership, Organizational Climate Strength, And Employee Job Satisfaction Using Multi-Level Modeling, Bharat Mohan

Dissertations

Employee job satisfaction, organizational climate, and supervisor leadership style have long been researched due to their influences on critical metrics for measuring organizational success. While the relationships between these three variables have been investigated, current research suffers from two major issues. First, no existing study has explored the inter-relationships between the aforementioned components within the same model. Second, existing studies are fraught with levels-of-analysis issues that yield findings that are either incomplete or inaccurate. This study addresses these issues by introducing organizational climate strength as a mediating variable (between supervisor leadership and employee satisfaction) and by employing multi-level modeling techniques. …

Making The Invisible Visible: Capturing The Multidimensional Value Of Volunteerism To Nonprofit Organizations, Sue Carter Kahl

Dissertations

Volunteers represent an important part of the nonprofit labor pool, and their contributions are diverse and significant. Yet, the assessment of the value that they bring to nonprofit organizations often is reduced to a few numbers and understood to be an economic decision based on their absence of wages. This value is traditionally reported as volunteer numbers, hours, and an hourly financial value assigned to volunteer time. These data are important tools for articulating volunteer contributions. However, the emphasis on numbers and economic value sometimes obscures important dimensions of service. Therefore, the purpose of this dissertation was to reveal more …

Employee Engagement And Burnout: A Quantitative Study Of Their Correlations With Job/Organizational Satisfaction, Sarah Burnett

Dissertations

Since Kahn introduced the concept of employee engagement in 1990, the focus on motivating employees has been en vogue in practitioner literature. The federal government as well now measures its agencies annually on how well they implement conditions conducive to engagement. Federal agencies are also ranked annually as “Best Places to Work” based on their aggregated score on three survey items deemed to represent job/organizational satisfaction. The concept of burnout, or the so-called “erosion of engagement”, however, has received significantly less attention. To begin to fill this void in the literature, secondary survey data from the 2017 Organizational Assessment Survey …

Discursive Leadership: Exploring The "Black Box" Challenge In Transcultural Leadership Studies, Christopher Patrick Brown

Dissertations

The increasingly globalized U.S. workforce includes significant numbers of adult immigrants integrating into the North American professional sphere. As such, it is important to have concrete ways to study and interpret different cultures’ thinking about teamwork, and their models of enacting shared leadership and communication in a multicultural context. Since 2006, hundreds of millions in federal grant funding has been invested in university-based language and culture programs focused on training government personnel and heritage populations in the languages and cultures of the Middle East and Central and Southeast Asia. Little is known about the performative strengths and challenges of the …

Exploring, Examining, And Explaining How Participatory Governance Adds Value To Saudi Foundations’ Philanthropic Strategy, Afnan E. Koshak

Dissertations

Foundations’ flexibility, given their independence from fundraising imperatives, competition forces, and accountability pressures, enables them to invest in long-term, high-risk, multi-level experiments to deal with the increasingly complex societal problems. This flexibility, coupled with the growing role philanthropy plays in promoting social welfare across the world, is arguably what makes studies that focus on foundations’ philanthropic approaches of utmost importance.

There is a mounting interest among scholars in the governance of foundations, the systems and processes concerned with ensuring the overall strategic direction of organizations. Influenced by agency and stewardship theories, an increasing number of studies address such topics as …

A Tale Of Two Influences: An Exploration Of Downward Accountability In World Vision International, Elena Mccollim

Dissertations

International nongovernmental organizations (INGOs) face increasing accountability challenges stemming from past scandals and their claims to advance the public good. Since the 1990s, INGOs have responded with numerous reforms. The creation of the Humanitarian Accountability Partnership in 2003 and the INGO Accountability Charter in 2009 reflect sector-wide efforts to enhance accountability to mission, intended beneficiaries, and peer organizations.

Many INGOs have adopted a broad range of accountability reforms. This dissertation focuses on how World Vision, the world’s largest INGO, has done so. Downward accountability remains elusive due to such factors as INGOs’ lack of transparency toward beneficiaries; the power imbalance …

How Navy And Marine Corps Veterans Make Meaning Of The College Choice Process In The Post-9/11 Gi Bill Era, Derek Abbey

Dissertations

The Post-9/11 GI Bill was implemented in 2009. Since then more than 1,900,000 people have used the benefit and more than $90 billion have been paid to institutions of higher learning and to Post-9/11 GI Bill users. During this period there has been a shift in the types of college and universities veterans attend, as well as the educational models they select. These shifts are different than the general population of students. This period also included a spike in questionable recruiting practices by some colleges. In response to many institutions taking advantage of veterans, the President of the United States …

Truth Or Myth? Millennial Stereotypes, Self-Image, And Engagement In The Workplace, Stephanie Van Dellen

Dissertations

There are approximately 58 million Millennials working for corporations in the United States. Millennials generally born between the years 1980 to 1995 are said to have been shaped by events such as the invention of the Internet and cell phones. Given that Millennials make up a large percentage of the active workforce, it is important to understand the perceived stereotypes of Millennials and how these generalizations may impact their engagement and effectiveness at work.

This research aims to better understand how managers perceive Millennial employees, how Millennials self-identify with their generational stereotypes, and how they differ from other generations. The …

Social Innovators And Developmental Stages, Juan Carlos Rivas Espinosa

Dissertations

ABSTRACT

The past two decades have seen increased interest in social innovation as a leading source of change. While social innovation literature experienced vast growth, particularly in the Western world, there is limited research on the individuals engaged in it, especially concerning their leadership practice. The extant research focuses mostly on identifying traits and competencies exhibited by social innovators. These individuals are often thought of as exceptional people able to think systemically to identify and solve problems in novel ways. The field runs the risk of perpetuating the idea that to be a social innovator one must possess a specific …

The Development Of Local Government Leaders: The Use Of Competencies And Methods In A City Context, Dominika Bukalova

Dissertations

How do local government leaders perceive the development of their leadership competencies and the methods they have used to acquire competencies to meet on-the-job challenges in a city context? There have been few attempts to document leaders’ perceptions of the competencies they need or how they get developed; however, the critical and ubiquitous role of city government demands that we increase understanding of these crucial issues. Not only does a majority of the world’s population already live in urban areas (i.e., areas in which competent local governmental activity is required), but this percentage is forecasted to increase from 55% to …

Seeking Mirrors: Representation And Identity At Asian Pacific Islander Film Festivals, Yang Jiang

Dissertations

Media representation plays an important role in shaping how we perceive ourselves. For ethnic and racial minorities, studies have confirmed that exposure to stereotypical and negative representations can harm the development of ethnic and racial identity. Currently, however, there is little understanding of how representation can support the development of ethnic and racial identity. Essentially, what might visibility, rather than invisibility, in media representation look like, and what is the relationship between visibility and ethnic and racial identity?

This dissertation sought to address these questions by looking at the experience of Asian Pacific Islander (API) attendees at API film festivals. …

Early Identification And Intervention In Patients With Atrial Fibrillation Using An Implantable Cardiac Monitor To Significantly Improve Guideline-Based Anticoagulation Therapy In An Outpatient Cardiology Clinic, Lisa Alvarez

Dissertations

The purpose of this research was to (a) examine the demographics of patients receiving care in an outpatient cardiology clinic, (b) describe the relationship between the atrial fibrillation (AF) and other variables (e.g., BMI), (c) examine the frequency and the length of time to AF diagnosis in patients implanted with an implantable cardiac monitoring (ICM) device, (d) observe provider patterns of treatment with oral anticoagulants (OACs), and (e) investigate documented considerations to either diagnose or rule out OSA in a group of outpatient AF patients in a cardiology clinic.

Background: AF is largely undiagnosed but can cause major morbidity and …

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 …

Exploring The Homeless Persons Perception Of Living In A Long-Term Care Facility, Janice Woods

Dissertations

Objective:The purpose of this study was to explore the lived experiences of homeless persons admitted to a nursing home facility. Originally, the study was to explore their understanding of and their experience with advance health care planning; coincidently, the participants were more open to their experience of living in a long-term care facility.

Method:A convenience sample of 13 participants (12 male, 1 female) at four long-term care facilities in Southern California were interviewed about their perception of advanced health care planning, including the physician’s orders for life sustaining treatment (POLST); a consent form required in all nursing homes. …

The Lived Experience Of Spiritual Well-Being Amongst Informal Caregivers Of Persons With Dementia On Palliative Care Living At Home, Michael Baumgardner

Dissertations

Title. The Lived Experience of Spiritual Well-Being Amongst Informal Caregivers of Persons with Dementia on Palliative Care Living at Home.

Purpose.This study explored the lived experience of spiritual well-being amongst informal caregivers of a person with dementia who were living at home and enrolled in palliative care.

Background. Patients with dementia comprise the third leading diagnosis in palliative care patients and many receive informal care from family members. Palliative care improves quality of life in patients and their informal caregivers. However, little is known about spiritual well-being in the setting of caregiving of persons with dementia on palliative care. …

Game Types, Game-Related Behaviors And Resilience: Creating A Roadmap For Effective Gamification Design In Higher Education, Patrick Marino

Dissertations

Gamification, or the use of game-based mechanics and thinking in real world applications, is on the rise in educational environments. While various applications seek to increase engagement and motivation for tasks related to student success, research regarding best practices for the design of such systems is lacking. In fact, conflicting outcomes from various gamification studies at the secondary and tertiary education levels suggest that not all gamification designs are effective for increasing student success. Meanwhile, research from the medical field indicates gamification can be used to increase resilience; which has been linked to various student success outcomes including academic performance. …

Academic Libraries And Toxic Leadership, Alma C. Ortega

Dissertations

Toxic leadership has yet to be officially recognized as an area of inquiry in the field of library and information studies. Indeed, the literature on academic libraries is only now beginning to address the topic. None of this should be surprising because leadership, in general, continues to be an under-discussed topic in the library and information studies literature.

The topic of leadership, of course, is the central theoretical construct of the leadership studies field, and, in this field, toxic leadership has been systematically studied and discussed. This literature reveals the negative consequences of having a toxic leader as the head …

Psychiatric Patients’ Perception Of Involvement In The Plan Of Care, Jaspal Kaur Gill

Dissertations

Background: There is an increased need to actively engage and involve patients in their care planning in healthcare facilities including psychiatric facilities (Wills, Riefer, Schauer, & del Vecchio, 2011). There has been a growing interest in patient-centered care and patients’ involvement in their plan of care as it leads to positive healthcare outcomes and increased patient satisfaction. However, there is a lack of research on how psychiatric patients perceive their involvement in the care planning while they are admitted to an inpatient psychiatric facility.

Aim: The aim of this qualitative phenomenological research study was to explore patients’ perception …

Patient Outcomes Associated With Delayed Rapid Response System Activation: A Retrospective Comparative Study, Ricardo Padilla

Dissertations

Purpose: The purpose of the dissertation study was to determine the difference in survival and length of stay (LOS) between patients who experienced a delay in Rapid Response System (RRS) activation and those patients who had no delay.

Rationale: There is evidence to support that the RRS is often not activated in a timely manner potentially leading to negative patient outcomes.

Background: Delaying treatment for in-hospital clinical deterioration has been associated with Serious Adverse Events (SAEs), including increased mortality, protracted LOS during hospitalization, and significant increased financial costs. The RRS was created as a hospital-wide approach to prevent SAEs; however, …