Digital Commons Network^™

Elucidating Mechanisms Influencing Maternal Postpartum Health: The Protective Benefits Of Breastfeeding And Associations With Allostatic Load, Experiences Of Stress, And Resiliency, Bi-Sek J. Hsiao

Doctoral Dissertations

Research has established breastfeeding as protective of maternal health, but little is known about the ways breastfeeding interacts with chronic stress pathways and interfaces with stressors such as discrimination and neighborhood deprivation, which are salient in the experiences of many marginalized communities. This research addresses these knowledge gaps through secondary analyses of prospective cohort data generated by the Community Child Health Research Network through Community Based Participatory Research processes. Analytical samples were derived from 2510 postpartum women from five regions in the U.S. who self-identified as Black, Hispanic, or White. Study 1 investigated and found an inverse association between breastfeeding …

Hospital Assessment And Response To Environmental Pollution As A Population Health Need: Identifying Prevalence And Predictors In Community Benefit Practices, Sarah Valentine

Doctoral Dissertations

Hospitals have a growing role in improving population health. Environmental pollution is an important determinant of health with disproportionate effects on Communities of Color. This warrants hospital action. To advance such action, it is important to take stock of current hospital engagement with environmental pollution and to identify factors associated with such engagement. I investigated the following. To what extent do New York State (NYS) non-profit hospitals assess, identify, and respond to environmental pollutants as part of community benefit practices? Do factors previously reported as associated with hospital engagement of social determinants predict engagement with environmental pollution as a community …

Older Women’S Experiences Of Intimate Partner Violence: A Phenomenological Study, Lourdes Irene

Doctoral Dissertations

Intimate partner violence (IPV) is a global public health problem, linked to long-term health, social, and economic consequences. Despite the growing number of women over age 60 in Puerto Rico, knowledge is lacking about culturally specific IPV in women of this age group. This lack of knowledge is problematic because women experiencing abuse often do not report it, health professionals are not educated to identify cases of abuse in older women, and researchers often includes IPV with other types of abuse, such as negligence by families. Therefore, the purpose of this study was to explore and describe the experiences and …

A Phenomenological Study Of Uninsured Individuals’ Primary Healthcare Experiences At Nurse-Managed Clinics In Mississippi, Linda Hale Banks

Doctoral Dissertations

The purpose of this phenomenological research study is to describe the lived experience of uninsured individuals accessing and receiving healthcare at nurse-led primary care clinics. This study is grounded in the existential phenomenological philosophy of Merleau-Ponty and guided by research procedures developed by Thomas and Pollio (2002). The study answers the question: What is the meaning of the patient’s perception of their lived healthcare experience as an uninsured individual? The research design methodology included a purposeful, convenience sample to recruit participants. Nine participants comprising five women and four men, ranging in age from 34 to 65, were interviewed to elicit …

The Lived Experience Of Nurses Caring For Patients Diagnosed With Infective Endocarditis Who Use Or Have Used Intravenous Drugs In Appalachia: A Phenomenological Study, Kendrea Lea Todt

Doctoral Dissertations

Infective endocarditis (IE) from intravenous drug use (IVDU) is an increasing problem in Appalachia. IE is an infection of the inner lining of the heart which may be contracted from body piercing, tattooing, or tooth brushing. In the person who uses IV drugs, the infection is generally needle borne. The Appalachian Region has been profoundly affected by the opioid crisis. Hospitalizations of Appalachians diagnosed with IE from IVDU are rising. Appalachians operate from a strong moral compass, gauging behavior as right or wrong. In the literature, health care provider attitudes towards patients with substance use disorder (SUD) are pejoratively negative, …

Characterizing The Role Of Psychological Stress In The Development Of Persistent Pain, Katherine M. Bernier Carney

Doctoral Dissertations

Persistent pain is a complex experience that can be difficult to treat if there is no obvious source. Nurses caring for patients with chronic pain may rely on pain severity to direct care, although this does not address the biopsychosocial factors that influence persistent pain states. Psychological stress is a potentially modifiable factor that has been proposed to influence the experience of pain, but the role of stress in developing persistent pain states remains undefined. The purpose of this dissertation was to examine stress-pain relationships by investigating how stress influences chronic pain trajectories. To address this query, three perspectives are …

Improving Medication Calculation Competence In Nursing Students Through Schema-Based Dimensional Analysis Instruction, Laureen Turner

Doctoral Dissertations

This study was aimed at improving the medication calculation competence of nursing students through a schema-based workshop in which dimensional analysis was used as the calculation method. The overreaching goal of this work was to improve the teaching of medication calculation in nursing education and prevent future medication errors.

This two-group descriptive posttest study included a historical comparison between fall 2016 and spring 2017 students. Spring students had the option to attend a newly designed workshop while fall students did not. Primary comparisons were of (a) percentage of students achieving 100% on the first attempt, (b) number of errors, and …

A Grounded Theory Inquiry Into Crying In Women Dealing With The Emotional Stress Of Personal Crisis, Mary Bess Griffith

Doctoral Dissertations

The belief that crying leads to healing is so widely held and of such longstanding that many healthcare professionals—including nurses, physicians, psychiatrists, and psychologists—accept it as fact even though there is little substantiating scientific evidence. Crying is commonly believed to be an essential factor in restoring mind-body equilibrium after physical and/or emotional trauma has been experienced. If, as has been hypothesized by many scientists and healthcare practitioners, emotional crying is a biopsychosocial healing modality, then specifics of its therapeutic praxis, including limitations and ambiguities, should be incorporated into nursing education and practice. In this grounded theory study, the meaning and …

Patient Portal Use In A Community Medical Group: A Healthcare Improvement Project, Pamela S. Kallmerten

Doctoral Dissertations

The American Recovery and Reinvestment Act (ARRA) of 2009 included the Health Information Technology for Economic and Clinical Health Act (HITECH) to provide stimulus for the provision of electronic access for consumers as a way to improve patient engagement. As described by the act, meaningful use of a tethered personal health record called a patient portal was theorized to improve patient engagement and result in improved clinical outcomes, reduced cost and increased patient satisfaction. Accordingly, financial incentives and penalties were to be awarded the eligible provider (EP) demonstrating meaningful use according to various stages with corresponding deadlines. A community medical …

Examining The Relationships Between Gratitude And Readiness For Self-Directed Learning In Undergraduate Nursing Students, Kellee Renee Vess

Doctoral Dissertations

The purpose of this study was to explore the relationships between gratitude and readiness for self-directed learning among nursing students enrolled in a four-year baccalaureate nursing program. For this study a sample of 59 nursing students were selected from a four-year baccalaureate nursing program, situated in a private, faith-based college in the Southeast United States. During data collection, participants were asked to complete the Gratitude 6-item questionnaire [GQ-], the 40-item Self-Directed Learning Readiness Scale for Nursing Education [SDLRS-NE], and two demographic questions (i.e., age and class rank). Using both parametric and nonparametric statistics, this study examined eight research questions, and …

Newly Licensed Registered Nurses' Experiences With Clinical Simulation, Carrie Ann Bailey

Doctoral Dissertations

The purpose of this study was to understand how new graduate nurses perceive the value of simulation in making the transition into professional practice. This study will use a descriptive qualitative approach with a sample of first year nurses. Kolb’s Experiential Learning Model serves as this study’s conceptual framework. For the current study, the sample consisted of 10 newly graduated, female nurses with less than one year of experience working in the hospital setting were interviewed. Data analysis included interviews and transcription by the researcher. Finally, participants were asked about themes to increase rigor. Four themes emerged from this research: …

A Process Improvement Toolkit To Guide The Attainment Of Meaningful Use Stage 2 Requirements, Katie M. Alfredson

Doctoral Dissertations

Healthcare is evolving. Reimbursement is transitioning to a model based on quality and patient outcomes. To remain relevant and survive this transition, providers of care must adapt and implement new models of care delivery that account for these changes. This toolkit was created as a deliverable of a Doctor of Nursing Practice dissertation that explored a successful primary care delivery model of a Patient-Centered Medical Home that utilized an interdisciplinary team approach that included nurses. Through this model high quality care was delivered to achieve desired outcomes, specifically, successful attestation for Stage 2 of the Meaningful Use Incentive Program during …

An Interdisciplinary Team Approach To The Patient-Centered Medical Home As A Means Of Meeting Meaningful Use Stage 2 Requirements, Katie M. Alfredson

Doctoral Dissertations

In an attempt to address the shortcomings of the current U.S. healthcare system, reimbursement structure is changing from fee-for-service to a value-based model. This requires drastic change in how care is delivered. Therefore, care delivery models and reimbursement incentive programs are evolving to promote advancements in care delivery. This project examined an interdisciplinary team model utilized at a rural, privately owned practice that is a Patient Centered Medical Home (PCMH). This practice has incorporated unique structures and processes to attain Stage 2 Meaningful Use requirements in the first year attesting for this stage became available as a means of addressing …

Under The Radar: Comprehending Mental Health Needs And Services In School-Based Health Centers For Children And Adolescents, Ranbir Mangat Bains

Doctoral Dissertations

Among children and adolescents, one in five suffers from mental health disorders. Those belonging to diverse racial and ethnic groups are less likely to receive adequate treatment than their white counterparts. They are also more likely to reside in households at or below the poverty level. Though public schools are the largest providers of mental health services, the services they provide are inconsistent. School-based health centers (SBHC) have been providing comprehensive health and mental health services within or near schools for over 40 years. Majority are located in urban, inner cities and evidence for their success in providing mental health …

Knowledge-Based Medication Administration: Program Evaluation And Optimization, Elizabeth Evans

Doctoral Dissertations

It has been reported by members of The Institute of Medicine that a patient is at risk for one medication administration error per day when hospitalized, thus prevention of medication administration errors is a priority patient safety goal. One recommendation to reduce the prevalence of medication administration errors is the use of barcoded medication administration (BCMA) systems. While there are many benefits to BCMA, there are also issues with existing systems. Suboptimal BCMA design and implementation has resulted in medication administration workarounds. A hospital located in southern New Hampshire, implemented a Knowledge Based Medication Administration (KBMA) system in January 2014. …

Needs Of Patient’S Families In The Hospital Tele-Intensive Care Unit, Mary L. Jahrsdoerfer

Doctoral Dissertations

Purpose: To explore, identify and describe the perceptions of family members of a patient admitted to a telemedicine intensive care unit (tele-ICU); and to determine if these needs differ from those established by the Critical Care Family Needs Inventory (CCFNI) in the traditional ICU setting. Background: The tele-ICU is a new care modality in which offsite nurses provide consultation to bedside clinical staff at geographically-dispersed ICUs. The last decade demonstrates a growing existence of tele-ICU’s in our healthcare culture. ’Information’, ‘close proximity’, ‘assurance’, ‘support’ and ‘comfort’ have been identified as the top five needs of family members in the traditional …

Exploring Perceptions Of Staff Registered Nurse Preceptors For Undergraduate, Pre-Licensure Nursing Students, Katherine C. Hall

Doctoral Dissertations

Staff nurses are increasingly called upon to accept more responsibilities and roles in addition to provider of patient care, including that of preceptor. Aside from dealing with demands of high acuity patients, working long hours with inadequate staffing, and carrying heavy workloads, nurses may view teaching and supervising students as an additional burden, time-consuming, and not part of their role. The purpose of this dissertation was to explore staff nurse experiences as preceptors to undergraduate, pre-licensure nursing students. Emphasis was placed on exploring RN’s perceptions of the role, specifically the preparation for, support in, and understanding of what the role …

An Evidence-Based Educational Intervention For Staff Nurses And The Rapid Response Team, Grace Katherine Gembrowski

Doctoral Dissertations

Rapid response systems (RRSs) have been proven to decease mortality, cardiac arrests, and ICU admissions. The three major health care system issues lead to failure to rescue: failure to communicate, failure to plan, and failure to recognize deteriorating conditions. It is crucial in a hospital setting that nurses have a basic knowledge base of why, when, and how the RRS should be activated as they are the first line of defense to recognizing signs of deterioration in patients. Previous research has shown that, although signs of patient deterioration are seen by staff, they are not always acted upon (Pusateri et …

Nursing Administration Of The 3-Ounce Water Swallow Screen, Heather L. Warner Dr.

Doctoral Dissertations

Introduction

Accurate and timely evaluation of swallowing is necessary to determine how to safely administer medications, maintain adequate nutrition and hydration, and avoid deleterious sequelae of prandial aspiration pneumonia. Use of a validated and reliable screening tool for determination of aspiration risk is a critical component of dysphagia management. The 3-ounce water swallow challenge (Suiter & Leder, 2008) is a validated and reliable screening tool that is well supported in the literature.

Statement of the Problem

While use of the 3-ounce water swallow challenge (Suiter & Leder 2008) administered by speech-language pathologists (SLPs) is supported by current research, who else …

Living With The Choice: A Grounded Theory Of Iraqi Refugee Resettlement To The U.S., Lisa Ann Davenport

Doctoral Dissertations

Though the United States has become a place of increasing resettlement for refugees, particularly Iraqi refugees who have been forced to flee their homeland due to violence, persecution and civil unrest, little is known about Iraqi refugee resettlement in the United States, or the way in which resettlement impacts health and adjustment. A grounded theory study was conducted to develop a substantive theory of Iraqi refugee resettlement. Participants in the qualitative study included 29 Iraqi refugees and 2 community partners who participated in face-to face interviews. Data analysis and interpretation revealed fundamental concepts related to Iraqi refugee resettlement. Results of …

Generation Of A Nursing Leadership Development Bundle, Lee A. Galuska

Doctoral Dissertations

Generation of a Nursing Leadership Development Bundle

Lee Ann Galuska, PhD

University of Connecticut, 2013

Abstract

Nurses are expected to have the skills and competencies to lead as well as partner in the process of healthcare transformation. This dissertation contributes to the understanding of strategies to enhance the development of leadership competency in nurses. Three metasyntheses were conducted using the Noblit and Hare (1988) method and provide holistic, synthesized translations of the experiences of nurses at all levels with leadership development. The first study explored nurses’ experiences with formal education for their leadership role and offers a description of how …

A Nursing Intervention To Improve Nutrition For Health Promotion For A Vulnerable Urban Adult Group, Meridell Joy Gracias

Doctoral Dissertations

Purpose: Low-income adults often have nutrition-related health issues, such as obesity, diabetes, and hypertension, and others. Factors identified as contributing to these issues are lack of nutrition education and lack of access to quality, healthy food choices. The purpose of this project was to improve nutrition for health promotion in a group of vulnerable adults in an urban setting, and answer questions of (a) Will a program of targeted nutrition education, with advocacy for quality food, be associated with increased knowledge and dietary behavior change? (b) Will such an intervention result in increased self-efficacy for food choices and their impact …

An Evaluation Of A Nursing Leadership Simulation Experience Using Multitrait Multimethod Matrix, Toby Embry

Doctoral Dissertations

The MTMM approach was used to evaluate construct validity of three nursing leadership traits (prioritization, delegation, and patient care management) across four assessment methods (multiple-choice tests--MCT, oral questioning-- OQ, high fidelity--HFS, and low fidelity simulation--LFS). Using a correlational descriptive design a 21-item MCT exam, a 21-item oral question instrument, a patient care HFS, and three LFS stations were embedded into a two hour objectively structured clinical examination (OSCE) assessment environment whose aim was to compare traditional assessment methods (MCT and OQ) in nursing education to burgeoning assessment methods (HFS and LFS). Generated scores from 137 senior-level baccalaureate nursing students at …

Quality And Safety Education In Newly Hired Rns And Rns In Staff Leadership Roles, Dennis Alan Bertch

Doctoral Dissertations

The intent of this project was to examine the potential knowledge, skills, and attitudes (KSA) gap of practicing bedside registered nurse (RN) care providers regarding the quality and safety education for nurses (QSEN) core competencies. Based on this perceived gap two key questions were explored: (a) do newly hired RNs and RNs in staff leadership roles demonstrate an understanding of the KSAs of the QSEN core competencies?; and (b) was there a difference in the understanding of the KSAs of the QSEN core competencies related to RN educational preparation, years of RN experience, and/or previous quality improvement training within and …

Examining The Effects Of A High School Healthcare Summer Immersion Program, Jenny M. Holcombe Curry

Doctoral Dissertations

The purpose of the current study was to assess the effectiveness of the DREAMWork (Diversity Recruitment and Education to Advance Minorities in the nursing Workforce) summer high school program within the context of the substantial current and anticipated nursing shortage in the United States (Buerhaus, 2002). Previous research has shown that creating positive perceptions of nursing through programs like DREAMWork can lead to an increase in student desire to pursue a career in nursing (Cohen, Palumbo, Rambur, & Mongeon, 2004; Tomey, Schwier, Marticke, & May, 1996). More specifically, this study was interested in …

Presence In Nursing Practice: A Critical Hermeneutic Analysis, Alicia Laurel Bright

Doctoral Dissertations

Research Topic

Presence, although it involves action at times, is a humanitarian quality of relating that is ethically generated and has real-world implications for both patient and nurse. It is an interpersonal process characterized by sensitivity, holism, intimacy, vulnerability, and adaptation to unique circumstances that results in enhanced mental wellbeing for nurses and patients, and improved physical wellbeing for patients. Knowing and being with are foundational to being present.

Theory and Protocol

This research is grounded in critical hermeneutics and follows an interpretive approach to field research and data analysis (Herda 1999). This orientation places the researcher and participants in …

Self-Transcendence And Spiritual Well-Being In Participants Of Short-Term, Faith-Based, Foreign, Health Care Missions, Elizabeth Ann Fiske

Doctoral Dissertations

The purpose of the study was to investigate the presence and possible relationship of self-transcendence and spiritual well-being in persons who have completed at least one short-term, foreign, health care mission (SFHCM). There is a paucity of literature related to SFHCM; however, these trips are becoming increasingly commonplace. In the anecdotal literature, SFHCM are often described as life changing. The descriptions of this growth experience in the literature are quite similar to the concept of self-transcendence as defined in the nursing literature. Reed's (2003) middle range theory of self-transcendence was used as the theoretical framework for this study. The major …

Into The Unknown: Military Nurses' Experiences In Disaster Response, Felecia Marie Rivers

Doctoral Dissertations

Frequently, military nurses are among the first responders to render aid following disaster events. Research has been completed regarding military nurses' experiences in combat, but little has been done to examine nurses' perspectives on their disaster response. The purpose of the study was to understand military nurses' experience of responding to disaster(s), with "disaster" defined as any non-combat mission-humanitarian relief, or response to a natural or human-made event-outside of warfare. A phenomenological approach to interviewing 23 military nurses was employed. Using a purposive, snowballing technique, single face-to-face interviews were conducted. Five figural polar themes of Nature of War v. Nature …

Nurse Educators' Implementation Of Concept Mapping, Case Studies, And Reflective-Thinking Exercises In Undergraduate Didactic Nursing Courses At Baccalaureate Schools Of Nursing, Danette Kathleen Dutra

Doctoral Dissertations

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Nursing Student And Faculty Perceptions Of The Characteristics Of Effective Instructors In The Simulated Clinical Experience, Bridget Parsh

Doctoral Dissertations

unavailable