Medicine and Health Sciences Commons^™

Intimate Partner Violence Screening In The Emergency Department, Rebecca Stuerman

Dissertations

Problem: Intimate partner violence [IPV] is a public health concern that affects one in three women worldwide. IPV can be addressed through identification and early intervention with minimal risk to the patient. The emergency department is an important setting for screening given the frequency with which people who experience abuse may present with IPV-related injuries and other related concerns (depression, suicidality, etc.). Successfully implementing a validated tool for screening and providing early access to resources and referrals may help to mitigate the longterm negative impacts of IPV. The need for increased staff education was a major barrier to screening for …

Life Matters, Marina Fischer

Dissertations

Problem: One of the challenges facing many primary care providers is managing hypertension. Hypertension contributes to cardiovascular disease events. Consequently, the high occurrence of hypertension related visits signifies a clinical practice gap in hypertension management resulting in substandard blood pressure outcomes. The purpose of this clinical scholarship project was to assess the difference of pre and post Quality of Life Scale (QOLS) scores in a hypertensive population.

Methods: This quality improvement project used a longitudinal, observational design with prospective data collection. The sample included newly diagnosed hypertensive adults ages 21 to 64 years old. The sample was administered the World …

The Mission System: An Electronic Health Record For Medical Treatment In Guatemala, Tawniece M. Curry

Dissertations

Abstract

Problem: The introduction of an electronic health record (EHR) system has become an essential component in monitoring and tracking patient information in most developed countries but are difficult to implement in underdeveloped countries. Guatemala is a country with poor health care and limited resources for patient tracking and monitoring. An organization in Guatemala, Nursing Heart Inc. (NHI), provides care to over 40 underserved rural communities but lacks the ability to monitor and track patient information. In order for NHI to properly monitor and evaluate their programs and track patients’ continuity of care, the introduction of an EHR system is …

Utility Of The Motivation To Change Lifestyle And Health Behaviors For Dementia Risk Reduction Scale (Mclhb-Drr) Based On A North American Sample, Angelina E. Witbeck

Dissertations

As the population ages, the prevalence rates of dementia continue to increase. Without a cure or promising treatment for dementia, the best course of lowering the prevalence rates of dementia is through preventative measures. Through an electronic survey, the study utilized the MCLHB-DRR scale to determine whether (1) gender, age, educational background, and socioeconomic status will impact the motivational factors to change lifestyle and health behaviors to reduce the risk of developing dementia and (2) direct experiences with individuals that have a dementia diagnosis are likely to impact one's motivational factors to change lifestyle and health behaviors to reduce the …

A Case Study In Resiliency: How A University Survived A Pandemic, Mary Ellen Stewart

Dissertations

This case study was conducted to investigate how the COVID-19 pandemic affected the campus of a small private university in central Mississippi, where traditionally, relational community and interaction were key contributors to campus culture. Through document analysis, individual interviews with campus leaders, and focus groups consisting of members of key departments, the role of resiliency was examined during the early days of the COVID-19 pandemic. Emerging from the data were the four thematic categories of leadership, campus culture, engagement and interaction, and challenges. Key components in each category revealed the significance of resiliency of university leaders, faculty, and staff as …

Testing Barriers To Non-Suicidal Self-Injury With College Students: Narcissistic Traits As Moderators, Philip Stoner

Dissertations

Research on non-suicidal self-injury (NSSI) has produced mixed findings, resulting in a lack of clarity regarding these behaviors (Klonsky & Meuhlenkamp, 2007). To address this, Hooley and Franklin (2018) developed the Benefits and Barriers Model (BBM) to provide a comprehensive understanding of NSSI, in which they identified the barriers that commonly prevent people from engaging in these behaviors (e.g., self-esteem, shame, and peer-bonding motivations/social norms). They also identified adverse childhood experiences (ACEs) as a distal predictor of NSSI, which aids people in overcoming the barriers to engaging in these behaviors. Recent NSSI literature has shown that college women in the …

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 …

Intimate Partner Violence Education For High School Students, Morgan Foster

Dissertations

Problem Adolescents are at risk for experiencing intimate partner violence (IPV). As early as seventh grade, over half of adolescents have reported being in a romantic relationship. Adolescent screening for and education of IPV is minimal, and only the Healthy Relationships Quiz developed by the U.S. Department of Health and Human Services [HHS] screens young adolescents across all aspects of IPV, including psychological and sexual violence. The purpose of this project was to develop an IPV education plan for high school students in a health course.

Methods An educational lesson plan for IPV was created for high school teachers.

Results …

The Associations Of Chronic Stress, Social Support, Health Behaviors And Metabolic Syndrome Among Hispanic Women, Edna Esquer

Dissertations

The Associations of Chronic Stress, Social Support, Health Behaviors and Metabolic Syndrome Among Hispanic Women

Background: Metabolic syndrome (MetS) prevalence is 25% among Mexican American women 30 – 49 years of age, compared to 22% among non-Hispanic Whites in the United States. Little is known about the additional contributions of chronic stress, social support and health behaviors to the development of MetS among this population.

Purpose: Describe the associations between chronic stress, social support, and health behaviors and the presence of MetS in Hispanic women living in an underserved community.

Methods: A retrospective cohort study design. The Adult Treatment Panel …

Healthcare Leadership In The Context Of Cognitive Diseases Of Aging: A Community-Based Participatory Research Model, Dean Sherzai

Dissertations

The Problem

The world is facing a tsunami of chronic diseases of the brain such as dementia, Parkinson's, and stroke. But all populations are not affected equally. Though we are all at greater risk of developing these diseases, minority communities such as the Black and Hispanic populations are at much greater risk of succumbing to these conditions. To date we have spent billions of dollars on research and public health measures that have repeatedly failed, but over the last decade it has become evident that much of these diseases can simply be averted through effective public health and community-based measures …

La Maestra’S Circle Of Care: Studying The Impact Of An Integrated Service Model On The Health And Well-Being Of Vulnerable Populations, Zara Marselian

Dissertations

ABSTRACT

There is an urgent need to reform the health care delivery system in the United States, as recognized through current bipartisan efforts. Society’s vulnerable populations especially need health care reform as health care outcomes are the poorest among disadvantaged populations. Moreover, vulnerable populations are twice as likely to develop chronic diseases than the general population and they remain ill due to other contextual, societal factors affecting their ability to achieve health and well-being. This population is subjected to adverse life events that suggest a more comprehensive approach to health and well-being is called for.

The Circle of Care is …

Increasing Patient Adherence To Gestational Weight Gain Goals In Pregnancy, Annie Vining

Dissertations

Abstract

Problem: The inability to maintain healthy weight gain during pregnancy may contribute to multiple pregnancy-related complications. Nutritional education and support may improve nutrition and vitamin consumption, and recommendations for healthy gestational weight gains have been published. However, pregnant women have reported minimal advice regarding healthy weight gain during pregnancy. A personalized, nutritional counseling program was initiated in a Midwestern, suburban OB-GYN private practice.

Methods: A quality improvement descriptive, correlational design was used. A cohort of pregnant women first trimester through six-weeks postpartum received individual counseling and face-to-face interaction at an office visit each trimester.

Results: Twenty ( …

Improving Access To Mental Health Care With Nurse Practitioners, Jessica Whelan

Dissertations

Problem: Over 40% of those with mental illness are untreated since the supply of psychiatrists does not meet the demand. The psychiatric mental health nurse practitioner (PMHNP) may be an adjunct in providing those services. The purpose of this quality assurance study was to evaluate outcomes of care between a PMHNP and a psychiatrist (medical doctor [MD]).

Methods: An observational, descriptive design with a retrospective medical record review of adult patients over a six-month period in a suburban, Midwestern, privately owned psychiatric practice.

Results: A total of 787 individual patients encountered at least one visit (N=787) although 3,679 …

A Vaccine Administration Training Program To Increase Adolescent Vaccination Rates, Claire Jensen

Dissertations

Abstract

Immunizations have been proven to control life-threatening diseases. Often Registered Nurses (RNs) administer vaccines but are unsure how to discuss vaccines with vaccine hesitant patients. Missouri’s adolescent vaccination rates are below its neighboring states. This initiative’s purpose was to increase adolescent vaccine administrations at a Missouri County Health Department (MCHD).

This quality improvement initiative had an observational, cross-sectional, descriptive design. RNs employed at three MCHD clinics attended an adolescent vaccine administration training program (VAT) and completed pre-/post-tests regarding the Advisory Council on Immunization Practices recommendations. Medical record reviews from March 1-April 30, 2018 and March 1-April 30, 2019 compared …

A Behavioral Weight Loss Program For Low-Income Adults With Obesity And Hiv, Sophai Thach

Dissertations

Problem: Obesity, having a body mass index (BMI) of 30 kg/m² or greater, increases the risk for cardiovascular disease. For people living with HIV (PLWH), this increases their risk for myocardial infarctions by 50% and causes this life-threatening event to occur at a younger age compared to those who are not diagnosed with HIV.

Methods: With obesity disproportionately affecting people with low income, this study aims to evaluate the effects of a 12-week behavioral weight loss program that utilizes journaling as a self-monitoring tool, weekly educational classes, and individualized goal-setting on PLWH with obesity who live in …

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 …

Permanent Housing And On-Site Nursing Care: Effects On Homeless Individuals With Hiv And Other Cormorbidities, Lynelle Hinden

Dissertations

Abstract

Problem. Providing housing to otherwise homeless individuals who are HIV/AIDS-positive has been demonstrated to improve control of the disease. This was a healthcare quality initiative to review the viral load and Cluster of Differentiation Protein Four positive (CD4+) counts over time of residents in an urban housing facility for HIV/AIDS-positive individuals. Also, a nurse-run clinic was introduced for residents, especially those with comorbidities such as hypertension and diabetes.

Methods. A repeated measures design was utilized. Viral loads and CD4+ counts were retrospectively reviewed from facility records at entrance into and five-years later at the facility. Additionally, measurements of blood …

The Predictors Of Juvenile Recidivism: Testimonies Of Adult Students 18 Years And Older Exiting From Alternative Education, La Toshia Palmer

Dissertations

Purpose: The purpose of this descriptive, qualitative study was to identify and describe the importance of the predictors of juvenile recidivism and the effectiveness of efforts to prevent/avoid juvenile recidivism as perceived by previously detained, arrested, convicted, and/or incarcerated adult students 18 years of age and older exiting from alternative education in Northern California. A second purpose was to explore the types of support provided by alternative schools and the perceived importance of the support to avoid recidivism according to adult students 18 years of age and older exiting from alternative education.

Methodology: This qualitative, descriptive research design identified …

The Effectiveness Of Combined Appointments And Influenza Immunization Rates In A Rural Wic Population, Lisa L. Sitler

Dissertations

Purpose: The purpose of this descriptive retrospective study was to examine predictors and barriers to influenza immunizations receipt in a low-income WIC population.

Method: A quality improvement project was conducted in October 2010 in which 129 caregivers of children having WIC appointments were randomly assigned to receive (a) influenza immunizations at the time of the WIC visit or (b) educational materials and a later immunization. Caregivers completed a survey about their perceptions of influenza immunizations. Tanahashi’s access to care model (1978) was used to identify predictors (acceptability, accessibility, availability, and effectiveness) of influenza immunizations.

Analysis: In analysis …

An Examination Of African Americans' Utilization Of Health Care, Brittany Powell

Dissertations

The study examined the relationship between perceptions of discrimination, social support, quality of health care received, and utilization of health care services among African Americans. Data was analyzed from 99 African American respondents that completed either an online or paper questionnaire. The responses demonstrated significant relationships existed between discrimination and quality of health care as well as social support and utilization of health care. Results concluded that the more discrimination one perceives, the lower quality of health care they are to expect, and therefore they are less likely to utilize services. However, the data also reflected that even in the …

Hospital Practices Related To Breastfeeding In Mississippi: A Socio-Ecological Approach, Amir Alakaam

Dissertations

Mississippi continues to have one of the lowest rates and the weakest support in respect to breastfeeding in the nation (Centers for Disease Control and Prevention, 2014a). Hospital practices supporting breastfeeding such as the Ten Steps to Successful Breastfeeding (TSSB) can dramatically increase breastfeeding rates and duration (Rosenberg, Stull, Adler, Kasehagen, & Crivelli-Kovach, 2008). The aim of this study was to explore breastfeeding practices in Mississippi hospitals based on two levels of the Socio-Ecological Model: the organizational level (phase I) examined the hospital practices based on the level of implementation of the TSSB; the individual level (phase II) examined knowledge …

Dispositional Optimism: Modeling Cardiovascular Disease Mortality With Traditional Risk Factors And A Psychosocial Personality Trait, Kiana Ramisi Luckett Robinson

Dissertations

Despite increased awareness of clinical risk factors for cardiovascular disease (CVD), heart disease remains a physical and economic burden to African Americans. The aim of this study was to investigate the relationship between dispositional optimism, a psychosocial personality trait, and CVD mortality, based on immediate cause of death. A cross-sectional design was used to examine the predictive value of dispositional optimism in CVD mortality concomitant with traditional CVD risk factors. The traditional CVD risk factors of interest consisted of body mass index, waist circumference, systolic and diastolic blood pressures, total cholesterol, and C-reactive protein. Also, aggregated mortality data for optimists …

A Descriptive Study Of The Leadership Role Of Community Health Ambassadors On Diabetes-Related Health Behaviors, Barbara Pullen-Smith

Dissertations

Diabetes is a chronic disease that bears a disproportionate burden among African American populations. The lack of access to affordable, culturally appropriate health care is a key barrier to effective diabetes prevention or disease management for racial/ethnic minority populations. Living in public housing communities, with concentrated poverty, exacerbates the burden of diabetes and reduces access to screening and early detection services to prevent the onset of diabetes. The purpose of the study was to describe the leadership role of lay health advisors, known as Community Health Ambassadors (CHAs), on diabetes-related health behaviors of African Americans living in a public housing …

Local Public Health System Partnerships: A Mixed Methods Multi-State Study, Priscilla A. Barnes

Dissertations

The purpose of this three-paper dissertation was to conduct a mixed methods multi-state examination of specific partnership-related activities among local public health systems (LPHSs) as well as to explore perceptions of LPHS practitioners regarding partnership practices.

In the first paper, secondary data analysis of questions from the National Public Health Performance Standards Program (NPHPSP, n = 110) was used to determine the frequency that partnership activities were conducted optimally (> 75% of the time) and whether any associations existed between three different partnership capacities. Activities were matched with relational, organizational, and programmatic capacities from the Collaborative Capacity Framework. Overall, 86% …

Promoting Healthy Behavior Change In Skin Cancer Risk Reduction Using The Transtheoretical Stages Of Change Model, Sherry L. Pagoto

Dissertations

Skin cancer is the most commonly diagnosed cancer in the United States with 20% of people developing some form of skin cancer in their lifetime (American Cancer Society, 1999). In spite of the high incidence of skin cancer, it is highly preventable. Approximately 90% of the cases are caused by exposure to ultraviolet radiation from the sun (Skin Cancer Foundation, 1992). The effect of an intervention aimed at reducing skin cancer risk was compared to a survey only control group in 99 Chicago beach-goers. The intervention was based on the Transtheoretical Stages of Change Model (TTM) and included sun sensitivity …