Medicine and Health Sciences Commons^™

Second Victim Syndrome: Nurses Suffering In Silence, Matthew Riehm

Dissertations

Medication errors are inherent in health care due to human fallibility and inherent systemic complexities. Nurses are often unjustly blamed after committing a medication error despite the multitude of contributing factors. Formal education and healthcare organizations focus on preventing medication errors, but little has been done to support nurses involved in these tragic incidents. Recent cases, including RaDonda Vaught and Kimberly Hiatt, demonstrated the victimization of nurses after committing medication errors that plague the healthcare system potentially causing profound psychological trauma, often known as Second Victim Syndrome, SVS. There is limited research on the phenomenon of SVS in nursing due …

Impact Of Social Determinants Of Health On Skill Of Involvement: Differences In First Year Adn And Bsn Nursing Students In Rural Oklahoma, Cynthia Brown

Dissertations

The impact of Social Determinants of Health (SDOH) on Skill of Involvement (SOI) has not been adequately studied in nursing education. The skill of involvement is defined by Benner (2022) as necessary to expert-level nursing and it brings humanity, meaningfulness, acute situational awareness, and rapid thinking required for strong clinical decision-making in crisis management of the deteriorating patient. It is important for nurse educators to understand how SDOH impacts SOI on nursing students in order to transform the delivery of nursing education. The purpose of this study was to determine the impact of SDOH on SOIs in first-year nursing students …

The Association Between Emotional Intelligence, Empathy, And Social Determinants Of Health Among Accelerated Bachelor Of Science In Nursing Students: A Multi-State Cross-Sectional Descriptive Study, Kwanza Thomas

Dissertations

This study investigated the association between emotional intelligence (managing and understanding), empathy, and social determinants of health (SDOH) among accelerated Bachelor of Science in Nursing (ABSN) students. Despite the exponential increase in ABSN programs in the United States, little is known about the association between these variables among this nursing student population. A cross-sectional, correlational descriptive design was used to survey 104 students completing ABSN programs in Georgia, Mississippi, Philadelphia, and Texas. Participants self-reported their socioeconomic and programmatic characteristics using a researcher-developed questionnaire. Emotional intelligence (managing and understanding) was measured using two instruments, including the Situational Test of Emotional Management …

Adaptive Leadership: Nurse Executives Building Organizational Adaptive Capacity During Times Of Crisis, Challenge, And Change, Kristian Poitier

Dissertations

Purpose: The purpose of this exploratory phenomenological study was to identify and describe the strategies used by nurse executives in acute care hospitals to build an adaptive capacity based on the five key characteristics of adaptive leadership identified by Heifetz et al. (2009).

Methodology: This qualitative phenomenological study identified and described the perceived impact of adaptive leadership on building an organization’s adaptive capacity as perceived by nurse executives in acute care hospitals, for-profit and not-for-profit, with the title of chief nursing officer (CNO) or chief nurse executive (CNE) in Southeast, West, and North Florida. The researcher was part of a …

Nursing Interventions For Psychosis And Other Mental Health Crises: A Hermeneutical Phenomenological Study Of Nurses’ Experiences, Christopher Jasensky

Dissertations

The nursing profession experiences caring for patients suffering psychosis and managing crises events in a way that is unique to all other healthcare providers. A gap in research and literature exists related to this phenomenon. The purpose of this study was to examine the lived experiences of nurses caring for patients experiencing psychosis or some other severe mental health issue. By analyzing the common expressions and behaviors of nurses in situations involving care of psychosis, the meaning of the care giving experience and thus, an understanding of the interactions involved with caregivers in psychosis was revealed. Participants provided experiential, firsthand …

Perceived Power By Nurse Managers In Dialysis Units: A Qualitative Case Study, Janie Griner

Dissertations

Nurses comprise the largest workforce in health care but lack power despite their numbers. Nurses have suffered short-staffing, burnout, job dissatisfaction, unsafe work settings, and cumbersome technology for decades. The dialysis nurse manager is an important component of the dialysis unit and plays a role in the retention and recruitment of nurses. Using a case study approach this qualitative, thematic analysis described dialysis nurse managers’ perception of power in dialysis units. A review of the current research revealed a gap involving dialysis nurse managers’ perception of power in the dialysis unit. The following research question was developed: • How do …

Perceptions Of Stress In Community Clinic Nurses During The Covid-19 Pandemic, Jomeka Smith

Dissertations

The COVID-19 pandemic is one of the largest healthcare crises that has affected the entire healthcare industry. Community health nurses in the front-line roles are greatly threatened by the COVID-19 pandemic that has decimated healthcare systems. The well-being of nurses is vital to perform their full potential of adequate patient care. Increased demands and pandemic related stressors can increase the risk of mental health problems. Nurses work in a variety of healthcare settings, however, the expectations, the fear of the unknown, and changes in demands have largely contributed to the unprecedented stressors that accompany nurses in clinical settings. Stress among …

The Leadership Experience Of Academic Chief Nurse Administrators In The State Of Georgia During The Covid-19 Pandemic Upon Return To Campus After Full Virtual Instruction: A Qualitative Study, Susie Jonassen

Dissertations

The impact of the COVID-19 global pandemic has been rated as the highest factor of intent to leave the profession in nurses serving in a leadership role. During the pandemic, crisis leadership swept across academia partly because nursing academia was not prepared for the rapid transition to virtual instruction. The reopening of nursing programs, while pandemic restrictions were still required, caused unprecedented disruptions and stress for academic leaders. One-third of nursing faculty anticipate retirement within the next two years. With the present burnout and shortage of nursing academia leaders, there was a need to explore the lived experience of academic …

Targeting Loneliness In Older Adults With Weekly Socialization, Tanja Johnson

Dissertations

Problem: Loneliness related to social isolation among the older adult population has become an increasing health concern with few interventions available for the general population. Loneliness has been directly associated with depression, poorer physical health outcomes, and overall quality of life.

Methods: The purpose of this study is to evaluate loneliness in the older adult population residing in a senior living community in an urban area in Missouri. Weekly one-on-one socialization, ranging from 45-60 minutes, will be implemented over 6 weeks, with pre and post-intervention screening for loneliness with the 28-item Visit-A-Bit (VAB) screening tool. Approval was received by both …

Risk And Protective Factors To Well-Being In Foster Care Youth Prescribed Psychotropic Medication In A Wraparound Program Of Care, Ann Reali Stratton

Dissertations

Background: Youth in foster care are prescribed psychotropic medications at higher rates and are more likely to experience disruptions to their medical care. Wraparound models of care have been shown to improve outcomes for youths on psychotropic medications, however, these methods have proved difficult to replicate in the foster care population. Government policies have called for better oversight in the foster care population and in response programs have been implemented, however, there remains little research for these programs. Objective: This research will evaluate the characteristics of foster care youth as they enter a Wraparound model of care and the predictive …

Lost In Interpretation: The Lived Experience Of Nurse Interpreters In The Clinical Setting, Byron Batz

Dissertations

The use of language interpreters in the health care setting constitutes a vital part of provider-patient communication but remains a relatively unexplored phenomenon. Registered nurses (RNs) are often called upon to serve as interpreters when linguistically diverse patients constitute a large segment of the patient population. That RNs serve simultaneously in an interpreter role – in addition to clinical and advocacy roles – is a complex facet of contemporary nursing practice in a diverse U.S. culture. The purpose of this qualitative descriptive study was to examine the lived experience of RNs serving as interpreters in health care institutions in Southern …

The Caregiver Of The Child With Cerebral Palsy: The Unnoticed Victim, Taylor Tusinski

Dissertations

The purpose of this study was to better understand the overall quality of life (QoL) in the primary caregiver who provides care to the child or adolescent, aged 0-17 with mild, moderate, or severe Cerebral Palsy (CP). This study aligned with a nonexperimental or observational design and examined the severity level of CP and the QoL in the mother and/or father.

For research question 1, regression results indicated that the overall model did not significantly predict the mother’s and father’s QoL [R² = .000, R² _adj = -.012, F(1,80) = .003, p = .957]. Regression results indicated that …

Atrial Fibrillation Management In Hispanic Adults, Tania Borja

Dissertations

Background: Research has found atrial fibrillation (AF) to be the primary or a contributing cause of death on 183,321 death certificates, and an underlying cause of death for 26,535 Americans in 2019. Findings indicate an increased AF diagnosis in White people compared to racial and ethnic minorities, contrasting widespread findings of increased prevalence of cardiovascular disease and ischemic strokes in minorities. Significant disparities—by race and socioeconomic status in disease distribution and access to testing and lifesaving treatments—have been documented, specifically associated with social determinants of health (SDOH); i.e., the conditions in which people are born, grow, live, work, and age. …

The Impact Of Social Determinants Of Health And Acculturation On Quality Of Life In Older Chinese American Adults With Chronic Pain: A Quantitative Study, Chi Lam

Dissertations

Despite a rapid increase in the older Chinese American adult population, there are very few research studies examining the impact of social determinants of health and acculturation on the quality of life in older Chinese American adults. The purpose of the study was to determine the impact of social determinants of health and acculturation on quality of life in older Chinese American adults with chronic pain. This quantitative, descriptive correlational study utilized Madeleine Leininger’s Transcultural Theory as its theoretical framework. Two research questions guided this study: (1) Was there a difference in the quality of life in older Chinese American …

Vaccine Hesitancy, Provider Time, And Decision To Vaccinate, Kenneth Shackelford

Dissertations

Problem: To date, there is a significant gap in the literature involving studies evaluating the time healthcare providers spend educating vaccine-hesitant caregivers about the necessity for their child’s immunizations. Due to alarming resurgence rates of vaccine-preventable diseases in children, this project aimed to answer the following question: In vaccine-hesitant caregivers of newborns through six months of age, what is the effect of provider discussion time on vaccine administration (item) at well-child visits during the child’s first six months of life?

Methods: Using a descriptive observation design, pre-collected data on provider discussion time and vaccine administration was evaluated retrospectively from …

Implementation Of A Vestibular Disorder Screening Tool In An Urgent Care, Kathleen A. Probst

Dissertations

Implementation of a Vestibular Disorder Screening Tool in an Urgent Care

Kathleen A. Probst

M.S.N., University of Missouri-Columbia, 2007

B.S.N., University of Missouri-Columbia, 2004

A Dissertation Submitted to The Graduate School at the University of Missouri-St. Louis in partial fulfillment of the requirements for the degree

Doctor of Nursing Practice

August 2023

Advisory Committee

Susan Dean-Baar, PhD, RN, CENP, FAAN

Chairperson

Jennifer Vines, DNP, MSN, RN

Troy Dinkel, MD

Copyright, Kathleen A. Probst, 2023

Abstract

Problem: Vestibular disorders disrupt everyday living and can cause reduced quality of life. Guidelines developed to screen for vestibular disorders are not efficient to use …

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 …

Daily Sbar Sheet For Pediatric Patients With Central Lines, Jordan M. Enzwiler

Dissertations

Problem: The patient’s daily central line Theraworx baths were not being documented and completed at a mid-Missouri teaching hospital. After completing a retrospective chart review for 2022, 8.35% (n=90) of daily central line Theraworx baths were documented. Daily central line baths decrease central line-associated bloodstream infections (CLABSI), prolonged hospital stays, and costs.

Methods: The quality improvement (QI) project utilized a pilot retrospective and prospective pre-post-design. A retrospective chart review on daily central line Theraworx baths was conducted on patients two years and older within the pediatric service line who had a central line. A situation, background, assessment, and recommendation (SBAR) …

Effect Of Confusion Assessment Scores On Identifying Delirium In Intensive Care Patients, Kayla Jacobs

Dissertations

Delirium in intensive care unit (ICU) patients can lead to increased length of stay in the hospital, increased risk of complications, increased polypharmacy, family distress and increased rate of mortality (Vasilevskis et al., 2018). Research has shown that addressing modifiable risk factors can improve survival rate by up to 15%, and routine screening for delirium in ICU patients leads to decreased patient anxiety, reduced in-hospital mortality, early recognition, and treatment of delirium (Krewulak et al., 2021 ; Vasilevskis et al., 2018). This quality improvement project used evidence-based intervention to increase accurate documentation of the confusion assessment method in the ICU …

Implementing Obesity Management Guidelines In Rural Primary Care, Taylor Bell

Dissertations

Abstract

Problem: In the United States, obesity is one of the leading causes of death among Americans and rates of obesity continue to rise. Geographic location significantly affects the number of obesity cases, with rural areas being affected more than other locations. Despite this, obesity continues to be undertreated by rural primary care providers.

Method: This quality improvement (QI) pilot project utilized a descriptive, observational design to evaluate the implementation of an evidence-based clinical practice guideline algorithm for obesity management in a rural primary care clinic. An algorithm was implemented on patients aged 18-60 years and with a BMI of …

Implementing Trauma-Informed Care Curriculum In A Doctoral Nursing Program, Mary D. Brown

Dissertations

Purpose: Trauma is highly prevalent with 70% of individuals encountering at least one traumatic event during their lifetime and approximately 30% experiencing four or more events (Wheeler & Phillips, 2021). Despite the dramatic impact of trauma, there is minimal literature to assist nurses in caring for patients with a trauma history. The purpose of this project was to evaluate the implementation of a virtual, asynchronous trauma-informed care (TIC) educational program for Doctor of Nursing Practice (DNP) students at a midsized, Midwestern public university using knowledge, attitudes, and competency scores as outcome measures.

Methods: This program evaluation (PE) project was an …

Implementation Of A Situation, Background, Assessment, Recommendation (Sbar) Patient Handoff Tool In The Electronic Medical Record (Emr), Kristen L. Chandler

Dissertations

Abstract

Purpose and Problem: Handoffs that are poorly conducted are implicated in 80% of preventable adverse events in healthcare facilities. Within a Pediatric Rehabilitation Facility in Maryland Heights, Missouri it was observed that nurse handoffs were not conducted and lacked the use of a standardized evidence-based tool, resulting in nurse dissatisfaction with the handoff process and miscommunication. Recognized by the World Health Organization, The Joint Commission, and Agency for Healthcare Research and Quality, the Situation, Background, Assessment, Recommendation (SBAR) evidence-based tool is effective in improving handoff communication, improving nurse satisfaction, reducing adverse events, and promoting patient safety. The purpose of …

Evaluation Of Simulation On Medication Errors In The Pediatric Intensive Care Unit, Carrie Clark

Dissertations

Problem: Medical errors are the third leading cause of death in the United States, the most common medical error being medication error. Pediatric patients are at an increased risk of medication error due to medication dosage calculation and the use of frequent high hazardous drugs.

Methods: The quality improvement (QI) project implemented the use of descriptive observational design using retro and prospective data. The data was collected over a 4-week and 4-week period by gathering data via safety and environmental management survey (SEMS).

Results: The data gathered consisted of an increase in medication errors of 150%. The data collected yielded …

Improving Postpartum Depression Screening Practices In The Postpartum Setting, Courtney Lynn Cole

Dissertations

Abstract

Problem: Postpartum Depression (PPD) is frequently undetected in women due to barriers that limit effective recognition and diagnosis. Depression screenings and treatment referrals improve outcomes in the immediate postpartum period. Follow-up methods for positive depression screens are often missed by postpartum care teams.

Methods: A descriptive, observational design was used for this quality improvement project. A formalized depression screening protocol was created to help guide nursing staff on a Postpartum Unit when detecting a positive depression screen. Convenience sampling was utilized and the sample included patients aged 18-45. Data collected throughout this quality improvement project included Edinburgh Postnatal Depression …

Improving Pediatric Asthma Outcomes Through Pictorial Asthma Action Plans, Julia Donovan

Dissertations

Problem: Asthma is the leading chronic disease of children and the leading cause of childhood emergency department (ED) visits, hospitalizations, and missed school days. Asthma action plans (AAPs), including photographs or pictures of asthma medications, symptoms, triggers, and devices, have improved parents’ understanding of their child’s asthma and have increased their comfort level in caring for their child.

Methods: An interventional pre-post study with a mixed-method research design, at a large, urban, primary care pediatric clinic with two locations, evaluated the effectiveness of a pictorial AAP on a child’s asthma control. A pictorial AAP was provided, and a childhood asthma …

Implementation Of A Structured Discharge Checklist For Children Admitted To The Hospital With Acute Asthma, Nicholas Fleming

Dissertations

Abstract

Problem: The transition process from a hospital setting to home is critical for pediatric patients and their families. However, there is no standardized process to ensure asthma discharge orders and asthma action plans are printed at the time of discharge

Methods: This observational quality improvement project utilized a pre-and-postimplementation of the Kamishibai Card (K-Card) process for pediatric discharge checklist compliance in an inpatient pediatric general medicine unit. This project used a sample of all children aged 2 years to 21 years with an asthma diagnosis admitted to the inpatient general medicine pediatric unit. This project included an …

Screening For Food Insecurity In A Suburban Pediatric Urgent Care, Rachel Foutz

Dissertations

Problem: Screening for Social Determinants of Health (SDOH), including food insecurity (FI) should be done on a regular basis at a child’s pediatrician. Many children in the state of Missouri do not have a pediatrician or do not regularly see their pediatrician and are therefore never being screened for FI.

Methods: This observational descriptive quality improvement (QI) project utilized a prospective observational analysis to implement a voluntary FI screening tool in a pediatric only urgent care. The project sampled pediatric patients aged two days to 21 years of life. All participants were given local resources after completing the screening. The …

Extubation Readiness Test In A Pediatric Cardiac Intensive Care Unit, Mary K. Holyoke

Dissertations

Extubation Readiness Test in a Pediatric Cardiac Intensive Care Unit

Abstract

Problem: The lack of standard extubation readiness tests (ERTs), that are practiced in pediatric ICUs to monitor extubation readiness, clinicians have the difficult task of weighing the risk versus benefit of extubation. ERTs can aid clinicians in deciphering patients ready to be successfully extubated and have shown to decrease length of mechanical ventilation and decrease extubation failures.

Methods: The quality improvement (QI) project utilized a descriptive observational design to assess the effects of the implementation of an ERT in a pediatric cardiac ICU. This project used a convenience sample …

Self-Care, Resilience, Self-Compassion, And Burnout In Doctoral Nursing Students: An Exploratory Needs Assessment, Logan Justice

Dissertations

Abstract

Problem: In the United States, one in three nurses experience symptoms of burnout, and doctoral nursing students are additionally challenged to juggle multiple school, work, and life demands (Reith, 2018; Woo et al., 2020). The purpose of this project was to explore the current self-care practices of doctoral nursing students to understand how self-care relates to resilience and burnout.

Methods: This exploratory needs assessment utilized a convenience sample of Doctor of Nursing practice (DNP) and Doctor of Philosophy (PhD) nursing students at a medium sized midwestern university. An electronic data collection survey was constructed to assess student self-care practices, …

Attention-Deficit Hyperactivity Disorder: Improving Outcomes Through Early Identification, Tina Lusk

Dissertations

Problem: Failure to identify and treat attention-deficit hyperactivity disorder (ADHD) is associated with academic underachievement, social difficulties, negative physical and mental health effects. Evidence suggests approximately 3% of a broad-based population sample and roughly 13% of an at-risk population are undiagnosed despite significant symptomology (Downey & Zun, 2018; Madsen et al., 2018; Okumura et al., 2019). The United States (U.S.) has no structured screening system for ADHD. Consequently, children receive no referral for diagnosis or treatment to mitigate its effects.

Methods: The Institute for Healthcare Improvement (IHI) Model for Evidence-Based Practice using the Plan Do Study Act (PDSA) cycle guided …