Medicine and Health Sciences Commons^™

Perinatal Palliative Care: Assessment Of Practice Barriers, Clinician Perspectives And Confidence, Charlotte Wool

Nursing Theses and Dissertations

Perinatal palliative care (PPC) is an emerging model of care that provides supportive services to families anticipating fetal or neonatal demise. Clinician reported practice barriers, their perspectives of PPC and confidence in caring for patients requiring PPC are unknown. The aim of this research is to fill a gap in understanding clinician perspectives, perceived practice barriers and reported confidence to providing PPC. A cross sectional survey design using the Perinatal Palliative Care Perceptions and Barriers Scale© was administered using a Web-based tool. Recruitment was completed via email invitation and list serves. Participants included physicians (n = 66) and advance practice …

The Influence Of Time Perspective On Physical Activity Intentions And Behaviors Among Adolescents Residing In Central Appalachia., Tauna Gulley

Electronic Theses and Dissertations

Obesity and inactivity are prevalent among central Appalachian adolescents. Appalachian residents have been labeled "fatalistic," a time perspective unsupportive of health-promoting behaviors such as regular participation in physical activity. The theory of planned behavior has been used extensively to explain the physical activity behaviors of adolescents. Constructs within the theory of planned behavior include attitudes toward the behavior, subjective norms, perceived behavioral control, and intention to perform the behavior. The purpose of this study was to determine the time perspective of central Appalachian adolescents and examine the relationship between time perspective and the constructs within the theory of planned behavior. …

Horizontal Violence In The Nursing Work Environment: Beyond Oppressed Group Behavior, Therese M. Mendez

University of New Orleans Theses and Dissertations

The United States has been experiencing a nursing shortage since the mid-1990s. The shortage is expected to deepen as the provisions of the 2010 Patient Protection and Affordable Care Act are enacted. Horizontal violence is a negative phenomenon in the nursing workplace that contributes to difficulty in recruiting and retaining nurses in hospitals. Horizontal violence has been described as a form of mistreatment, spoken or unspoken, that is threatening, humiliating, disrespectful or accusatory towards a peer. The effects of this nurse on nurse aggression can be devastating for the nurse involved and also for the patients under the nurse's care. …

Knowledge Of The Effects Of Alcohol On Fetal Development Among Women Of Childbearing Age., Mary Bales

Undergraduate Honors Theses

While Fetal Alcohol Syndrome Disorder is a recognized problem with alcohol ingestion during the formation of facial features, Fetal Alcohol Spectrum Disorders are not as widely recognized. These disorders result from exposure to alcohol throughout pregnancy when the brain and nervous system are developing. The resulting disorders include attention deficit disorders, social disorders, inappropriate behaviors, learning disorders, and intellectual disability. The incidence of children with alcohol-related disorders is increasing as evidenced by children needing special services in the educational systems. It is unknown how much alcohol ingestion is safe during pregnancy or how genetic factors are involved in the development …

Rn Transition To Practice Program In The Primary Care And School Settings: Development, Implementation, And Evaluation, Maria-Idalia O. Lens

Doctor of Nursing Practice (DNP) Projects

New graduate registered nurses (RN) are facing a difficult time finding jobs since the economy of the United States has declined. Since then the California Institute of Nursing and Health Care, along with funding from the Betty Moore Foundation, have developed RN transition programs. These programs were developed to increase skills, confidence, and experience among new RN graduates to promote their transition into the nursing workforce. The programs also were designed to retain newly licensed nurses in the nursing profession while engaging competencies that could be transferred to both acute and outpatient care settings. In addition, the programs are intended …

Motherhood And Childbirth Experiences Among Newcomer Women In Canada: A Critical Ethnographic Study, Fatmeh Ahmad Alzoubi

Electronic Thesis and Dissertation Repository

Statement of the Problem: Motherhood and childbirth are very sensitive experiences and have a strong impact on family functioning, social identity, and cohesiveness. Although motherhood and childbirth have been discussed extensively in the scholarly and popular literature, much of this work has been conducted from a North American perspective, with little attention to how motherhood and childbirth are experienced by newcomer women from diverse racial and cultural backgrounds.

Methodology and Theoretical Orientation: A critical ethnographic study using in-depth interviews with 16 newcomer women was utilized to explore newcomer women’s experiences and understandings of motherhood and childbirth in the aftermath of …

Four Distinct Generations Of Workers Makes Leadership Challenging, Joyce K. Kutin

Joyce K Kutin RN, MSN, MOL

The Bureau of Labor Statistics for the year 2000 stated that Baby Boomers (age thirty-six through fifty-four) represented fifty percent of the United States labor force while Generation X (age twenty to thirty-five) represented some thirty-three percent, a significant decline in workforce. This demographic, time bomb indicates the urgency for many organizations in developed countries to prepare for and cope with the imminent retirement of their aging workforce.

Impact Of Multiple Children On Parental Supervision Practices, Parental Developmental Competence, And Unintentional Injury Risk, Jennifer L. Taylor

Dissertations

Unintentional injury is the leading cause of childhood mortality and morbidity in the United States. The effects of injury on children, families and society encompass physical, mental, emotional, and financial consequences. The highest injury rates are among preschool age children, especially preschool children who have siblings. Child injury prevention strategies can reduce the rates of childhood unintentional injuries and minimize the burdens to children, families, and society created by these injuries. To design and implement effective child injury prevention strategies, further investigation is needed to understand the relationship between the variables influencing the occurrence of child injuries. The specific aim …

Sleep Loss And Its Health Impact Among Family Caregivers Of Persons With A Primary Malignant Brain Tumor, Jean Pawl

Nursing Dissertations (PhD)

Sleep impairments for caregivers are multifactorial. Assumptions are that caregivers of those with primary malignant brain tumors (PMBT) are similar to caregivers of persons with dementia as cognitive impairments are present at diagnosis. The shorter trajectory of PMBTs and rapid deterioration of recipients’ health may influence sleep in caregivers of persons with a PMBT. The purposes of this study were to use a sleep impairment model to characterize caregiver sleep using objective and subjective measures, and to examine sleep loss effects on psychosocial and physiologic health outcomes.

A secondary data analysis using baseline data from a larger study of mind-body …

Chest Tube Dressings: A Comparison Of Different Methods, Susan Kathleen Blackburn Jones

Dissertations

This study is an experimental design with randomization comparing the use of standard gauze dressings (SGD) to transparent adhesive dressings (TAD) to cover chest tube insertion sites in post-operative patients who have undergone cardio-thoracic surgery. The study was conducted in a 400 bed, tertiary non-academic teaching hospital in the Midwestern United States. Seventy-nine patients were enrolled in the study; 39 received TAD and 40 received SGD. The non-inferiority margin was set at 15% in keeping with current recommendations (Kaul & Diamond, 2006). The TAD was found to be not inferior to the SGD with regards to the proportional differences in …

The Determinants Of A Nurse's Discretionary Decision To Respond To Situations That Place Patients At Risk For Safety Events But Requires A Response That Is Beyond The Scope Of Nursing Practice, Kathy Baker

Theses and Dissertations

A nurse’s contribution to patient safety in regards to early detection of issues in the clinical setting is undisputed (Redman, 2008). If these patient situations require a response that is beyond the scope of nursing practice, in most instances nurses are not sanctioned to intervene without physician consultation (Gaba, 2000). The evidence in the nursing literature does suggest that some nurses exercise professional discretion and are, at times, making the decision to initiate interventions independently (Benner, Hooper-Kyriakidis, & Stannard, 1999; Hutchinson, 1990; Tiffany, Cruise, & Cruise, 1988). The focus of this inquiry was to examine the determinants of a nurse’s …

Response To And Recovery From Endotracheal Suctioning In Preterm Infants Using Routine Versus Four-Handed Care, Sharon Cone

Theses and Dissertations

Neonatal Intensive Care Units have experienced profound advances in technology and treatment modalities over the last two decades. Infants born at the edge of viability are now surviving despite prolonged hospitalizations. These infants born preterm are prone to a high degree of stress from life sustaining and routine interventions. Much focus has been directed toward addressing noxious environmental factors such as noise, light, and infectious disease; however, little has been done to examine the stress experienced by the professional caregiver who work in these environments. Environmental press theory, which focuses on the interplay between human beings and their surroundings, is …

Advancing A Culture Of Safety Through The Creation Of A Unit-Based Safety Team, Lynda K. Carr

Theses and Graduate Projects

Hospitals are challenged to create a strong culture of safety within their organization to eliminate harm to patients. This paper describes a project to advance a culture of safety on a cardiovascular acute care unit at an urban hospital through the creation of a unit-based safety team. Based on the premise that patient safety is a local phenomenon, the rationale for the project is to aim interventions at the unit level where they will have the greatest impact. Four key steps in creating an effective unit-based safety team are highlighted: team member selection, team development, enacting interventions, and evaluating interventions …

Caring For A Preterm Infant During The First Six Months Post Nicu Discharge: A Mother’S Perspective, Lois Phillips-Pula

Theses and Dissertations

Overview There are numerous studies in the current literature focusing on the intense emotions experienced by parents, following the birth of a preterm infant, (i.e., born prior to 37 weeks gestational age [GA]). Research findings have helped us understand the fear and anxiety they feel while attempting to navigate the neonatal intensive care unit (NICU) environment. What happens in those early weeks and months at home after discharge, however, is surprisingly absent from the literature. It is well known that preterm infants are readmitted to the hospital during the first few months after discharge at a rate of 10% - …

Facilitating The Staff Nurse's Role In Creating A Culture Of Care On An Obstetrical Care Unit, Laura Struve Hanson

Theses and Graduate Projects

The art of caring is foundational to the nursing profession, but too often nurses prioritize care for others above care for themselves. Nurse self-care and peer care are integral in the creation of a unit culture of care. This project introduces a new nursing practice model based on Jean Watson's caring theory and Caritas Processes to guide staff nurses on an obstetrical unit in creating a culture of care for self and peers. The practice model relies on nurse courage, intentional collaboration, and creativity to uniquely integrate the Caritas Processes into professional practice. This progression fosters the emergence of holistic …

Introducing Integrative Medicine At The Bedside To Patients With Post-Traumatic Headache Pain, Melissa E. Allard

Theses and Graduate Projects

The use of integrative medicine is growing, and the nursing profession has a responsibility to meet the changing needs of patients. This paper describes a model of nursing for delivering integrative medicine practices at the bedside to persons suffering with post-traumatic headache pain related to traumatic brain injury (TBI) and is grounded in Katherine Kolcaba's Comfort Theory. A patient is best served when the holistic principles of integrative medicine are facilitated by a nurse who is centered and able to introduce these modalities with positive intention. The goal of the practice model is to provide the foundation for nursing to …

Creating A Healing Environment In The Intensive Care Unit, Elissa Egbers

Theses and Graduate Projects

The intensive care unit (ICU) can be a very stressful environment. Patients are critically ill and require constant monitoring. Indeed, high tech care in the ICU environment includes multiple factors that may impair the patient's ability to sleep and rest. The purpose of this paper is to describe a practice model that is conducive to patient healing in an intensive care unit in a large urban hospital. This practice model is significant to patients, families, and nursing staff and is based on Florence Nightingale's Environmental Model of Nursing and her thirteen canons. This paper describes the potential implementation of the …

Care Of Self: How Reiki Is Used By Nurses To Reduce Stress On An Acute Care Unit, Leann Olson

Theses and Graduate Projects

As the nursing shortage escalates and patient acuity levels continue to rise, nurses can expect to experience increased stress and burnout. Indeed, studies show that job dissatisfaction among nurses today is widespread. Finding ways to reduce the stress, improve job satisfaction, and retention is important not only for nurses, nursing units, and organizations, but also for patients. This paper describes a nursing practice model that was developed to reduce stress and burnout among nurses in an acute care unit of a large urban hospital. The model uses the energy therapy of Reiki and is guided by Martha Rogers' Science of …

A Bridge To One World: An Indigenous Wisdom-Based Approach To Designing A Transcultural Patient Family Advisory Council, Julie Lundberg

Theses and Graduate Projects

As health care organizations face increasing challenges to accommodate diverse patient populations amid growing concerns of persistent health disparities, there is urgent need to better understand and listen to diverse, unique patient experiences. This paper describes the design and implementation of a transcultural Patient Family Advisory Council (PFAC) as a concrete step towards ensuring that the voices of culturally diverse patients and families are effectively engaged to improve the patient experience at a large, Midwestern healthcare organization. Storytelling, ritual and dialogue provide a wisdom-based approach to the design of a Bridge to One World practice model grounded in Leininger's Culture …

Living With Hiv: Views Through The Blog, Linda Eastham

Theses and Dissertations

The purpose of this qualitative descriptive study was to develop a greater clarity of how HIV infected individuals live and work within the sphere of HIV infection as represented through unsolicited, personal narratives posted on blogs. Existing, single author, personal blogs were identified via a search engine. Blogs were defined as the blog author's postings and all responses, whether written by the blog author or a reader respondent. Inclusion and exclusion criteria were developed to respect indicators of bloggers' intentions for privacy, e.g., blogs which required a password were excluded. A total of 14 blogs met inclusion criteria. Actions to …

Healthcare Acquired Infection Risk And Toothbrush Contamination In The Icu., Michelle Frazelle

Theses and Dissertations

Healthcare acquired infections (HAIs) are a complex and multi-factorial problem associated with high morbidity, mortality, and cost. Toothbrushes (TBs) may be at risk for contamination with potential pathogenic microorganisms (PPMs) from the patient care environment or autoinnoculation from the patient. We focused on three PPMs: multiply resistant Staphylococcus aureus (MRSA), vancomycin resistant Enterococcus (VRE), and Acinetobacter. Specific aims were to (1) describe environmental factors associated with TB contamination in the ICU; (2) describe the relationship between TB contamination and oral colonization in critically ill adults.

Understanding Mothers Of Late Preterm Infants, Brenda Baker

Theses and Dissertations

The experience of becoming a mother is a personal and social experience influenced by individual characteristics, friends and family, and the infant. The journey to become a mother encompasses concepts of maternal competence and responsiveness. The purpose of this study was to examine maternal competence and responsiveness to the infant in mothers of late preterm infants compared to mothers of full term infants. The conceptual model for this work was based on the work of Reva Rubin describing maternal identity and role development. Maternal competence and responsiveness are components of maternal role and are influenced by social support, maternal self-esteem, …

“This Is Me. I Like Who I Am”: A Qualitative Descriptive Study Using Photo Elicitation To Examine The World Of The School-­Age Child With Cystic Fibrosis, Renee Carol Burk

Doctoral Dissertations

School-age children with Cystic Fibrosis (CF) possess valuable knowledge about themselves. They have experience and ability to offer insight about living with CF. Previous studies, exploring the perceptions of CF children, give little attention to eliciting and listening to their voices. Also, traditional data collection methods limit children from participating in research. The purpose of this study was to explore and describe how school-age children with CF see themselves in the world they live.

The study utilized qualitative description methodology. Symbolic Interactionism served as the researcher’s philosophical lens. It is a perspective that seeks to understand the social world of …

Are Nursing Students’ Clinical Skills Competency And Self-Confidence Levels Improved Via Video Ipods? A Randomized Controlled Pilot Study, Margaret M. Hansen Edd, Msn, Rn

Nursing and Health Professions Faculty Research and Publications

Background: Mobile technologies allow students the opportunity to enhance learning while away from the traditional classroom setting. However, educational outcome research is lacking in the use of mobile health (m-health) applications in healthcare professional practice development.

Objectives: The aim of this pilot study was to discover whether male and female urinary catheter insertion videos delivered via iPods increases students’ skills competency and self-confidence levels.

Methods: A prospective replicated study including second year, semester two, undergraduate nursing student participants (NSP) (N=16) was conducted: nine control participants (no video iPods) and seven intervention participants (video iPods). Nursing students attending a mandatory skills …

Military Sexual Trauma Exposure And Heart Rate Variability Outcomes In Female Veterans, Elizabeth Ann Davis Lee

Theses and Dissertations (ETD)

Area of Investigation and Hypothesis: Decreased heart rate variability (HRV) has been used as a predictor of cardiac and all-cause mortality. Studies have documented decreased HRV in a variety of conditions, including posttraumatic stress disorder (PTSD), depression, age, coronary artery disease (CAD), diabetes mellitus (DM), and tobacco use but improvement with beta blocker (BB) treatment. No prior study evaluated the relationship between military sexual trauma (MST) exposure and HRV outcomes. The hypothesis of this study was that female veterans exposed to MST would have lower time domain HRV measures than a reference cohort reporting non-exposure. Methods and Procedures: Electronic medical …

Creating A Self Learning Module For Nurses Caring For Patients Undergoing Angioplasty And Receiving Anticoagulation Therapy, Stacy Incardone

Nursing Masters

Nurses in the Cardiac Catheterization Lab (CCL or commonly referred to as the Cath Lab) play a critical role in the delivery of high quality care to their patients. Being knowledgeable and current on evidence based practice is the key to being an effective and efficient nurse. Every year there are annual competencies that nurses must demonstrate to prove that they are capable of performing these patient tasks independently. These annual competencies are institution and unit specific and may include tasks such as demonstration of inserting an intravenous catheter, drawing a blood specimen from an arterial line, and reading and …

Caring, Interaction, And Active Teaching Strategies: Factors That Contribute To The Success Of The Associate Degree Nursing Student, Penelope Sue Logsdon

Dissertations

This exploratory study examined successful associate degree nursing students’ perceptions regarding the importance of caring by the nursing faculty, nursing faculty/student interaction, and faculty use of active teaching strategies. Participants completed a researcher developed survey instrument that measured both the importance and frequency of the caring, interaction, and active teaching strategies. The survey instrument measured six demographic factors and 30 statements regarding caring, interaction, and active teaching. Participants rated the statements for both importance and frequency on a four-point Likert scale. Five community and technical college associate degree nursing programs participated in the research with a total of 270 successful …

Professionalism And Social Networking: Can Patients, Physicians, Nurses, And Supervisors All Be ‘Friends’?, Joy Peluchette, Katherine Karl, Alberto Coustasse, Philip Rutsohn, Dennis Emmett

Management Faculty Research

This study examines the use of Facebook by certified nurse anesthetist students. Our results showed that, contrary to expectations, most were neutral about faculty, physicians, and supervisors viewing their Facebook profiles but expressed concerns about patients seeing such information. Many (30%) of our respondents had observed unprofessional content posted on the social network sites of their classmates including: intoxication or substance abuse, profanity, sexually suggestive photos or comments, and negative work-related comments. A vast majority indicated they would accept a ‘friend’ request from their supervisor and a physician but not a patient. Surprisingly, about 40% had initiated a ‘friend’ request …

Effects Of Voluntary Public Reporting On The Nurse Sensitive Measures Of Falls And Falls With Injury In Hospitals: A Massachusetts Perspective, Patricia Noga

Graduate Doctoral Dissertations

Background: Interest and efforts in the health care industry to be transparent by collecting and publicly reporting performance measures about healthcare quality and cost has increased in recent years. The National Quality Forum (NQF) endorsed a set of 15 national quality measures for nursing-sensitive care that could be used for public accountability and quality improvement, including measures of patient falls and falls with injury. Patient falls have been among the largest category of reported incidents in hospitals, and are a serious concern for healthcare leaders and healthcare team members. In 2006, Massachusetts hospitals began voluntarily publicly reporting the nurse sensitive …

Prehabilitation Before Total Knee Arthroplasty Increases Strength And Function In Older Adults With Severe Osteoarthritis, Ann M. Swank, Joseph B. Kachelman, Wendy Bibeau, Peter M. Quesada, John Nyland, Arthur Malkani, Robert V. Topp

College of Nursing Faculty Research and Publications

Preparing for the stress of total knee arthroplasty (TKA) surgery by exercise training (prehabilitation) may improve strength and function before surgery and, if effective, has the potential to contribute to postoperative recovery. Subjects with severe osteoarthritis (OA), pain intractable to medicine and scheduled for TKA were randomized into a usual care (UC) group (n = 36) or usual care and exercise (UC + EX) group (n = 35). The UC group maintained normal daily activities before their TKA. The UC + EX group performed a comprehensive prehabilitation program that included resistance training using bands, flexibility, and step training at least …