Medicine and Health Sciences Commons^™

Family-Centered Psychosocial Care For Pediatric Oncology Patients, Jessica W. Casey

UNLV Theses, Dissertations, Professional Papers, and Capstones

Psychosocial conditions are prevalent in pediatric oncology patients (Kahalley et al., 2013). Family and social support are essential aspects of a patient's health care outcomes (Merck & McElfresh, 2019). Anxiety and depression are common in pediatric oncology patients due to trauma during treatment (Pao & Kazak, 2015). These patients also can have preexisting developmental or behavioral conditions before starting treatment. Treatment side effects can also cause cognitive and behavioral changes (Nixon, 2014b). Nurses should be knowledgeable and confident in their ability to care for patients' psychosocial health and development. The purpose of this Doctor of Nursing Practice (DNP) project is …

Increasing Genetic Testing Rates To Improve Early Detection And Prevention Of Breast And Ovarian Cancer In Women, Makensey Beth Durrant

UNLV Theses, Dissertations, Professional Papers, and Capstones

Screening rates for cancer related genetic mutations are low in the primary care setting, despite evidence-based guidelines recommending screening in all patients who meet criteria. Genetic mutations, such as the breast cancer susceptibility 1 and 2 (BRCA1/2) gene mutations, drastically increase breast and ovarian cancer risk in patients. The United States Preventive Services Task Force (USPSTF) and the National Comprehensive Cancer Network (NCCN) provide evidence-based guidelines on criteria for genetic testing in women at risk for breast and ovarian cancer related gene mutations. Primary care providers (PCPs), including advanced practice registered nurses (APRNs), are at the front lines of preventative …

Increasing Human Papillomavirus Vaccination Intent And Knowledge Through An Educational Intervention, Angelica E. Musumeci

UNLV Theses, Dissertations, Professional Papers, and Capstones

Human papillomavirus (HPV) is a widely discussed topic in healthcare as it affects patients of all genders and ages who partake in sexual activity. The most significant concern it poses to those at risk is HPV-related cancer. Fortunately, a vaccination exists that targets specific strains associated with these types of cancers. Despite evidence-based research supporting the vaccination’s efficacy and safety, lack of awareness and misinformation diminish the receipt of the vaccine and drive the lack of protection. Thus, educational interventions directed at parents and caregivers, which aims to improve their understanding of HPV and the vaccination’s benefits, is key to …

Decreasing Central Line-Associated Bloodstream Infections In The Critical Care Unit, Kimberly J. Foxworth

UNLV Theses, Dissertations, Professional Papers, and Capstones

Central line-associated bloodstream infections (CLABSI) are a rising problem in the critical care setting in the United States. According to Flogren et al. (2007), "an estimated 248,000 bloodstream infections occur in hospitals across the United States each year, and a significant amount of these infections are associated with the use of a central venous catheter" (p.160). The Center for Disease Control and Prevention (CDC) defines a CLABSI as "recovery of a pathogen from blood culture (a single blood culture for organisms not commonly present on the skin and two or more blood cultures for organisms commonly present on the skin) …

The Road Ahead: An Occupational Therapy Manual To Infant Development For Parents In The Nicu, Nicole Suzuki-Uyeno

UNLV Theses, Dissertations, Professional Papers, and Capstones

Occupational therapists have been collaborating with the parents of our tiniest patients in the neonatal intensive care unit (NICU) for quite some time. They have a wealth of information and expertise in the area on infant development and parent education. Admitting a baby to the NICU is a shock for most parents and can take a toll on a family. The role of the occupational therapist is to help educate the family and to provide the tools to safely take care of their baby and to smoothen the transition from the hospital to home.

In the NICU, the OT has …

Improving Nurse Self-Efficacy Regarding Depression Among Cardiovascular Disease Patients: An Education Intervention, Presten Beatty

UNLV Theses, Dissertations, Professional Papers, and Capstones

Depression is a principal cause of increased morbidity, mortality, and decreased quality of life for cardiovascular disease patients. Low levels of nurse confidence have been the outcomes of several studies and anecdotal reports regarding providing care for and approaching patients with acute and chronic illnesses in conjunction with behavioral and mental health issues. Current literature suggests that improving nursing education on the prevalence and impacts of depression improves nurse confidence. Depression screening tool education provided to nurses, with detailed disease information, empowers nurses in their attitudes, knowledge, and behaviors regarding patient depression. By improving depression screening rates among cardiovascular disease …

A Quality Improvement Project To Improve Health Care Provider Self-Efficacy In Rural Primary Pediatric Care Clinics Through Training Intervention, Alison Borgsmiller

UNLV Theses, Dissertations, Professional Papers, and Capstones

American Association of Pediatrics recommends screening for various developmental delays in children, but it does not explicitly recommend a tool for screening social and emotional development at well-child checks (WCCs). Therefore, provider self-efficacy (SE) is lacking, and screening rarely occurs. This quality improvement (QI) project sought to improve healthcare provider SE using the Ages and Stages Questionnaire: Social-Emotional, Second Edition (ASQ:SE-2), an evidence-based practice screening tool for identifying such delays in children at 30–60-month WCC visits.At rural healthcare centers in San Luis Obispo, California, participants completed the Self-Efficacy Twelve Questionnaire prior to and 30 days following a training intervention. While …

Reducing Door-To-Balloon Time In Stemi Via Er Nurse Driven Protocol, Torrie Clontz

UNLV Theses, Dissertations, Professional Papers, and Capstones

Over 605,000 patients will suffer an ST-segment elevated myocardial infarction in the United States each year. The gold-standard definitive treatment for this is percutaneous coronary angioplasty or the ballooning open and stenting of the blockage. The American Heart Association has set the evidence-based gold standard of 90-minutes from identification of blockage to reperfusion of heart muscle. In a health system in Las Vegas, NV, this goal is frequently missed due to lack of protocols in place to expedite patients towards definitive treatment. The purpose of this evidence-based practice change is to reduce STEMI patient morbidity and mortality via a nursing …

Improving Nurse Leaders’ Knowledge And Confidence In Transformational Leadership Skills In The Online Environment, Tanya Haight

UNLV Theses, Dissertations, Professional Papers, and Capstones

Leadership is critical to the success of most organizations, and the achievement of an organization's goals is largely dependent on the leaders' ability to engage, motivate, and influence their teams—often referred to as Transformational Leadership. This is especially true for healthcare organizations wherein the morbidity and mortality of patients may be affected by the quality of leadership. At the start of the COVID-19 pandemic, in-person meetings transitioned to the online format without nurse leaders' formal training. Leaders cited this lack of orientation as impeding their ability to sustain an online-virtual transformational leadership presence with their teams. They reported varying degrees …

The Nursing Leader’S Role In Decreasing Implicit Rationing By Improving The Nursing Work Environment, Allison Mchugh

UNLV Theses, Dissertations, Professional Papers, and Capstones

Despite all the literature about missed care and its contributing factors, it is prevalent in most hospitals worldwide. Missed care is the result of care that is implicitly rationed. For this paper, implicit rationing is defined as how nurses decide what care is delivered based on the present work environment. Many factors influence implicit rationing. One such factor is the work environment. The association between the nursing work environment and implicit rationing is well described in the literature. The nursing leader is in a formal position responsible for patient outcomes and the nursing practice environment. Therefore, it is important to …

Improving Self-Efficacy And Knowledge While Reducing Anxiety In High-Risk Breast Cancer Patients Through Standardized Education, Shelley Miles

UNLV Theses, Dissertations, Professional Papers, and Capstones

Breast cancer is the leading cause of death of women in the United States. Patients at high risk for developing cancer are more easily identified in today’s world. Early identification might be due to strong family history or genetic mutations, such as BRCA1 or BRCA2. Screening and risk reduction guidelines have been developed over recent years for these patients. Adherence to these guidelines continues to be a problem. The factors stemming from this problem include lack of knowledge about being high-risk, understanding the guidelines, and anxiety and depression about the perceived risk of developing breast cancer. These factors can cause …

Evaluation Of An Advance Care Planning Workshop To Improve The Self-Efficacy Of Health Care Providers, Joy Patrick

UNLV Theses, Dissertations, Professional Papers, and Capstones

Advance care planning (ACP) involves discussions between the patient and their care providers and those close to them about future care. Every patient is entitled to ACP; however, research has shown that providers do not regularly implement them for various reasons. In addition, multiple barriers may be preventing providers from initiating ACP. Among them are lack of knowledge and confidence, apprehension, time, and fear. This Doctor of Nursing Practice (DNP) addresses the problematic barriers to regular ACP discussions between providers and the patients. Specifically, the purpose of this DNP project is to develop, implement and evaluate an online module to …

Parental Education On Human Papillomavirus Vaccination, Marguarette J. Suprien

UNLV Theses, Dissertations, Professional Papers, and Capstones

The human papillomavirus (HPV) is a worldwide condition that produces several diseases, including cervical, anogenital, and oral cancer, among others (Fishman et al., 2014). The Center for Disease Control and Prevention (CDC; 2016a) stated that HPV is among the most reported sexually transmitted diseases in the United States. Over 150 viruses are associated with HPV, and 40 types of the virus can be spread via sexual contact, including vaginal, oral, and anal sex (CDC, 2016; CDC, 2016b; CDC, 2016c). Evidence shows that approximately 79 million individuals are infected in the United States, and 14 million Americans are infected with the …

Associations Between State Regulations And Midwifery Workforce Access, Acacia Herndon

Undergraduate Research Symposium Podium Presentations

Background: U.S is worst in maternal care; Credible support for CNMs as a solution; Independent licensing has been ineffective; Other factors may influence access

Investigating Acculturation, Health-Promoting Lifestyle, And Health Status Among Nigerian Immigrants In The United States, Frank Uche Akpati

UNLV Theses, Dissertations, Professional Papers, and Capstones

The United States has a significant number of immigrants from Africa. More come from Nigeria than other African countries. Even though acculturation influences health behavior in other cultures, this relationship is understudied in the Nigerian immigrant community in the United States which can influence their health care. This study examined the relationship between acculturation, health-promoting lifestyle, and health status of Nigerian immigrants. Key constructs from Berry’s acculturation model guided the study. Acculturation was conceptualized as occurring through varying levels of ethnic society immersion (ESI) and dominant society immersion (DSI). The study also examined the influence of education on acculturation using …

Social Support Of Mexican Immigrant Women With Gestational Diabetes Mellitus: A Constructivist Grounded Theory Study, Angela Sojobi

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this study was to explore the perception of social support among Mexican immigrant women with gestational diabetes mellitus (GDM) within the context of their culture and discern the process through which social support can influence their adherence to the GDM management protocols. The incidence of GDM is highest in low-income, ethnic minority communities such as the Mexican immigrant community. Adhering to the GDM management protocols may prove challenging for some women, especially if social support is lacking. If uncontrolled, GDM can result in adverse maternal-fetal outcomes. Among Mexican immigrant women, the incidence of poor glycemic control and …

Factors Associated With Medication Decision Making In African American Families Of Children With Adhd: A Mixed Methods Study, Amy Glasofer

UNLV Theses, Dissertations, Professional Papers, and Capstones

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral pediatric disorder in the United States. Pharmacotherapy is a recommended component of treatment for ADHD. While medication treatment of ADHD is not optimized overall, minority groups experience medication treatment disparities. The persistently lower rates of medication treatment in minority groups may have culturally specific origins which cannot be generalized across minorities. The purpose of this dissertation was to assess and extend knowledge regarding medication decision making (MDM) in African American caregivers of children with ADHD. To assess the state of the science on ADHD disparities, a review of 41 descriptive studies exploring …

Relationships Between Mindfulness, Nonacademic Factors, Stress, And Test Performance: A Cross-Sectional Study, Rebecca A. Baumeister

UNLV Theses, Dissertations, Professional Papers, and Capstones

Successful test performance is essential to nursing students. Poor performance comes with consequences such as inability to progress or removal from the program, leading to attrition. The influence of academic factors on test performance have been widely researched and stress is known to hinder it, yet other factors may also impact test performance.

Dispositional mindfulness has the potential to support test performance, but no known studies have focused on these two variables among undergraduate nursing students. A gap also exists in relation to the influence of nonacademic factors on undergraduate nursing students’ test performance. Due to the ongoing nursing shortage, …

Job Burnout: An Examination Of Outpatient Clinics, Aysa M. Chavarria

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this study was to examine job burnout of medical providers in outpatient clinics. Job burnout is a psychological syndrome resulting from job interpersonal stressors; it is measured using three dimensions: (1) emotional exhaustion – feelings of being emotionally overextended and exhausted by one’s work, (2) depersonalization -a unfeeling and impersonal response toward patients, and (3) personal accomplishment – feelings of competence and achievement in one’s work (Maslach & Jackson, 2020). Using a convenience sample, healthcare providers in Southern Nevada were asked to participate. The study was approved by the University of Nevada, Las Vegas, Internal Review Board …

Effects Of A Discourse Intervention On End-Of-Life Knowledge And Attitudes Of Bsn Nursing Students, Jayme Gullone Haynes

UNLV Theses, Dissertations, Professional Papers, and Capstones

Introduction. A number of challenges exist to providing effective, formalized end of life (EOL) education for undergraduate nursing students. Despite advanced resources provided by the End-of-Life Nursing Education Consortium (ELNEC), many nursing program curricula are overloaded with content and have little opportunity to incorporate other content and information.

In addition, the topic of EOL care may elicit significant emotional responses from nursing students with numerous studies indicating nursing students experience fear and anxiety when caring for patients at EOL. Recent research demonstrates the need to approach emotionally laden topics such as EOL care from a pedagogical perspective that acknowledges and …

The Effects Of Real-Time Computerized Needle Tip Location Feedback On State Anxiety And Immediate Performance Of Simulated Ultrasound-Guided Regional Anesthesia, Joseph Janakes

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Complications of ultrasound-guided regional anesthesia (UGRA) in the clinical setting are severe and frequently related to improper needle tip placement, which is a challenging skill for novice student learners. Accordingly, anesthesia education programs are incorporating simulation-based teaching methods that use expensive procedural task trainers to aid in UGRA training. However, it was unknown if the task trainers with real-time computerized needle tip location feedback affect student anxiety and immediate simulated UGRA performance, leaving educators wondering if the cost was justified.Aims: The purpose of the study was to examine the effects of real-time computerized needle tip location feedback on students’ …

New Nurse Reality Shock & Early Burnout: Can Role Transition Education Received During New Nurse Residency Positively Affect Satisfaction?, Bonnie L. Stolzman

UNLV Theses, Dissertations, Professional Papers, and Capstones

Newly licensed nurses are at incredibly high risk for reality shock leading to early burnout which results in many of them resigning their positions or leaving nursing altogether. Common feelings leading to reality shock often involve exhaustion, cynicism, depersonalization, decreased self-efficacy, and decreased job satisfaction. The result of early burnout presents significant financial strain and quality concerns for our already struggling healthcare systems. In the 1960s and early 1970s, Marlene Kramer brought her research regarding newly licensed nurses and their experience of “reality shock” to publication. Kramer felt strongly that reality shock was a key factor that led newly licensed …

Health Disparities And Covid-19 Pandemic: Increasing Clinical Research Participation Among African Americans, Kashica J. Webber-Ritchey, Abbi D. Lane-Cordova

Journal of Health Disparities Research and Practice

Health disparities in African Americans is a persistent issue. Higher rates and severity of the novel coronavirus-19 [COVID-19] among African Americans only widens health disparities. Effective COVID-19 treatment options are imperative, requiring representation of African Americans in clinical research. However, low participation and under-representation of African Americans is complex in nature. This article describes health disparities, the impact of COVID-19, and participation in clinical research among African Americans. We offer strategies for researchers to enhance the inclusion of African Americans. We also offer strategies in conducting clinical research during COVID-19.

Synergistic Effects Of Incident Diabetes Between Snoring, Family History Of Diabetes, And Obesity, Yoo-Jeong Jeon, Seung Ku Lee, Jin-Young Kim, Chol Shin

Nursing Faculty Publications

Objective: The general public recognizes the connections between obesity, family history of diabetes (FHD), and diabetes, but remains unaware of synergistic effects that occur due to their combination. In this study, we investigate the synergistic effects of event diabetes between snoring, FHD, and obesity. Materials and Methods: Study subjects were selected among participants in the Korean Genome and Epidemiology Study Ansan- Ansung cohort, an ongoing prospective population-based study. Ansan-Ansung cohort initiated in 2001 and 2002 and has been followed biennially. At baseline, the initial cohort of 10.030 subjects, aged 40 to 69 years. A total of 5.759 participants were included …

Serum Micronutrient Status, Sleep Quality And Neurobehavioral Function Among Early Adolescents, Xiaopeng Ji, Charlene W. Compher, Sharon Y. Irving, Jinyoung Kim, David F. Dinges, Jianghong Liu

Nursing Faculty Publications

Objective: To examine associations between serum micronutrients and neurobehavioral function and the mediating role of sleep quality in early adolescents. Design: In this cross-sectional study, peripheral blood samples were analyzed for iron and zinc levels. The Pittsburgh Sleep Quality Index and Penn Computerized Neurocognitive Battery were used to assess sleep quality and neurobehavioral function, respectively. The generalized linear regressions (bootstrap) were performed to estimate the associations. Setting: Jintan, China Participants: 226 adolescents (106 females) from the Jintan Child Cohort study. Results: Adolescents with low iron (< 75 ug/dl) (OR=1.29, p=0.04) and low zinc (< 70 ug/dl) (OR=1.58, p0.05). Conclusion: Iron and zinc deficiencies may possibly be associated with poor sleep and neurobehavioral function among early adolescents. Poor sleep may partially mediate the relationship between micronutrients and neurobehavioral function.

Implementation Of A Protocol In The Freestanding Emergency Department To Screen For And Identify Possible Victims Of Human Trafficking, Joe Alvarado

UNLV Theses, Dissertations, Professional Papers, and Capstones

Human trafficking (HT) victims often seek medical care in the emergency room setting. In a recent study among HT survivors, 88% attested to receiving medical care while in captivity, with 63% treated in the emergency care setting. Freestanding emergency departments typically have lower acuity and lower patient volumes than hospital-based emergency departments. This setting creates shorter wait times and minimizes the length of stay at every point during the emergency room experience. For traffickers, this is an ideal situation if their victim needs medical attention, and they want to get in and get out of the emergency room with less …

Transient Ischemic Attacks Evaluation And Management In Specialized Urgent Care Facilities, Zandra Kay Johnson

UNLV Theses, Dissertations, Professional Papers, and Capstones

PURPOSE: Transient ischemic attacks (TIA) are a health problem that affects many people each year. A local Las Vegas organization allowed this DNP student to develop and implement an intervention to increase the perceived ability of providers to manage low-risk TIAs in specialized urgent care facilities. The aim was to raise the comfort level of providers at on-demand medicine also known as urgent care. Additional goals were to increase awareness of stroke and TIA symptoms and educate providers on the new TIA guidelines.

METHODS: This quality improvement DNP study used a convenience sample of 30 providers. Eleven participants completed the …

Increasing Perioperative Outpatient Nurses’ Knowledge Of Pediatric Anxiety Through Use Of A Developed Clinical Guide, Christine Oliver

UNLV Theses, Dissertations, Professional Papers, and Capstones

Elevated perioperative anxiety levels in the pediatric population is a main concern when providing nursing care in a specialty area. In the United States, over five million pediatric patients will have some type of surgery each year and greater than 65 percent of those pediatric patients will exhibit preoperative anxiety. The care of pediatric patients in the outpatient surgical setting has grown significantly, and pediatric care is no longer restricted to specialized facilities or hospitals. This increased number of pediatric patients in day surgery centers has created a shift in nursing care for perioperative nurses. Anxiety has been directly related …

Developing Strategic Partnerships To Impact Population Health: A Professional Development Module, Andra S. Scano

UNLV Theses, Dissertations, Professional Papers, and Capstones

Massive organizational changes occurring in our health care delivery system have provided opportunities for nurse leaders who think in terms of population health, to develop new skills needed to impact the populations they serve. Aspects of these changes include a focus on the delivery of primary and community-based care and the development of partnerships, alliances, and other linkages across settings to build integrated systems (Williams, 2020, p. 17). Turner (2020) asserts that population-focused nurse leaders are charged with creating a new future for healthier communities which often involves strategic partnership development. However, strategic partnership development is a complex task that …

An Evaluation Of Care Coordination In Reducing Depression Symptoms And Emergency Room Visits, Stacy Sumpter

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Individuals living with multiple chronic conditions (MCC) account for 26% of the population; however, they consume 84% of healthcare resources, are three times more likely to have depression than healthy individuals, and have increase emergency room (ER) visits and healthcare resource use. This population requires coordinated health care to reduce unnecessary spending and the misappropriation of healthcare resources. The purpose of this project was to evaluate the efficacy of care coordination (CC) and the support system it provides in lowering depression symptoms and ER visit frequency as a viable measure to reduce overall healthcare costs.

Methods: The healthcare providers, …