Medicine and Health Sciences Commons^™

Factors Mediating Disruptive Behaviors In A Veterans Affairs Medical Center, Marylois Lacey

Dissertations

. Disruptive behaviors are often related to care giving situations in which the patient wants something that is not possible, refuses to participate in what is required, demands instant gratification, or demands immediate emotional support. In response to the patients’ demands and actions, health care providers use limit setting, activity demand, and denial of request. This study sought to answer the following questions: (a) Are code greens associated with symptoms of a medical and/or psychiatric diagnosis, denial of request, limit setting, and activity demand? (b) Are activity demand, denial of request, and limit setting more likely to be associated with …

Quality Of Life Among Southwest American Indians And Alaska Natives Living With The Hepatitis C Virus, Rydell Todicheeney-Mannes Phd, Rn, Acns-Bc

Dissertations

Background: Hepatitis C Virus is considered to be a global public health threat because seventy-five percent of infected persons have no symptoms and are unaware of their infection. It is significant to note that AI/ANs commonly contend with issues that prevent them from receiving or seeking medical care. Objectives: The purpose of this study was to: (a) Characterize the level of depression, alcohol consumption, stigma, and quality of life; (b) Examine the relationship among the variables of age, gender, residing on an AI/AN reservation, current partner status, depression, alcohol consumption, and stigma with quality of life in a sample of …

The Journey To Becoming-Authentic From The Voices Of Nursing Students Living With Attention Deficit Hyperactivity Disorder, Sheryl Lynn Allen

Dissertations

Research and literature on nursing students living with attention deficit hyperactivity disorder (ADHD) in higher education is deficient in supporting the needs of a growing population. The aim of this study sought to uncover the essence of nursing students’ experiences through a hermeneutic phenomenological approach and promote deeper understanding of the meaning of lifeworld experiences through the lens of critical social theory (CST). CST sustains freedom from ideological restraints to allow exploration into individual experiences. The voices of student participants provide the medium for articulating meaning. An integrative approach using van Manen’s (1990) and Munhall’s (2012) methods guided this study. …

Group Empowerment Capacity And Capability In Schools Of Nursing, Mary Louanne Friend

Dissertations

Nursing education is experiencing rapid changes as nurses are expected to transform and lead health care delivery within the United States. The ability to produce graduates who can promote a culture of safety, and provide patient centered care in collaboration with others will require nursing administrators and faculty who are empowered and able to achieve goals. The Sieloff Theory of Group Empowerment within Organizations (Sieloff & Bularzik, 2011) provided the theoretical basis for this exploratory correlational study examining group empowerment capacity and empowerment in administrators and faculty within the United States. Empowerment was conceptualized as the ability of the group …

Acupuncture For Sleep Disturbances In Veterans With Post Traumatic Stress Disorder, Heather C. King Phd

Dissertations

Post Traumatic Stress Disorder (PTSD) has emerged as a significant problem among Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans. Disturbed sleep is one of the most frequently reported symptoms among OEF/OIF veterans with PTSD. PTSD itself is impairing, but the burden of this disorder is likely heightened when accompanied by sleep disturbances. Sleep disturbances have been associated with a 75-90% increased risk of co-morbid conditions, increased levels of depression and anxiety, daytime sleepiness and fatigue, reduced psychomotor performance, diminished work productivity, and decreased quality of life. These consequences of disturbed sleep emphasize the critical need for additional evidence based therapies …

A Descriptive Exploratory Study Of The Experience Of Gay Partners Of Hiv-Positive Men, Jon Christensen Phd, Msn, Rn

Dissertations

HIV disease/AIDS has been the focus of much research since its introduction in 1981 and continues to have profound implications for those living with the disease and for those who are in close social relationships with them. One group that has received minimal attention in the HIV/AIDS literature is gay partners of HIV infected men. The aim of this study was to explore and describe the experiences of gay men living with a life partner who has HIV disease/AIDS who were not primary caregivers. A qualitative study using an interpretive descriptive approach was employed to study the experiences of ten …

Effects Of Acculturation On Mammography Utilization Among Korean American Women, Jungeun K. Kim Phd

Dissertations

The purpose of this study was to examine the relationship between acculturation and mammography utilization among Korean American (KA) women. The specific aims of this study were to determine the differences in demographic characteristics, perceived health beliefs, self-efficacy, and knowledge of breast cancer, and mammogram history among the four cultural groups (American identity, Bicultural, Korean identity, and Marginality) of KA women, and to examine the effects of the level of acculturation on the likelihood of getting a mammogram. Breast cancer remains the most commonly diagnosed cancer among KA women. However, KA women consistently have lower screening rates for breast cancer. …

Compassion Fatigue: Prevalence Among Nurses At A Midwest Pediatric Hospital, Branch Carole

Dissertations

Compassion fatigue is a term used to describe the unique stressors affecting people in care-giving professions (Joinson in 1992). For nurses, the impact of compassion fatigue may result in stress-related symptoms, job dissatisfaction, decreased productivity, patient satisfaction, safety issues, and job turnover. The purposes of this non-experimental descriptive survey using electronic distribution to collect data were to identify the prevalence of compassion fatigue composed of burnout and secondary traumatic stress and compassion satisfaction among nurses and nursing staff who deliver direct patient care at the hospital and the relationship between demographic variables (age, work category, level of education, work experience) …

A Pilot Project To Develop A Tool To Assess Gain In Knowledge In Third Graders Participating In A Science Based Drug Prevention Education Curriculum, Miriam Dawn Butler

Dissertations

Drug use and abuse presents a significant problem to individuals, families, and law enforcement in communities across the United States. Methamphetamine is a particular concern in one rural eastern Missouri county. Much work is being done in this county by multiple agencies to decrease methamphetamine production and use. Little attention, however, has been focused on prevention in the elementary schools. Substance use and experimentation may begin as early as 12 years old or even earlier. By initiating a proven drug prevention education curriculum before children begin to experiment with tobacco, alcohol and illicit drugs, drug use may be delayed or …

A Comparison Of Medication Managemnt Between Older And Younger Adults Living With Hiv, Judy A. Frain

Dissertations

The aims of this study were to examine whether there are differences in medication management between older and younger adults living with Human Immunodeficiency Virus and to explore the relationship between age and personal factors including cognitive ability, depression and self-efficacy on medication management. The research utilized a descriptive-correlational, cross-sectional design to compare medication management between older and younger adults living with HIV and to describe differences in predictive factors of cognition, depression, and self-efficacy on medication management ability between older and younger adults living with HIV. Results indicate both older and younger adults have high rates of mild cognitive …

Move Montana: An Exercise Program For Children, Adolescents, And Their Families, Deanna Lynn Babb

Dissertations

Despite advances in medical science, the prevalence of obesity in the US has more than doubled in the last three decades, to over 72 million people (CDC, 2009). The purpose of this project was to pilot an exercise program that would increase physical activity in a group of adolescents and one of their parents or guardians. A convenient sample of 10 adults and eight adolescents returned surveys and exercised through the entire eight weeks (N = 18). Ten of the 18 participants (56%), six parents and four adolescents, reported increased frequency of exercise each week throughout the eight week period. …

Implementation Of Mental Health Screening In An Adolescent Health Care Clinic, Lisa Colleen Isenberg

Dissertations

The purpose of this project was to increase the awareness of adolescent mental health issues and emphasize the importance of screening for depression and suicidal ideations, to provide clinicians mental health screening tools, and to determine the barriers and challenges involved in performing mental health screenings in practice. This project implemented mental health screenings in an adolescent, urban, walk in health clinic and evaluated the mental health screening and implementation process from the patient and the provider perspectives and determined the resources needed for follow up. This practice evaluation project included a mental health screening on consenting 18-24 year olds, …

First Year Baccalaureate Nursing Program Outcomes: Effects Of Prerequisite Courses And Preadmission Testing, Sonya House

Dissertations

Schools of Nursing are faced with the difficult task of selecting students for admission into nursing programs. This responsibility is challenging as the number of students applying to programs typically outweighs the number of students who can be admitted. As a result, faculty must identify methods for selecting students who have the greatest likelihood of being successful. As noted in the literature, attrition that occurs as the result of being academically underprepared is found in the beginning of nursing programs (Murray, Merriman, & Adamson, 2008). The central research question represents the purpose of the study: To what extent do prerequisite …

Psychometric Properties Of Standardized Patient And Faculty Rater's Evaluations Of Pre-Licensure Nursing Student Competencies, Karen A. Macauley Phd, Dnp, Fnp-Bc, Gnp, Bc

Dissertations

The use of simulation as a teaching modality has been rooted in the military, aviation, space, and engineering for centuries (Bradley, 2006). Clinical simulation allows for training of healthcare providers that might be too costly, risky, or hazardous in the clinical setting (Bradley, 2006). A variety of simulation modalities are used including virtual learning, task trainers, mannequins, and standardized patients (SPs). External demands for improved accountability of clinical performance is requiring nursing educators to reevaluate methods of teaching and how we measure nursing competence (Nehring & Lashley, 2010). Standardized patients have been used in medical school curricula to teach and …

Risk-Appropriate Maternal Care: Identifying Risk Factors That Effect Maternal Outcome, Lucy R. Van Otterloo Phd, Msn, Rnc, Cns

Dissertations

Although maternal deaths are the most tragic of obstetric events it continues to be a rare event. Maternal morbidity, on the other hand, is increasing and poses a greater impact on the economic, psychological, and physical health of the woman and her family, yet it has not been the focus of measurement or research since there is no systematic collection of data available. As complications increase, the likelihood of adverse maternal outcomes such as longer postpartum stays due to the need for more extensive care will also increase. Nurses are being challenged to use their knowledge and skills to identify …

Nursing Students' Attitudes Toward Science In The Nursing Curricula, Jill Deanne Maroo

Dissertations

The nursing profession combines the art of caregiving with scientific concepts. Nursing students need to learn science in order to start in a nursing program. However, previous research showed that students left the nursing program, stating it included too much science (Andrew et al., 2008). Research has shown a correlation between students’ attitudes and their performance in a subject (Osborne, Simon, & Collins, 2003). However, little research exists on the overall attitude of nursing students toward science. At the time of my study there existed no large scale quantitative study on my topic. The purpose of my study was to …

Perceptions Of Workplace Bullying Among Practicing Registered Nurses, Crystal Regina Threadgill

Dissertations

Workplace bullying (WPB) is a social and organizational problem. Within the health care arena, employees, particularly registered nurses, are at risk. WPB has several adverse effects and has been cited in the literature as closely associated with burnout and nurses leaving their positions. This quantitative study examined workplace bullying among practicing registered and its relationship with burnout and nurses’ intent to leave their current position.

The surveys utilized were the Negative Acts Questionnaires-Revised (NAQ-R), Maslach Burnout Inventory Survey, Intention to Turnover Scale and a demographic survey. Of the surveys distributed, a total of 185 were returned from one selected hospital …

Toward A Model For Predicting Depression Among Veterans, Nita Aurora Magee-Cornelius

Dissertations

Major depression, identified as a leading cause of disability in the United States, is often first diagnosed by primary care providers. This disability is associated with increased morbidity, mortality, and a lower quality of life. With approximately one in every three veteran diagnosed with depression and the rate of suicide increasing in the United States military (Department of Veterans Affairs, 2009), the Patient Health Questionnaire-2 items (PHQ-2) can be instrumental in identification and monitoring of depressive symptoms. The purposes of this retrospective study were to determine the prevalence of depression, as measured by the federally mandated PHQ-2 in the VA, …

The Impact Of Technology Attitudes And Skills Of Rural Health Clinic Nurses On The Level Of Adoption Of Electronic Health Records In Mississippi, Jennifer Lynn Styron

Dissertations

The evolution of health information technology continues to reform the delivery of efficient, safe, and equitable healthcare in the United States. One such example is the emergence of electronic health records (EHRs) and the discerning emphasis placed on using this technology in meaningful ways. While the integration of EHRs into daily practice impacts all healthcare professionals, nurses remain a prominent driver in the successful adoption and usage of these systems. It is therefore imperative to understand the impact of nurses’ technology attitudes and skills on the level of EHR adoption in Mississippi.

This quantitative study examined the technology attitudes and …

Nutritional Status Of Patients With End Stage Liver Disease: An Outpatient Assessment, Anna Marie Cumming-Browne Hefner Phd, Msn, Cpnp, Rn

Dissertations

Cirrhosis is the 12th leading cause of death in the United States. It is well documented end stage liver disease drives a patient to a catabolic state thus depleting them of essential nutrients. Malnutrition is often unrecognized and untreated in outpatients. Though BMI, nutritional intake, anthropometric measurements have been used in clinical trials, there still remains no standard nutritional assessment. The purpose of this dissertation was to (1) identify the incidence of malnutrition in patients with compensated and decompensated liver disease utilizing defined nutritional parameters (Subjective Global Assessment, anthropometric measurements, hand grip strength, and laboratory values) and (2) correlate with …

Description Of Medical-Surgical Nurses Care Of Patients At Risk For Pressure Ulcers, Barbara Jean Mayer Phd

Dissertations

Aim: The purpose of this qualitative study was to explore and describe the level of understanding of PU development and prevention and perceptions of implementing PU prevention measures in nurses caring for patients in medical-surgical units. Method: The study was conducted in three (3) community hospitals within the same healthcare system using an Interpretive Description approach. Six (6) focus groups were conducted including thirty (30) participants. Findings: Participants described their knowledge of PU development and prevention as good and perceived continuing education as important in maintaining knowledge levels. Two (2) methods of identifying patients at risk for PU development were …

A Case Study Exploring Restraint And Seclusion Use In School-Age Children On An Inpatient Psychiatric Unit, Michelle Buckman Phd

Dissertations

Perceptions of children restrained and secluded (R&S) were explored using Yin's methodology and critical theory. The literature presented reviewed proponent's and opponent's views of the R&S intervention used on inpatient psychiatric units for the containment of violent patients. Despite reports of physical and emotional injury to staff and patient during restraining and secluding children, the intervention is still in use. Using Machover's framework, a semi-structured interview and drawings were used to illicit information from a 12 year old boy about his perceptions of R&S. Then, a presentation of barriers to conducting research is made. Results of the child's perceptions included …

Determinants Of Health-Related Quality Of Life In Arab American Patients With Type 2 Diabetes, Yousef Zakarni Phd

Dissertations

HRQL is an important aspect of chronic illnesses such as diabetes and needs to be considered by healthcare providers. It is one of the most important outcomes of healthcare interventions, representing an integral public health goal in Healthy People 2000, 2010, and 2020. Arab Americans (AAs), one of the most rapidly growing minorities in United States, tend to have a high prevalence of type 2 diabetes. The purpose of this study was to describe determinants of HRQL, including social support attitude, religiosity, and select demographics for AA patients with type 2 diabetes. A descriptive correlational study using a cross sectional …

Developing A Clinical Nurse Leader Practice Model: An Interpretive Synthesis, Miriam Bender Phd

Dissertations

Objective: The Institute of Medicine's Future of Nursing report identifies the Clinical Nurse Leader (CNL) as an innovative and necessary new role for meeting higher healthcare quality standards. The American Association of Colleges of Nursing CNL White Paper defines core competencies necessary for practice. The literature documents preliminary evidence of improved outcomes associated with CNL integration into clinical microsystems. However, the CNL role is not yet clearly defined in terms of fundamental activities and responsibilities necessary to produce outcomes. Lack of practice clarity limits the ability to articulate, implement, and measure CNL-specific practice and outcomes. The purpose of this study …

Elevated Blood Glucose Levels In The Emergency Department: Missed Opportunity For Informing And Referring, Melissa D. Rouse Phd, Rn, Cns-Bc, Cen, Hacp, Cphq

Dissertations

The purpose of this research was to examine (1) the rates of elevated blood glucose ≥ 150 mg/dL in adults without a prior history of diabetes, receiving care for a non-diabetes related visit to the ED and (2) Emergency Department provider patterns for informing and referring discharged Emergency Department patients for follow-up of elevated random blood glucose levels. A descriptive, correlational, cross-sectional design, with purposive sample was used. Retrospective chart review was done for patients age 18 and older, treated in two EDs from March 1, 2010 through March 22, 2010. Significant relationships were found between blood glucose level and …

Relationship Of Internet-Delivered Mantram Repetition Program To Burnout, Stress Of Conscience, Spiritual Wellbeing, And Mindfulness In Healthcare Workers, Sheryl Leary Phd

Dissertations

This study evaluated the effect of the Mantram Repetition Program (MRP), an internet-delivered stress management course on burnout, stress of conscience, spiritual wellbeing, and mindfulness on a self-selected group of healthcare workers (HCWs). A quasi-experimental repeated measures design was used. Participants enrolled in a six-session MRP delivered over three months and completed baseline, post-course, and three-month post-course assessments. Measurement tools included the Maslach Burnout Inventory-General Survey (MBI-GS), the Stress of Conscience Questionnaire (SCQ), the Functional Assessment of Chronic Illness Therapy Spiritual Wellbeing Scale (FACIT-12), and the Mindfulness Awareness Attention Scale (MAAS). Statistically significant effects of the MRP showed a decrease …

Emergency Nurses' Knowledge, Attitudes And Preventive Practices Regarding Firearms And Firearm Injury Prevention For Children, Dorothy Ann Gomez

Dissertations

In 2010, there were 134 deaths attributed to unintentional firearm injuries of children under 19 year and 3,019 nonfatal injuries (CDC, 2011). Nurses are expected to identify potential dangers in the community and protect those at risk. It was found that there is limited research on the effectiveness of current firearm injury prevention practices of nurses. The study was designed to examine the knowledge, attitudes and practice characteristics of Emergency Nurses toward firearm prevention practices. A convenience sample of 189 emergency nurses completed a voluntary, anonymous survey on practices regarding childhood gun safety. Seventy-one percent of respondents agreed that firearm …

Risk Perception In Cardiovascular Disease, Michelle Ellen Block

Dissertations

Cardiovascular disease (CVD) remains among the leading causes of death in the United States despite widespread knowledge about risk factors as well as effective primary prevention strategies. Risk perception is a complex phenomenon that plays an important role in how persons view disease and ultimately how they make health behavior choices. This study is supported by the knowledge that few studies have examined how persons perceive cardiovascular risk or the variables thought to contribute to the formation of risk perception.

Purpose: The purpose of this study was to examine how accurately persons perceive personal risk for cardiovascular disease and identify …

Opening The Black Box: Understanding Adult Inpatient Falls, Laura M. Rogers

Dissertations

Within the United States, falls are the largest category of adverse events reported in hospitals. Injuries associated with falls include increased costs, extended length of stays, increased mortality and morbidity, and liability to hospitals. The purpose of this study was to discover, describe, and systematically analyze universal and diverse care meanings and expressions of adults experiencing a fall while hospitalized. The research was conceptualized with the ethnographic theoretical framework of Culture Care Diversity and Universality (Leininger 2001, 2006). Data collection took place in a large academic medical center, over a five month period and included 24 participants: eight adult inpatients …

Caregivers Of Older Adults: Burden, Perception Of Strain, And Health, Juana Ferrerosa Phd, Msn, Rn, Phn

Dissertations

Background: By the year 2030, the older population in the United States is projected to double from 35 to 70 million. Consequently, increasing the number of informal caregivers required to care for an aging population. Research suggests that levels of caregiver strain and their ability to cope can impact the health of caregivers. Tsai's (2003) Middle-Range Theory of Caregiver Stress guided this study and was modified to present an innovative approach which used perceived caregiver strain as a specific stressor in the Control Process of the model; it provided a basis for examining caregiver strain and its effect on the …