Medicine and Health Sciences Commons^™

Perception Of Pediatric Readiness Across A Health System's Emergency Departments, Rebekah L. Sabo

Doctoral Dissertations

The recent pandemic and pediatric respiratory syncytial virus surge have reinvigorated pediatric care readiness conversations. National strategies and associations exist to guide health systems in improving the quality of emergency care offered to pediatric populations by first assessing readiness for care. These research strategies center on survey implementation and staff engagement in general emergency departments with the goal to improve staff readiness to care for pediatric patients that may present for treatment. What impact would developing a consolidated pediatric readiness program that includes: pediatric emergency care coordinator designation for each emergency department, pediatric readiness education and committee engagement have on …

A Grounded Theory Of Patient Flow Management Within The Emergency Department, Ellen Benjamin

Doctoral Dissertations

Background: Emergency department (ED) crowding is an urgent threat to patient safety and negatively impacts healthcare staff and institutions. Patient flow researchers have employed a range of methods to address this crisis, including an increase in the use of operations research and operations management strategies. However, identified patient flow solutions are inadequate. Research describing the complexities of patient flow processes and investigating the work and contributions of ED nurses is needed. Purposes: The purposes of this study were to explore how ED nurses perform patient flow management and to develop a constructivist grounded theory of patient flow management within the …

The Meanings Of Daily Activities And Attitudes Of Older Breast Cancer Survivors: A Case Study Research, Wadha Alquraini

Doctoral Dissertations

Objectives: The aim of the study was to explore how older breast cancer survivors made meaning from daily activities and their attitudes to life and behaviors in it. Method: Secondary data was analyzed from nine older women with breast cancer. Data on living women was used to elicit the influence of breast cancer on survivors' attitudes and behaviors. Results: Eight significant themes were identified that were related to breast cancer meanings, attitudes to it, and behaviors that impact participants' survivorship; breast cancer means death or being close to death, survivor-provider relationships, social support, the meaning of dignity or …

Improving Adherence To Annual Retinal Screening Among Adult Diabetics In Rural Midwest, Sarah Hunger

Doctoral Dissertations

Background: Diabetic retinopathy (DR) affects millions of people worldwide and is a main cause of preventable blindness. Experts recommend annual retinal screenings on all diabetic patients. Studies show continuing trends of non-adherence, as well as significant barriers to screenings. Recommendations to overcome barriers and methods to improve adherence among diabetics are topics of interest among healthcare providers. The purpose of this project was to increase annual retinal screening adherence among adult diabetics at a privately owned primary care practice in the rural Midwest.

Methods: Staff and 59 patients, chosen through convenience sampling were involved. Pre- and post- implementation surveys were …

Mental Health Burden And Attitudes And Intention To Seek Mental Health Services In Saudi Women Living In The United States, Wjdan A. Almutairi

Doctoral Dissertations

Background: The number of Saudi nationals immigrating to the U.S. continues to increase. Saudi women immigrants may be at increased risk for mental health disorders, including depression and anxiety, due to immigration-related stressors such as language difficulties, family separation, and cultural adjustment. Purpose: The purpose of this study was to measure anxiety and depression levels in Saudi women living in the U.S. and to assess factors affecting their intention to seek mental health services in the U.S. Methods: A descriptive cross-sectional design was employed, using online self-reported surveys. The study included a convenience sample of 160 Saudi women living in …

Identity Formation And Role Expansion For Nurse Practitioner Residency Preceptors: A Qualitative Thematic Analysis, Angel Chen Kuo

Doctoral Dissertations

Employer-based nurse practitioner residency programs have been implemented to address the significant shortage of primary care providers in the community clinic settings. However, there continues to be a shortage of clinicians who serve as preceptors to nurse practitioner residents and students. Preceptors, also referred to as clinician educators, are essential in the training of learners and their socialization into the profession. Just as there is a shortage of clinicians of diverse backgrounds to reflect the population served in the community, there is also a significant shortage of preceptors of color to train learners from diverse backgrounds. The purpose of this …

Addressing Interprofessional Competence In Interpretation Of Electronic Fetal Monitor Tracings, Susan H. Hébert

Doctoral Dissertations

Interpretation of electronic fetal monitor (EFM) tracings is a critical clinical practice skill nurses and physicians perform during the intrapartum stage of pregnancy. However, if performed inaccurately can potentially jeopardize the well-being of the neonate. This risk is present because if concerning EFM tracings are not interpreted accurately, preventative care interventions to promote the well-being of the unborn child do not occur. The project was initiated by completing a scoping literature review on the methods for training and evaluating EFM interpretation competence, which revealed current EFM interpretation training and evaluation methods are lacking. A concept analysis defined nurse competence in …

The Lived Experience Of Losing Employment After Diagnosis With Dementia: A Phenomenological Analysis, Susan K. Blaine

Doctoral Dissertations

The purpose of this study was describing the experiences of people with dementia (PWD) who lose their employment after diagnosis with dementia, but sooner than originally planned. A phenomenological approach based on tenets of Maurice Merleau-Ponty was used. Six telephone interviews were conducted, with participants sharing their experiences. Transcripts were transcribed verbatim, and subsequently analyzed via a hermeneutical analysis approach. Themes were identified within and between transcripts, considering the contextual grounds of Merleau-Ponty’s phenomenology: body, others, time, and world, and the contextual ground of participants’ experience: the stigma of dementia. An overarching, central theme of “still working” was identified across …

Use Of A Checklist As A Decision Support Aid For Heart Failure Assessment And Management, Maryann Hogan

Doctoral Dissertations

Heart failure is a serious chronic health problem requiring ongoing management to control disease progression. Consequences of inadequate heart failure management include acute exacerbation, worsening baseline status, and possibly death. Nurses play a key role in surveillance of patients with heart failure and in management of their condition as part of the interprofessional health care team. During episodes of acute decompensation of heart failure, nurses must be able to detect onset of signs and symptoms, initiate appropriate nursing interventions promptly, and communicate with the provider and other team members as needed. Although heart failure is a common health problem in …

Physical Activity, Daily Step Counts And Functional Ability In Older Adults: Using Nhanes Database, Chunfang(Maggie) Chen

Doctoral Dissertations

Maintaining functional ability and independence are essential in the healthcare of older adults. Physical activity(PA) has been acknowledged as effective and economical health promotion strategies in older population. However, the amount of PA needed to maintain functional ability in older adults remains unclear. This investigation used PRISM Dose-response Curves Stimulation Variable slope model to explore the relationships between the amount of PA and functional ability in community-dwelling young-old, middle-old and old-old age group adults. ANOVA analysis was used to examine the relationship between functional ability and self-perceived active level changes compared to 10 years ago. NHANES 2005-2006 older participants datasets …

Formalized Diabetes Education In A Safety-Net Clinic, Haley N. Wanic

Doctoral Dissertations

Uncontrolled diabetes mellitus in a Hispanic population can be helped through a quality improvement project focused on progressive verbal and written diabetes self-management education (DSME) Purpose of this article is to review the background, an organizational assessment, a literature review, results of the quality improvement project that took place at a safety-net clinic in the Midwest. This project included four patients and data was analyzed through descriptive statistics. Results include improved hemoglobin (Hg) A1c, minimal workflow adjustments for providers, completed microalbumins, and written education given to patients. In conclusion, the quality improvement project showed positive trends in outcome measures over …

Improving Patient Portal Enrollment Through Education And Technology At Rural Family Practice, Kelsey Crampton

Doctoral Dissertations

Background: Patient portals are available through many healthcare offices. They offer the opportunity to improve patient engagement and quality of patient care, but few patients enroll. At a small rural primary care office, less than 20% of the patients were enrolled in the patient portal.

Objective: The purpose of this quality improvement project was to address the barriers reported by patients at this clinic and determine whether changes in portal enrollment volume occurred. Reported barriers included a lack of knowledge about the portal and difficulties with the sign-up process.

Methods: Over three months, strategies included the development of a …

Reducing Delirium And Functional Decline In Hospitalized Older Adults: Pre-Implementation Of Cocare Help, Thomas D. Finn, Autumn Baldwin, Elizabeth Hill

Doctoral Dissertations

Background: Delirium is a change in consciousness characterized by rapid onset and fluctuating attention, causing impairment in the ability to process and recall information, occurring in 30% of hospitalized older adults. Delirium can increase falls, length-of-stay, mortality, and cost. The CoCare Hospital Elder Life Program® (HELP) is an evidence-based bundle of interventions targeting cognitive impairment, sleep deprivation, immobility, visual/hearing impairment, and dehydration, embedding geriatric principles in care to prevent delirium.

Objectives: To further analyze the pre-implementation of the HELP in order to optimize success of program administration.

Methods: Mixed methods were used to collect retrospective/prospective data (interviews (N=25], surveys [N=25], …

The Experiences And Needs Of Individuals With A Variant Of Uncertain Significance (Vus) On Genetic Tests For Hereditary Cancer Syndromes: A Grounded Theory Study, Danielle Gould

Doctoral Dissertations

Background: The use of multigene panel testing for identifying individuals with hereditary cancer susceptibility has expanded in recent years. The number of individuals who have a variant of unknown significance (VUS) result is increasing. However, little is known about the experiences and needs of this group. This study’s purpose was to describe the experiences and needs of individuals with a VUS result by focusing on their experiences in communicating with healthcare providers and family members. Methods: A constructivist grounded theory approach was used. Recruitment took place from January–July 2021 through social media: the Prospective Registry of Multiplex Testing (PROMPT), and …

The Use Of Simulation With The School Of Nursing And Health Professions (Sonhp) Prelicensure Students To Support Affirming Practice With Transgender Communities, Genevieve Charbonneau

Doctoral Dissertations

This dissertation investigates how prelicensure nursing students are prepared to address healthcare disparities with transgender patients, specifically through simulation scenarios at the University of San Francisco School of Nursing and Health Professions Simulation Center.

A critical review of current literature reveals how microaggressions against transgender communities create and sustain barriers to equitable healthcare. The qualitative study was designed to explore the lived experience of prelicensure nursing students who are actively seeking to understand the healthcare needs of transgender patients in the San Francisco Bay Area.

This was a qualitative research study including data that suggests that using simulation scenarios featuring …

The Psychosocial Experiences Of African American Sexual And Gender Minority Caregivers Of People With Dementia, Lakeva Harris

Doctoral Dissertations

Over 50 million people in the United States provide unpaid care to a family member or friend. One-third of these caregivers (16 million) provide care to someone with Alzheimer’s disease and related dementias (ADRD). Of these caregivers, more than 20% state caregiving has led to a decline in their health. African American caregivers are less likely to report being in very good or better health than their white caregiving peers. Similarly, lesbian, gay, bisexual, transgender, and/or queer (LGBTQ) caregivers are more likely to report fair or poor health than their heterosexual, cisgender peers. The overlap of these minoritized identities may …

Examining A Fatigue Management Model That Identifies Risk Factors And Consequences Of Fatigue In Older Individuals, Maral Torossian

Doctoral Dissertations

Fatigue is experienced by 40-74% of older individuals living with a chronic disease. Despite advances in scientific knowledge around risk factors and consequences associated with fatigue, a comprehensive model that can serve as a guide for healthcare providers caring for older individuals with fatigue is lacking. Thus, the purpose of this study was to examine a fatigue model based on the Theory of Unpleasant Symptoms (TUS). The model included psychological, physiological, and situational risk factors of fatigue, as well as fatigue outcomes, such as physical, social, and cognitive performances, perceived health, and quality of life (QOL). This was a secondary …

Psychosocial Effects Of Providing Nursing Care To Patients From A Multi-Casualty, School-Associated Shooting Event, William Travis Mccall

Doctoral Dissertations

Secondary traumatic stress describes symptoms consistent with post-traumatic stress disorder but that result from witnessing or experiencing the trauma of another individual through a helping relationship. The associated symptoms include intrusions, avoidance, and hyperarousal. Secondary traumatic stress is also associated with the development of compassion fatigue and burnout. The current state of the science identifies that secondary traumatic stress may affect those nurses who provide care to critically ill or injured patients. Research has most commonly examined the prevalence of secondary traumatic stress, compassion fatigue, and burnout among nurses in emergency department settings. While attention is frequently given to the …

Perseverance: A Focused Ethnographic Study Of The Emergency Triage Nurse, Ellen C. Smithline

Doctoral Dissertations

Introduction: The emergency triage process is not meeting the needs of the patient or the healthcare team. Current and past research has focused primarily on the emergency triage nurse’s ability to accurately designate the triage acuity score, while largely ignoring the impacts of the complex and dynamic environment in which they are immersed. Therefore, the purpose of this study was to describe the factors that influence the decision-making process of the emergency triage nurse (ETN). Method: This was a focused ethnographic study that included four phases. Phase 1 was the grand tour of the emergency triage and waiting room area. …

Nurse-Delivered Shoe-Lacing Intervention: Effect On Comfort And Toe Pressures For Active Community-Dwelling Adults (Age 65+), Mary C. Clayton-Jones

Doctoral Dissertations

Significance: Problems with shoe fit are endemic, affect gait and balance and lead to falls. Falls are physically, emotionally, and economically costly. Low-cost, easily implemented interventions, that reduce pain and improve balance meet the “triple aim” of the Institute for Healthcare Improvement. Purpose: Evaluate the impact on community-dwelling adults (65+) of two nursing interventions involving foot repositioning and shoe relacing. Outcome measures: Toe pressures, experiences of pain and comfort. Method: Repeated-measures, mixed-methods lab-based study. Walk #1 Control. Intervention #1, participant’s heel secured to back of shoe, the participant’s chosen lacing pattern snugged. Intervention #2, heel secured to back of …

Hospital Assessment And Response To Environmental Pollution As A Population Health Need: Identifying Prevalence And Predictors In Community Benefit Practices, Sarah Valentine

Doctoral Dissertations

Hospitals have a growing role in improving population health. Environmental pollution is an important determinant of health with disproportionate effects on Communities of Color. This warrants hospital action. To advance such action, it is important to take stock of current hospital engagement with environmental pollution and to identify factors associated with such engagement. I investigated the following. To what extent do New York State (NYS) non-profit hospitals assess, identify, and respond to environmental pollutants as part of community benefit practices? Do factors previously reported as associated with hospital engagement of social determinants predict engagement with environmental pollution as a community …

Perceptions And Experiences Of Adopting A Technology Based Intervention For Alcohol Screening And Referral To Treatment In Primary Care, Sonya L. Lachance

Doctoral Dissertations

Alcohol abuse is a significant concern in the United States. Today in the U.S., 15.1 million adults ages 18 and older, have been identified as having an alcohol use disorder. Alcohol abuse and binge drinking are highest amongst college students. More than 58.0 percent of college students admit to regular binge drinking or heavy alcohol use every month. Left unaddressed, this leads to negative health consequences later in life. The United States Preventive Services Task Force states that there is strong evidence that screening patients in primary care can reduce alcohol use disorder. Though screening, brief intervention, and referral to …

Older Women’S Experiences Of Intimate Partner Violence: A Phenomenological Study, Lourdes Irene

Doctoral Dissertations

Intimate partner violence (IPV) is a global public health problem, linked to long-term health, social, and economic consequences. Despite the growing number of women over age 60 in Puerto Rico, knowledge is lacking about culturally specific IPV in women of this age group. This lack of knowledge is problematic because women experiencing abuse often do not report it, health professionals are not educated to identify cases of abuse in older women, and researchers often includes IPV with other types of abuse, such as negligence by families. Therefore, the purpose of this study was to explore and describe the experiences and …

The Lived Resettlement Experience For Single Refugee Mothers From The Democratic Republic Of Congo, Lauren Michelle Mefford

Doctoral Dissertations

At least 72% of the 50,000 Congolese refugees resettled in the USA in the last 5 years are women and children. Many are single refugee mothers (SRM) disadvantaged by obstacles (i.e., childcare) that hinder them from becoming self-sufficient within the required timeframe post-resettlement. Published research on resettlement has focused general challenges, but an understanding of the unique needs and perspectives of SRMs is lacking. This phenomenological, qualitative study provides insight into the lived resettlement experience for SRMs from the Democratic of Congo (DRC). Participants (n=7) were recruited from a refugee resettlement agency in East Tennessee and partook in open-ended, unstructured …

Fall Risk Factors Among Hospitalized Older Adults With Alzheimer’S Disease And Related Dementias, Jean Bettencourtt Sconza

Doctoral Dissertations

Falls are a common and devastating complication of hospital admission for older adults. Falls are especially significant for those with Alzheimer’s Disease and related dementias (ADRD) as they are at high risk to fall and to suffer injuries from falling. Despite the large body of research on falls in hospitals, less is known about fall risk factors among patients with ADRD. The purpose of this retrospective case-control study was to determine which risk factors are predictors of falls among hospitalized older adults with Alzheimer’s disease and related dementias (ADRD) by comparing those who fell with those who did not fall. …

Mediation And Moderation Of Sleep In Arthritis Fatigue, Jean L. Cody

Doctoral Dissertations

Fatigue is a highly prevalent symptom for older adults with arthritis. Fatigue is a concerning symptom as it is associated with decreased activity and exacerbates co-morbid conditions. Physical activity and sleep quality have been shown to influence arthritis fatigue. However, the relationship between physical activity and sleep quality over time has not been clearly identified. The purpose of this pilot study was to examine the relationship between physical activity, sleep and arthritis fatigue. This study examined the direct effects and the mediation and moderation of sleep upon fatigue. The study utilized an experimental, longitudinal repeated measures design using mediation and …

Core Content Items And Constructs To Inform Student Nurse Handoff Communication, Kelley Mcafee

Doctoral Dissertations

This study describes nurse educators’ perceptions of content items for a high-risk, high frequency process essential for entry as a nurse generalist into clinical practice. The process of interest is student nurse handoff communication. Research Questions:

1. What do nurse educators identify as core content for successful student nurse handoff communication?
2. Do nurse educators identify with one handoff communication tool for student use?
3. Are student nurses expected to engage in nurse handoff communication during simulation experiences and/or clinical experiences?
4. What educator characteristics are associated with his/her perceptions of the core content?

Geographical Disparity Of Adverse Childhood Experiences And Chronic Diseases In Saudi Arabia, Fahad Alhowaymel

Doctoral Dissertations

Background: Adverse childhood experiences (ACEs) have been linked to numerous negative physical and mental health outcomes and have been shown to increase risk for chronic diseases in adulthood. In Saudi Arabia, few studies have examined ACEs prevalence and their relation to chronic diseases across geographical settings. Purpose: The purpose of this study was to examine ACEs prevalence and association with chronic diseases across the provinces of Saudi Arabia, and to determine the moderating effect of geographical setting on the ACE-chronic disease relationship. Methods: A cross-sectional design was used with an existing Saudi national dataset from the National Family Safety Program …

Use Of Stay S.A.F.E. Strategy During Medication Administration In Reducing Errors, Cidalia J. Vital

Doctoral Dissertations

Healthcare related medical errors are the third leading cause of death in the United States. Interruptions and distractions can lead to an increased risk of nurses making errors in healthcare, particularly during medication administration. Student nurses should receive education during their prelicensure period on the management of interruptions especially before being given the responsibility of performing high risk tasks such as medication administration. Using a novel interruption management strategy called Stay S.A.F.E., nursing students were interrupted during a simulated medication administration. Students were evaluated on the time spent on the task and if errors were committed. Lastly, perceived workload was …

Extraction And Analysis Of Data For Fragility Fracture Patients To Help Determine The Likelihood Of Follow-Up With A West Michigan Fragility Fracture Service, Michael Joseph Lamphere

Doctoral Dissertations

Fragility fractures and secondary fractures are a large physical, financial, and emotional drain on the individuals and families affected. Improving post fragility fracture care and increasing follow-up rates with specialty services, such as a fracture liaison service, may promote post-fracture recovery and help prevent future fractures. The purpose of this doctoral project was to increase and improve post osteoporotic fracture care by increasing appropriate referrals and follow-up care. Patient data was retrieved and analyzed on 60 fragility fracture patients referred to a local fracture liaison service. The analysis found that patient gender, fracture site, and history of a previous fracture …