Medicine and Health Sciences Commons^™

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

Dissertations

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

Targeting Loneliness In Older Adults With Weekly Socialization, Tanja Johnson

Dissertations

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

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

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

Dissertations

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

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

Dissertations

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

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

Dissertations

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

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

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

Dissertations

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

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

Acute Agitation Intervention Tool For Reduction Of Polypharmacy, Brooks J. Propst

Dissertations

Introduction: Patients with behavioral health diagnoses are among the highest risk for
aggression. For pediatric patients with behavioral health needs, urgent treatment is
needed for aggressive behavior, due to the potential unwanted outcomes. The purpose of this Quality Improvement (QI) pilot project was to implement an Acute Agitation Intervention Tool that uses the Broset Violence Checklist (BVC) to guide
pharmacological intervention for mild and moderate to severe agitation in pediatric
patients with behavioral health needs ages 8 to 18 to decrease the number of medications that patients are getting per agitation event over a 12-week period.

Methods: This QI included …

Evaluation Of A Substance Abuse Screening Tool In The Pediatric Emergency Room, Jody Sims

Dissertations

Abstract

Background: Substance abuse among adolescents is one of the most serious social health problems in the United States. The prevalence of alcohol use in adolescents is as high as 80%, while opioid overdose deaths among adolescents have risen by greater than 50% in the last 10 years. Alcohol, tobacco, and other substance use has also increased among youth and is not being properly evaluated in the pediatric hospital setting. The purpose of this project was to evaluate the use of a substance abuse screening tool with SBIRT trained staff in the pediatric emergency room setting.

Methods: The CRAFFT substance …

Effects Of Resilience Coaching On Behavioral Health Nurse Burnout, Dalila Franklin

Dissertations

Abstract

Background: Inpatient, staff nurse burnout negatively impacts nurses’ mental and physical health, hospital nurse retention and turnover, and patient care. The Stress First Aid for Health Workers program attempts to bolster resilience and subsequently reduce burnout among mental health nurses in this project.

Method: This quality improvement (QI) project was an observational pre-post survey design and was conducted on a cohort sample of inpatient, behavioral health nurses at an urban, mid-sized, Midwestern hospital psychiatric unit to assess personal, work-related, client-related, and overall burnout utilizing the Copenhagen Burnout Inventory (CBI) tool to quantitatively measure burnout pre- and three months post-implementation …

Fall Prevention Among Older Adult Behavioral Health Patients, Jodie Shipley

Dissertations

Abstract

Problem: Inpatient falls are a major patient safety issue. Behavioral health units experience higher rates of falls among elderly patients with between 13.1 to 25 falls per 1,000 occupied bed days (OBD). The risk of falls for the aged population is increased on a psychiatric unit due to a myriad of issues including psychotropic medications, over-activity on the unit, and confusion (Wong & Pang, 2019).

Methods: This QI project is an observational descriptive pilot intervention evaluation of a redesigned fall prevention program with the aim to reduce falls on a midsized suburban Midwestern inpatient geriatric behavior health …

Evaluating Sbirt In A Behavioral Health Urgent Care, Christina L. Williams

Dissertations

Background: Adolescent substance use (SU) is a major health concern. Most youth who engage in alcohol and other SU do not meet criteria for SU disorder (SUD). Nonetheless, evidence shows SU during adolescence impacts cognitive, social, and emotional development, increases risk of physical injury, and may progress to SUD in adulthood. Only half of clinicians properly screen adolescents for SU; those identified with SUD often receive no intervention. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based intervention to address this problem. The purpose of this project was to evaluate implementation of SBIRT using CRAFFT 2.1+N, a SU …

Education To Improve Long-Acting Injectable Antipsychotic Use, Travis Donald Wolfangel

Dissertations

Purpose: Long-acting injectable (LAI) antipsychotics are underutilized as an evidence-based treatment for schizophrenia and schizoaffective disorder. The purpose of this quality improvement project was to determine if a web-based LAI education module changed advance practice prescribers’ knowledge, attitudes, and practice behaviors regarding LAI antipsychotics one month after receiving LAI education at a community-based mental health organization.

Methods: This QI project was an observational pre- post-educational design. The 20-item Knowledge, Attitudes, and Practices (KAP) questionnaire was used to assess advanced practice providers’ knowledge retention, attitude changes, and practice modifications regarding LAI antipsychotics and prospective patient chart reviews were performed. …

An Evaluation Of Mindstrong™ Implementation With Graduate Nursing Students, Angela B. Sabblut

Dissertations

Problem: Nursing graduate students are at increased risk of greater stress, anxiety, and depression (Hoying, 2020; Melnyk et al., 2020). Cognitive Behavioral Therapy is the gold standard in the treatment of anxiety and depression (Hoying et al., 2020; Melnyk et al., 2015; Melnyk et al., 2020). MINDSTRONG™, a CBT-based training program, has been proven in many studies to be effective in helping individuals prevent or cope with these issues (The Ohio State University College of Nursing, 2020).

Methods: This Quality Improvement (QI) project was a descriptive-observational, pre-post design. Sample and setting were nursing graduate students from a Midwestern, middle-sized urban, …

Evaluating Mindfulness On Loneliness In An Older Adult Population, Jessica Tieskoetter

Dissertations

Problem: Loneliness is a widespread public health concern and has negatively impacted mortality and health outcomes among older adults. This quality improvement project’s purpose was to evaluate mindfulness on loneliness and quality of life among adults aged 65 years and older, participating in a weekly befriending socialization program.

Methods: A descriptive cohort design was utilized to assess loneliness pre-and post-implementation of a mindfulness telephone line over three months. A convenience sample of 22 older adults enrolled in a befriending socialization program was used. The Iowa Model of Evidence-Based Practice framework was applied to guide the implementation of a practice change …

Evaluating The Effectiveness Of Implementing Depression Screenings With Uninsured African American Adults, Pamela Talley

Dissertations

Problem: Uninsured African Americans are underdiagnosed and often untreated for depression. Individuals usually do not present to their primary care provider with a complaint of depressed mood, however, may report symptoms such as decreased energy, general body aches, digestive concerns, somatic complaints, or older adults' memory or cognitive problems. The purpose of this quality improvement pilot project was to examine the results of the implementation of a depression screening (PHQ-9) in a primary care setting for uninsured adults for detection, diagnosis, and treatment of depression in African American clients.

Results: The PHQ-9 screening questionnaire was given to 100% (N …

Readmit Clinical Risk Index: Identifying Risk Factors To Reduce 30-Day Psychiatric Readmissions, Victoria Faulkner

Dissertations

Abstract

Problem: There has been a growing concern in the past decades over the increase in community-based adults who require readmission to psychiatric care shortly after discharge. It is estimated that nearly half of discharged psychiatric patients will be readmitted within twelve months after discharge. This has been primarily attributed to the absence of screening tools and resources to assists behavioral healthcare providers in identifying socio-demographic factors contributing to readmissions. Screening tools like the READMIT Clinical Risk Index identify patients at risk for psychiatric readmission. This quality improvement project aims to identify socio-demographic factors that lead to 30-day readmission …

Minimizing Workplace Violence By Initiating An Evidence-Based Community Meeting, Olivia Gabrielle Foster

Dissertations

Problem: Workplace violence (WPV) in healthcare has become an epidemic demanding change. WPV is three to four times higher in the healthcare industry compared to other workplaces. For this project, WPV will be defined as any act of physical violence from a patient to a staff member. Community meetings are one evidence-based approach to decreasing WPV in psychiatric inpatient hospitals. Methods: This descriptive observational project compared data before and after implementing a targeted WPV community meeting, including unit rules, staff and patient expectations, a definition of WPV, and medication options available to reduce anxiety and irritability. This project …

Rural Pregnant Women’S Experiences With Substance Use Disorder: A Qualitative Study, Cami Weber

Dissertations

Rural pregnant women with substance use disorder (SUD) are an understudied vulnerable population that often experiences poor pregnancy outcomes (Higgins et al., 2019; Jumah, 2016; Kramlich et al., 2018; Shaw et al., 2015). Despite the high prevalence and high burden associated with SUD, rural women are less likely than non-pregnant women to seek addiction treatment and complete an outpatient treatment program during pregnancy (Shaw et al., 2015). This study aimed to give voice to rural Missouri women with SUD. The research questions explored the life experiences and motivations for seeking treatment using a qualitative, descriptive research design with grounded theory …

Psychological Distress During The Covid-19 Pandemic In Nursing Students: A Mixed Methods Study, Mayantoinette Watson

Dissertations

During such an unprecedented time of the largest public health crisis, the COVID-19 pandemic, nursing students are of the utmost concern regarding their psychological and physical well-being. Questions are emerging and circulating about what will happen to the nursing students and the long-term effects of the pandemic, especially now that hospitals are being overwhelmed with COVID-19 cases and patients as well as a significant need for nursing staff (Jividen, 2020). Expectations, demands, change, and the fear of the unknown during this unprecedented time can only contribute to the many stressors that accompany nursing students through laborious clinical and didactic courses …

Benzodiazepine Reduction Program In A Psychiatric Mental Health Setting, Tracy Pacini

Dissertations

Benzodiazepine Reduction Program in a Psychiatric Mental Health Setting

The purpose of this pilot project was to reduce side effects and adverse effects of long-term benzodiazepines (BZDs) use in a non-profit community health center. This was a quality improvement project. The evidence-based practice (EBP) framework identified for the project was from the Institute for Healthcare Improvement (IHI) Plan-Do-Study-Act (PDSA) framework to decrease BZD use in a non-profit community health center. This model is focused on four stages: 1) gathering a proactive healthcare team to examine and identify solutions to reduce BZD usage, 2) testing the pilot program that the team …

Impact Of Social Isolation In Hiv-Positive Individuals During A Pandemic, Corina Jane Bakoylis

Dissertations

Problem: The global pandemic of COVID-19 caused concern for immunocompromised individuals. The purpose of this quality improvement initiative was to assess the impact of social isolation on feelings of loneliness, depression, and social isolation experiences in HIV-positive individuals residing in a long-term care facility.

Methods: A mixed-method convergent design with a purposeful sample of HIV-positive adult residents residing in a long-term care facility was utilized. An evaluation of loneliness using the University of California Los Angeles (UCLA) Loneliness Scale (Version 3) and depression using the Patient Health Questionnaire-8 (PHQ-8) were completed. Personal experiences were also assessed with five predetermined open-ended …

Evaluation Of Depression, Anxiety And Stress In Graduate Nursing Students, Rachel Dunston

Dissertations

Mental health issues are growing in the United States. Postgraduate school is widely known to increase the level of psychological difficulties (Dyrbye et al., 2006) experienced by students. There is a need to address mental health care in graduate nursing students. This project was a descriptive observational comparison pre-post-intervention design used to see if online modes of delivery would aid in decreasing mental health issues for nursing graduate students. Participants were provided with access to three podcasts and encouraged to use the Sanvello mobile application provided to all students at this university. The first podcast focused on using the Sanvello …

Identification Of Veterans Experiencing Symptoms Of Mental Illness For The First Time After Covid-19 Diagnosis, Brittania Phillips

Dissertations

There has been a general increase in psychiatric symptoms since the COVID-19 pandemic began. Literature that has been published since the start of the pandemic has indicated there is an increased risk of depression, insomnia, altered mental status, new-onset psychosis, neurocognitive syndrome, and anxiety. The military veteran population is at higher risk for psychiatric illness than the general population, and should be screened accordingly. This quality improvement project was developed in collaboration with the mental health clinic at urban medical center in the Midwest to identify new symptoms of mental illness after COVID-19 diagnosis utilizing the PDSA model and descriptive …

Evaluation Of A Dirfloortime® Program For Autism Spectrum Disorder, Jennifer L. Pipitone

Dissertations

Problem. Parents with children who have neurodevelopmental disorders, such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) experience high levels of parenting stress. The prevalence of ASD is on the rise in the United States. As a result, there has been an increase in the use of treatment modalities, in effort to better understand which modalities have the most positive impact on children and their parents. DIRFloortime® is a developmental treatment modality used to help strengthen the parent-child bond and used to decrease parental-child stress. The Autism Parenting Stress Index (APSI) measures the impact of an intervention …

Intimate Partner Violence Education For High School Students, Morgan Foster

Dissertations

Problem Adolescents are at risk for experiencing intimate partner violence (IPV). As early as seventh grade, over half of adolescents have reported being in a romantic relationship. Adolescent screening for and education of IPV is minimal, and only the Healthy Relationships Quiz developed by the U.S. Department of Health and Human Services [HHS] screens young adolescents across all aspects of IPV, including psychological and sexual violence. The purpose of this project was to develop an IPV education plan for high school students in a health course.

Methods An educational lesson plan for IPV was created for high school teachers.

Results …

Evaluation Of An Elopement Risk Assessment Tool In An Acute Inpatient Psychiatric Hospital, Beth Lockhart

Dissertations

Persons admitted to acute care, inpatient psychiatric facilities often pose a threat to themselves or others, a situation which could quickly devolve if they were to leave treatment prematurely. There is a need for an elopement risk assessment with appropriate interventions correlating to level of risk. An acute care, inpatient psychiatric hospital implemented an elopement risk assessment tool in March of 2020. This quality improvement project used an observational descriptive design and comprised of a retrospective chart review, aimed to determine the effectiveness of the risk assessment tool on decreasing elopements. Charts of those that eloped in 2019 (n=8) and …

A Descriptive Study Of Health-Related Risks And Outcome Differences By Loneliness Status In A Sample Of Older Veterans, Rachael Beard

Dissertations

There is a need to understand the influences and outcomes related to loneliness in veterans living with complex illness. Patients require self-care to manage complications and exacerbations associated with complex illness. Deficits in self-care result in negative health outcomes and drive resource utilization upward. The identification of potential factors related to self-care is important. Loneliness may be one factor that influences patients’ ability and desire to care for themselves. Descriptive correlational design was used to evaluate loneliness both as a predictor and outcome in veterans admitted to the hospital for three complex respiratory illnesses (heart failure, chronic obstructive pulmonary disease, …

Empowering Nurses Of Minority In The Face Of Incivility And Bullying: Through The Lens Of Phenomenology, Corrine Floyd

Dissertations

Abstract

Up to 85% of nurses have reported exposure to incivility in the workplace (Hunt & Marini, 2012). The often-subtle nature of incivility toward nurses in a minority population may partially explain why it remains a problem. Healthcare organizations realize the need for civility to counter the high turnover rate, staff shortages, and low job satisfaction reported by nurses, but lack understanding of how nurses of a minority population perceive incivility and bullying. This study aimed to answer the research question how do nurses with minority representation experience incivility and bullying versus empowerment in the workplace? A descriptive phenomenological design …

Utilizing Mindfulness-Based Exercises To Reduce Anxiety Severity Scores According To The Gad-7, Kelly Calhoun

Dissertations

Abstract

Problem: Generalized anxiety disorder (GAD) affects thousands of Americans every year. Mindfulness, a practice of bringing oneself into the present moment, has been shown to impact anxiety symptoms positively.

Objective: This prospective observational correlational study utilized mindfulness-based exercises to help decrease anxiety severity according to the generalized anxiety disorder-7 (GAD-7) in an outpatient psychiatric practice.

Methods: Participants practiced mindfulness exercises for two months. The GAD-7 was completed three times to monitor symptom severity. Two participant satisfaction surveys were completed to determine whether participants felt the exercises were beneficial for decreasing their anxiety.

Results: A repeated measures ANOVA was used …

Screening For Delirium In The Emergency Department, Melissa Minks

Dissertations

Abstract

Delirium is a problem for many older adults who are acutely ill. Delirium often comes on suddenly, can be severe, and is often difficult to diagnose, especially in the presence of dementia. Missed delirium has a mortality rate of 30.8% and costs millions. What is the purpose of this study?

Methods The 4A’s Test screening instrument was implemented and evaluated in the Emergency Department of a rural Midwestern hospital from May 1, 2019 through August 31, 2019.

Results There were 122 participants in the study with 61 in each cohort. In 2018, three (5%) were diagnosed with delirium without …