Intimate Partner Violence Screening In The Emergency Department, Rebecca Stuerman

Dissertations

Problem: Intimate partner violence [IPV] is a public health concern that affects one in three women worldwide. IPV can be addressed through identification and early intervention with minimal risk to the patient. The emergency department is an important setting for screening given the frequency with which people who experience abuse may present with IPV-related injuries and other related concerns (depression, suicidality, etc.). Successfully implementing a validated tool for screening and providing early access to resources and referrals may help to mitigate the longterm negative impacts of IPV. The need for increased staff education was a major barrier to screening for …

Encouraging Human Papillomavirus Vaccine Uptake: A Healthcare Improvement Project, Lauren E. Woll

Dissertations

Abstract

Problem: Human papillomaviruses are the causative agents of >95% of cervical cancers, most oropharyngeal and anogenital cancers, yet the vaccination status of the population remains critically low despite Gardasil9 offering robust protection against HPV-related disease.

Methods: This quality improvement project utilized a descriptive, observational design to assess the effect of the HPV Encouragement Bundle, a two-step intervention to improve HPV vaccine uptake. Quantitative data was collected via retrospective chart review to assess the effect of the intervention on first-dose administration of Gardasil9 (series initiation), as well as overall Gardasil9 vaccine uptake.

Results: Following implementation, Gardasil9 first dose uptake increased …

Life Matters, Marina Fischer

Dissertations

Problem: One of the challenges facing many primary care providers is managing hypertension. Hypertension contributes to cardiovascular disease events. Consequently, the high occurrence of hypertension related visits signifies a clinical practice gap in hypertension management resulting in substandard blood pressure outcomes. The purpose of this clinical scholarship project was to assess the difference of pre and post Quality of Life Scale (QOLS) scores in a hypertensive population.

Methods: This quality improvement project used a longitudinal, observational design with prospective data collection. The sample included newly diagnosed hypertensive adults ages 21 to 64 years old. The sample was administered the World …

The Mission System: An Electronic Health Record For Medical Treatment In Guatemala, Tawniece M. Curry

Dissertations

Abstract

Problem: The introduction of an electronic health record (EHR) system has become an essential component in monitoring and tracking patient information in most developed countries but are difficult to implement in underdeveloped countries. Guatemala is a country with poor health care and limited resources for patient tracking and monitoring. An organization in Guatemala, Nursing Heart Inc. (NHI), provides care to over 40 underserved rural communities but lacks the ability to monitor and track patient information. In order for NHI to properly monitor and evaluate their programs and track patients’ continuity of care, the introduction of an EHR system is …

Improving Postpartum Hypertension Discharge Education: A Pilot Project, Kathryn Barth

Dissertations

Problem: Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal morbidity, mortality, and postpartum readmission. Several evidence-based algorithms and protocols have been implemented in the inpatient setting to treat severe blood pressure and prevent complications. However, there remains an opportunity to improve the postpartum care transition and discharge education for patients with these conditions in an attempt to decrease 30-day postpartum hypertension readmissions.

Methods: This pilot project utilized a descriptive design and took place on a postpartum unit at a Midwest metropolitan high-risk obstetrical teaching hospital. Interventions included patient-specific discharge education, distribution of a home blood pressure …

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 …

Implementation Of Pediatric Adverse Childhood Experiences Screening In Primary Care, Alexzandra Hillyer

Dissertations

Implementation of Pediatric Adverse Childhood Experiences Screening in Primary Care

Problem: Over half of children worldwide have experienced abuse in the past year. In 2012, The American Academy of Pediatrics released a policy statement emphasizing the importance of primary care providers implementing Adverse Childhood Experience (ACE) screening into all well-child examinations.

Methods: This quality improvement project was a descriptive, observational pilot study in which Center for Youth-Well ACE Questionnaire (CYW-ACE-Q) was implemented into a large, metropolitan pediatric primary care clinic. A convenience sample was utilized composed of pediatric patients between the ages of 5 and 18 being seen for a …

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 …

Community Health Nurse Educators And Disaster Nursing Education, Jody Spiess

Dissertations

Abstract

The world is struggling with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and the need for disaster nursing education has never been more clear. Recently, the American Nurses Association reported that of the over 32,000 nurses surveyed; only 11% felt well prepared to care for a COVID-19 patient (ANA, 2020). Community health nurse educators are tasked with educating future nurses on disasters, yet, little is known about this population’s perceived competence in disaster preparedness. The purpose of this study is to describe community health nurse educators' perceived competence in disaster preparedness.

The study is a descriptive, correlational …

The Impact Of Medicare Insurance Plans Upon Healthcare Services Utilization Considering Patients' Characteristics And Their Access To Medical Care, Steven Stout

Dissertations

The annual average cost of healthcare for services utilization by a Medicare beneficiary is projected to grow from about $10,000 to over $16,000 by 2023. As an ongoing initiative to address this trend, the federal government contracts with private insurance companies and other entities, called Medicare Advantage Organizations (MAOs), to develop and administer alternative health insurance plans designed to contain service utilization and costs. One feature of some Medicare Advantage plans is the presence of risk-bearing contracts with primary care physician organizations that voluntarily accept financial responsibility for the overall cost of care for patients attributed to them. In this …

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 …

Increasing Patient Adherence To Gestational Weight Gain Goals In Pregnancy, Annie Vining

Dissertations

Abstract

Problem: The inability to maintain healthy weight gain during pregnancy may contribute to multiple pregnancy-related complications. Nutritional education and support may improve nutrition and vitamin consumption, and recommendations for healthy gestational weight gains have been published. However, pregnant women have reported minimal advice regarding healthy weight gain during pregnancy. A personalized, nutritional counseling program was initiated in a Midwestern, suburban OB-GYN private practice.

Methods: A quality improvement descriptive, correlational design was used. A cohort of pregnant women first trimester through six-weeks postpartum received individual counseling and face-to-face interaction at an office visit each trimester.

Results: Twenty ( …

Improving Access To Mental Health Care With Nurse Practitioners, Jessica Whelan

Dissertations

Problem: Over 40% of those with mental illness are untreated since the supply of psychiatrists does not meet the demand. The psychiatric mental health nurse practitioner (PMHNP) may be an adjunct in providing those services. The purpose of this quality assurance study was to evaluate outcomes of care between a PMHNP and a psychiatrist (medical doctor [MD]).

Methods: An observational, descriptive design with a retrospective medical record review of adult patients over a six-month period in a suburban, Midwestern, privately owned psychiatric practice.

Results: A total of 787 individual patients encountered at least one visit (N=787) although 3,679 …

Same-Sex Sexual Coercion Among Women: The Impact Of Minority Stress On Perpetration And Victimization Experiences Of Women Of Diverse Sexual Identities, Allison Kirschbaum

Dissertations

The purpose of the current study was to investigate women’s experiences with same-sex sexual coercion perpetration and victimization. Specifically, I sought to explore the role that the stress of living as a sexual minority plays in these experiences as well as to determine whether the psychological variables of perceived powerlessness, psychological distress, social support, and alcohol use mediate the relationship between minority stress and perpetration and victimization experiences. Data were collected online from self-identified women and individuals assigned female at birth who reported experiencing genital sexual contact with another woman (N=339). Of the cisgender women in the sample, 31.6% reported …

A Vaccine Administration Training Program To Increase Adolescent Vaccination Rates, Claire Jensen

Dissertations

Abstract

Immunizations have been proven to control life-threatening diseases. Often Registered Nurses (RNs) administer vaccines but are unsure how to discuss vaccines with vaccine hesitant patients. Missouri’s adolescent vaccination rates are below its neighboring states. This initiative’s purpose was to increase adolescent vaccine administrations at a Missouri County Health Department (MCHD).

This quality improvement initiative had an observational, cross-sectional, descriptive design. RNs employed at three MCHD clinics attended an adolescent vaccine administration training program (VAT) and completed pre-/post-tests regarding the Advisory Council on Immunization Practices recommendations. Medical record reviews from March 1-April 30, 2018 and March 1-April 30, 2019 compared …

A Behavioral Weight Loss Program For Low-Income Adults With Obesity And Hiv, Sophai Thach

Dissertations

Problem: Obesity, having a body mass index (BMI) of 30 kg/m² or greater, increases the risk for cardiovascular disease. For people living with HIV (PLWH), this increases their risk for myocardial infarctions by 50% and causes this life-threatening event to occur at a younger age compared to those who are not diagnosed with HIV.

Methods: With obesity disproportionately affecting people with low income, this study aims to evaluate the effects of a 12-week behavioral weight loss program that utilizes journaling as a self-monitoring tool, weekly educational classes, and individualized goal-setting on PLWH with obesity who live in …

Permanent Housing And On-Site Nursing Care: Effects On Homeless Individuals With Hiv And Other Cormorbidities, Lynelle Hinden

Dissertations

Abstract

Problem. Providing housing to otherwise homeless individuals who are HIV/AIDS-positive has been demonstrated to improve control of the disease. This was a healthcare quality initiative to review the viral load and Cluster of Differentiation Protein Four positive (CD4+) counts over time of residents in an urban housing facility for HIV/AIDS-positive individuals. Also, a nurse-run clinic was introduced for residents, especially those with comorbidities such as hypertension and diabetes.

Methods. A repeated measures design was utilized. Viral loads and CD4+ counts were retrospectively reviewed from facility records at entrance into and five-years later at the facility. Additionally, measurements of blood …

Implementing The Cdcs Core Elements Of Outpatient Antibiotic Stewardship Program Into The Urgent Care, Deanna Powelson

Dissertations

Purpose: The inappropriate use of antibiotics has led to the development of antimicrobial

resistance which is a severe threat to the public and an increasing global problem. The

Centers for Disease Control and Prevention (CDC) estimates at least two million illnesses

and 23,000 deaths are caused by antibiotic-resistant bacteria in the United States (CDC,

2014). The purpose of this quality improvement (QI) project was to evaluate the

effectiveness of an antibiotic stewardship program (ASP) on urgent care providers'

prescribing on viral respiratory tract infections (RTIs) including the common cold,

pharyngitis, and bronchitis.

Methods: This QI project implemented the CDCs Core …

Implementation Of The National Asthma Guidelines In A Residential Pediatric Clinic, Patricia A. Foster-Staples

Dissertations

Abstract

Purpose: Foster care children admitted to residential facilities are a unique and vulnerable group, many presenting with undiagnosed or poorly managed asthma. The alarming rate of residents admitted to a particular residential primary care clinic with a diagnosis of asthma led to the project question: “Based on record reviews, does staff education about the importance of utilizing the national guidelines for asthma education influence the implementation of such guidelines in a residential pediatric clinic?” The purpose of this quality improvement project was to implement a systematic process to influence practice change. The project was conducted over a period …

The Effectiveness Of Combined Appointments And Influenza Immunization Rates In A Rural Wic Population, Lisa L. Sitler

Dissertations

Purpose: The purpose of this descriptive retrospective study was to examine predictors and barriers to influenza immunizations receipt in a low-income WIC population.

Method: A quality improvement project was conducted in October 2010 in which 129 caregivers of children having WIC appointments were randomly assigned to receive (a) influenza immunizations at the time of the WIC visit or (b) educational materials and a later immunization. Caregivers completed a survey about their perceptions of influenza immunizations. Tanahashi’s access to care model (1978) was used to identify predictors (acceptability, accessibility, availability, and effectiveness) of influenza immunizations.

Analysis: In analysis …