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Syrian Refugee Women's Experiences With The Ontario Health Care System: A Critical Ethnography Study, Areej Al-Hamad

Electronic Thesis and Dissertation Repository

There has been growing interest in migration and refugee research; the vulnerability of Syrian refugee women and how they adapt to their host communities. However, there is limited evidence regarding the pre- and post-migration trauma and its impacts on the health of Syrian refugee women in the Canadian context. The purposes of this critical ethnography using intersectional perspectives were: (1) to explore and describe Syrian refugee women’s experiences and meanings of pre- and post-migration trauma and its impact on their health in the context of repeated displacement and migration from their homes and families; (2) to critically examine how the …

Improving Clinicians’ Access To Patient Education And Va Resource Information, Ella Bermudez

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: In a western US Veterans Administration (VA) hospital system, patient education materials are provider-specific, not standardized, and not located in a central, readily available location.

Context: How does a patient education tool affect the clinicians' delivery of health education in increasing health literacy compared to written information alone in the US veteran population? An integrated literature review was performed using Cochrane, Joanna Briggs Institute (JBI), Scopus, CINAHL, and PubMed databases to address the PICOT question above and determine the impact of patient education tools on health literacy and patient engagement. The literature recommended improving patient education for better …

Assessing Nurse Practitioners' Knowledge And Clinical Practice With Regard To The Oral-Systemic Link, Angela Haynes

Electronic Theses and Dissertations

Nurse Practitioners (NPs) comprise a significant portion of the U.S. primary care workforce and play an essential role in patients' health awareness, prevention strategies, disease management, and in providing appropriate provider referrals. Nurse Practitioners receive education on the oral-systemic connection, yet there have been limited studies on the clinical practice of NPs assessing the oral cavity to evaluate the condition of the teeth and the oral tissues. The purpose of this study was to explore the nurse practitioners’ knowledge and practice habits of assessing the oral cavity for diseases or abnormalities in the mouth that can, in turn, affect overall …

The Effect Of An Online Educational Intervention On The Community Knowledge Of Physical Health, Mental Health And Self-Efficacy During The Covid-19 Pandemic, Kerstin Ashby Ferguson

Doctor of Nursing Practice Projects

Background

Community health education during times of pandemic is of utmost importance to disseminate information regarding safety precautions, educate the public regarding the disease process, and provide accurate health information during a time when individuals are specifically vulnerable to inaccurate sources of information. During the COVID-19 pandemic, physical gatherings were highly restricted; therefore, it became important to incorporate technology into the educational process.

Purpose

The purpose of this project was to determine if a thirty-day, online community health education program would increase the health knowledge and self-efficacy of participants.

Methods

This project utilized a quantitative quasi-experimental pre-test/post-test design from a …

Transforming Clinical Care Through Sexual Wellness Education For Community College Students, Chelsea Ovanek

Doctor of Nursing Practice Final Manuscripts

Abstract

Title: Transforming Clinical Care Through Sexual Wellness Education for Community College Students

Statement of the Problem: Unintended pregnancy remains a serious public health challenge throughout the world (World Health Organization [WHO], 2018). College-aged students continue to be a vulnerable population for this health issue, with estimates that 1 in 5 women will give birth before age twenty and 80% of those pregnancies unintended (Guttmacher Institute, 2019). Despite the statistics, approximately 40% of college students have received formal education on unintended pregnancy, sexually transmitted infections (STIs), or effective contraception use (Diedrich, Klein, & Peipert, 2017). According to the World Health …

Does Access To Telephone Counseling Improve Smoking Cessation In Disadvantaged Populations?, Karin Warden-Thomas

Evidence-Based Practice Project Reports

Tobacco usage leads to the development of a multitude of diseases. Years of research have shown that evidence-based interventions such as counseling and pharmacotherapy increase smoking quit rates. Studies have demonstrated that either proactive or reactive telephone counseling has been beneficial in providing long term smoking abstinence particularly in disadvantaged populations (Haas et al., 2015). The purpose of the project was to improve smoking cessation by facilitating access to telephone counseling using an electronic medical order. The Stevens Star Model of Knowledge Transformation (Stevens, 2004), was the framework employed to support the process for change. This evidenced-based project occurred at …

Health Care Access And Utilization By U.S. Farmworkers, Genesis Bojorquez

Dissertations

Background: Agriculture industry has the highest fatality rate among all United States industries. Farmworkers experience high rates of occupational injury, illness, and mortality, yet have limited access to health care. Implementation of the Patient Protection and Affordable Care Act (ACA) of 2010 increased health care accessibility and broadened farmworker eligibility for health insurance, yet no study has measured the impact of the ACA upon U.S. farmworkers.

Purpose: The purpose of this research was to examine health care access and health care services utilization among U.S. farmworkers following the implementation of the ACA in 2010.

Specific Aims:

1. Apply the …

A Multicomponent Tailored Intervention Program Protocol For Weight Loss In An Underserved Adult Patient Population With Obesity, Rita R. Arnold

Evidence-Based Practice Project Reports

Obesity is a multifactorial, individualized, chronic disease that increases known risk factors for significant comorbidities and mortality. The primary purpose of this Evidence-Based practice project was to improve indicators of obesity (weight, BMI) among patients served by a free medical clinic, using a tailored multicomponent intervention. The secondary purpose was to determine if the weight loss intervention was associated with a decrease in blood pressure and depression symptoms. The intervention was guided by the Health Promotion Model by Nola Pender. The Johns Hopkins Nursing Evidence Based Practice Model (JHNEBP) guided implementation of the project. A comprehensive literature review was completed …

Homeless Tailored Primary Care And Access To Ongoing Primary Care Services, Jessica J. Stoefen

All Graduate Theses, Dissertations, and Other Capstone Projects

Homelessness is an increasing problem worldwide. The system for providing medical care to individuals experiencing homelessness is currently a patchwork of multiple different agencies. Many individuals do not utilize routine primary care (PC) services, instead present to emergency departments for nonemergent care. A systematic literature review was conducted using Cochrane Database of Systematic Reviews, CINAHL Plus with Full Text, Consumer Health Complete – EBSCOhost, and PsycINFO from 2014-2019 with the exception of Cochrane which was searched from 2009-2019, to evaluate if tailored PC clinics focused on providing PC services with additional supports to homeless individuals were more effective at engaging …

The Implementation Of An Open Source Electronic Medical Record At A Faith-Based Community Clinic, Gabri Warren

Graduate Theses, Dissertations, and Capstones

Faith-based nursing and healthcare is increasingly gaining popularity as the industry looks to minimize costs and improve health outcomes. Historically, qualitative studies have not shown the extent to which individuals and communities are impacted by health initiatives initiated by faith institutions. Healthcare technology can help support the specialty by providing increased quantity and quality data to analyze. Traditional, proprietary EMRs are too costly; however, open source systems offer a low cost, and easily modifiable option to non-profit, or smaller organizations. The data collected by an open source system allows organizations to improve the care that patients receive, and helps guide …

Comparison Of A Self-Audit Tool To Accrediting Health Care Agencies’ Standards Of Care In A Corrections Setting, Matthew C. Widerman

Doctoral Projects

Millions of individuals enter correctional facilities each year and require health services. Inmates are bound to a set of rules, wherein they are thought of as objects of surveillance, punishment, or rehabilitation, rather than as patients. In addition to standards of care defined by national accrediting bodies and state boards of practice, correctional facilities also have state laws that define expected health services for incarcerated persons. All health care providers have a responsibility to provide the highest quality care, but in prisons, patients are still inmates bound to correctional rules. Policies and procedures guide health care practices in correctional facilities, …

Std Education Among African American Women: An Educational Improvement Initiative, Marqueta V. Abraham

Electronic Theses and Dissertations

Research reveals there is a knowledge gap facing African American women regarding sexual health education, specifically sexually transmitted diseases. The Sexually Transmitted Disease Knowledge Questionnaire (STD-KQ) was used to assess participants’ knowledge and attitudes regarding sexually transmitted diseases. The STD-KQ self-assessment was administered to African American women and utilized to develop a 45-minute education seminar to bridge the knowledge gap. After an education seminar was held, a posttest was administered to test the women’s knowledge and to determine their level of awareness. Using a paired-samples t test, the researcher found an overall increase in awareness of the types of sexually …

Implementing Screening To Assess Readiness To Change In Overweight And Obese Patients At A Patient-Centered Medical Home, Jarrod Gant

Doctoral Projects

Obesity is at epidemic levels within the United States (U.S.), but the Southern U.S. has some of the most obese states. Mississippi (MS) is the most obese state in the country (Robert Wood Johnson Foundation, 2018). Factors such as diet, sedentary lifestyle, cultural influences, and socioeconomic status contribute to the state’s citizens being overweight and obese.

Contributing to the state’s obesity is the fact that MS has more people living in poverty than any other state (Center for American Progress [CAP], 2018). Lacking the ability to afford healthy foods and the ability to afford quality healthcare adds to the state’s …

Management And Support Of Uninsured Patients With Diabetes Type Ii Within A Nurse Managed Clinic, Emma Spencer

Dissertations

The purpose of the project was to improve the quality of care for the uninsured, Type II Diabetics residing in a Midwestern urban underserved community. Community Health in Partnership Services (CHIPS) was a nurse-managed clinic, located in that area, that sought to lessen the burden of being uninsured. An annual fee of $35.00 allowed an uninsured community member access to a variety of different health care providers including specialists. In order to utilize this health care team efficiently, it was necessary to implement nurse-led care coordination for patients diagnosed with Type II Diabetes. This quality improvement project followed the Plan …

Exploring Help-Seeking Intentions Of Homeless Veterans Attending A Stand Down Event, Tara Vaughn

Nursing Theses and Dissertations

Lack of help-seeking behavior among homeless veterans results in higher burden of disease and lower quality of life. No studies have been conducted involving help- seeking intentions of homeless veterans within the veteran stand down population. Pender’s Revised Health Promotion Model was used to guide this descriptive correlational study with the aim of exploring the extent selected personal characteristics and experiences and behavior-specific factors affect help-seeking intentions among homeless veterans attending a stand down event.

A convenience sample of 86 homeless veterans (mean age 56) was recruited from a 3-day veteran stand down event in Northern California. Each participant was …

Implementing An Honors Nonprofit Internship: Hub Of Hope, Janet Wagner

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Human trafficking is the term used to describe modern-day slavery, which is a global problem, but it is also present here in the United States. During this last year, I have worked with the Northwest Arkansas nonprofit Hub of HOPE. This organization, founded in 2016 by Jennifer Sorey, supports victims of human trafficking and raises awareness by educating Arkansans on the pervasiveness of human trafficking and its implications for our community. As part of my work, I completed the Sexual Assault Nurse Examiner training to understand how to work with human trafficking victims who are also victims of sexual assault …

Creating Voice In School Nurses Through Increasing Self-Efficacy, Kate King

Doctor of Nursing Practice Scholarly Projects

Creating voice in school nurses is essential to implement and promote health care in schools. Increasing self-efficacy, the knowledge, practice and internal belief of the nurse that he or she is an expert, creates voice and thus, the ability to assist students and families navigate various concerns and health issues. Therefore, the purpose of this project was to increase selfefficacy by providing school nurses with an interactive educational module that focused on social modeling and persuasion, responses to stress reaction experiences and attainment and application of evidence based practice, all skills of self-efficacy. The interactive educational model was presented to …

Early Identification Of Frailty Predictors In A Vowed Religious Community Of Catholic Men: A Strategy For Successful Aging In Place, Julia Senn-Reeves

Graduate Theses, Dissertations, and Capstones

Background: The population in the United States is aging and experiencing age- and disease-related changes, leading to increased frailty, as well as increased disability, morbidity, and mortality. Timely recognition of these vulnerabilities, and intervention implementation, are crucial to prevent adverse outcomes and to support successful aging in place. Purpose: The purpose of this project is to develop and implement a multifaceted assessment process to identify early predictors of frailty among members of a vowed religious community of Catholic men to ultimately support successful aging in place. Participants: A single vowed religious community of Catholic men in the United States, living …

Improving A Midwestern Community Mental Health Organization's Smoking Treatment Services For Individuals With Serious Mental Illness, Leah J. Magnuson

Doctoral Projects

Tobacco smoking is the leading cause of preventable death in the United States. Billions of dollars are lost yearly in direct and indirect healthcare costs as well as lost work productivity due to smoking. While smoking rates have declined among those of the general population, they remain high among those with serious mental illness (SMI). Many of those with SMI desire to quit and are able to quit smoking when they are provided with appropriate interventions and resources. It is recommended for those with SMI to receive combined interventions in the form of pharmacotherapy and cognitive behavioral therapy to help …

Bringing Truth To The Table: An Evidence Review To Dispell Common Dietary Myths, Madison Pierce

Senior Theses

Background/Significance

Nurses are most directly involved with patient care and are in an excellent position to be patient educators. Patients are more likely to actively listen after establishing rapport, especially for loaded topics such as lifestyle choices. While nurses have general nutrition knowledge, they may lack current, scientifically-based information to help patients implement a healthy diet. Nurses can both educate and be an example of health habits that patients should emulate, and therefore need to be adequately informed about topics like dietary misconceptions.

Purpose

The purpose of this project is to provide current evidence-based information regarding dietary misconceptions to nurses …

Improving Health Literacy Among Latino Migrant Dairy Farmworkers, Dayna A. Stimson

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background/Purpose: Latino migrant farmworkers are a marginalized and medically underserved population in Vermont and nationally. They experience significant health disparities and barriers to healthcare access compared to others living in rural areas. Barriers include limited knowledge regarding available services and low general and health literacy. These barriers lead to poorer health outcomes. The purpose of this evidence-based project was to enhance health literacy and follow-up care for migrant farmworkers by improving health literacy in a community health outreach setting.

Methods: In northwestern Vermont, 33 outpatient migrant farmworkers were recruited following health screening visit and referred for follow-up. AHRQ …

Development Of A Measure Of State Infrastructure For School Nursing Services Delivery, Wendy A. Doremus

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Healthcare systems are increasingly accountable for safety and quality. States have a key role in protecting and promoting the health of their youth, setting regulations and standards for school health services structures and processes. Yet, the lack of an instrument for state-level self-assessment of equity and quality infrastructure supports hinders progress toward improving in school health services delivery. This macro health system project, conducted in three phases, developed a valid and reliable instrument for state-level self-assessment of infrastructure necessary for supporting quality school nursing services. The phases were identification of state-level structures and processes domains and indicators; a content expert …

Understanding The Healthcare Experiences Of Deferred Action For Childhood Arrivals (Daca) Recipients, Jacob A. Kluesener

Honors Undergraduate Theses

Background: There is limited research on the healthcare experience of Deferred Action for Childhood Arrivals (DACA) recipients both before and after enrollment in the program. DACA is a program designed to defer deportation to children and young adults in the United States for up to 2 years. The goal of this qualitative study is to explore the lived experiences of DACA students with regards to access to healthcare and perceptions of treatment. Method: This study is qualitative and uses a phenomenological approach. DACA Recipients (N = 5) were recruited from the UCF student population and 1:1 interviews were conducted. Interviews …

Staff Retention Through Standardized Training Materials In Adult Primary Care Clinic, David Smith

Master's Projects and Capstones

As non-profits, community health clinics face a unique set of challenges. Primary amongst these is a shortage of financial resources. Staff turnover, including Registered Nurses (RNs) and Medical Assistants (MAs), can result in avoidable increased wage costs related to training of newly-hired RNs/MAs (clinical staff). Retention of experienced RNs/MAs can be directly correlated with job satisfaction, the obverse of which is job frustration. The intent of this RN/MA training and orientation project is to ameliorate frustration related to a lack of informational resources and clear competency expectations. Upon completion and implementation, project efficacy will be assessed via four longitudinal measures: …

Implementing A Telephone Triage System, Joanyett Mays-Scott

Master's Projects and Capstones

Implementing a Telephone Triage System

Abstract

Introducing a telephone triage system requires conscientious regard to the organizational configuration and culture, staff abilities and experience, observed need and expected outcomes, staffing issues, and the physical location in which the system will be introduced (Murdoch et al., 2015). For this microsystem A SWOT analysis and microsystem assessment were performed. This community health center’s goal was to have standardized, evidence-based triage protocols followed by the nursing staff and the contracted nursing staff. The workflow was introduced in a series of lunch and learns provided by clinical nurse managers. Once workflows were established a …

Changing Health Care Policy By Utilizing Kingdon's Policy Stream Theory, Brittney Welch

Graduate Theses, Dissertations, and Capstones

The purpose of this paper is to describe the policy process of changing current regulations regarding rural health clinics (RHCs). Using Kingdon’s Policy Stream Theory for guidance, the change project was designed to amend current regulations regarding the directorship of the RHCs, consequently allowing Nurse Practitioners (NP) to act as medical directors for rural health clinics (RHCs). This change fulfills the Institute of Medicine’s charge to have nurses work to the highest level of their education, as well as a defined need to fill a gap in the health care system by decreasing rural health disparities. The Rural Health Care …

Nurse-Led Triage Clinic In An Hiv Supportive Housing Apartment Community, Sally Breen

Dissertations

Problem: HIV-positive persons living in supportive housing who were otherwise homeless are reported to have better health outcomes than those who remain homeless. This was a quality improvement project to obtain baseline information regarding the implementation of onsite nursing services for individuals and their families residing in an HIV-positive supportive housing apartment community in an urban Midwestern city. Methods: A nurse triage clinic was implemented in partnership with the Doorways organization. Two registered nurses staffed the clinic two days per week. Data was collected on demographics and clinic utilization over a nine-week period. Results: Of the apartment residents, N=95, the …

Aligning With Patient-Centered Medical Home Standards: Depression Screening In Women's Health, Charity Galgani

Dissertations

Problem: The Patient Centered Medical Home (PCMH) model of care improves health care quality and patient experience of care, and decreases costs. Depression screening is a requirement for becoming a PCMH. The purpose of this quality initiative was to obtain baseline data to describe depression screening rates among female adult patients receiving women’s health care within a Midwestern public health department seeking PCMH recognition.

Methods: The study utilized a descriptive, observational design and was guided by the Plan-Do-Study-Act framework. A retrospective medical record review was used to assess the rate of depression screening utilizing the PHQ-2 and PHQ-9 tools, and …

Oral Health Literacy In Parents And Care Providers Of Young Children, Rachel Nye

DNP Scholarly Projects

Tooth decay ranks first as the most common chronic disease in childhood (U.S. Department of Health and Human Services [HHS], 2000). In addition to the morbidity directly related to cavities, there are a myriad of other systemic implications of this disease. The purpose of the study was to determine baseline oral health literacy levels for a sample of pediatric caregivers living in the Upper Peninsula and to determine the impact of a community based education program on these levels. The program was offered at three locations. A paired sample t-test of sixty-four complete data sets demonstrated a statistically significant increase …

An Exploration Of Barriers To Health Care Access Among Uninsured Patients: Using The Moderating Effect Of Patients’ Enablement, Enedelia L. Jessup

Electronic Theses and Dissertations

ABSTRACT On March 23, 2010, Congress passed the Patient Protection and Affordable Care Act (ACA) to increase value of care, improve clinical outcomes, decrease health care costs, and increase affordability in health care access. The purpose of the study attempts to examine the moderating effects of patient enablement impacting barriers, low socio economic status, and unmet basic needs, toward health care access in uninsured populations post ACA. Only certain aspects of patient enablement in self-management of an individual’s health care goals have been conducted with uninsured populations with barriers toward health care access. The research design was a quantitative, exploratory, …