Medicine and Health Sciences Commons^™

Traits Of Character That Facilitate Formation Of Exemplary Nurses In Bachelor Of Science Nursing Programs, Jean Marks

Dissertations

Constructivist grounded theory methods were applied in this study to explore traits of character that facilitate the formation of exemplary nurses in Bachelor of Science Nursing (BSN) programs. Interest in this study was prompted by a desire to examine attributes beyond academics alone that contribute to the formation of excellent nurses. The intent was to promote clarity in describing these attributes for further scholarly discussion.

Framing this study was Aristotle’s doctrine of the golden mean (Aristotle, 350 B.C.E./1934). Operational definitions consistent with this doctrine were created for the concepts of character, character traits, and exemplary nursing practice. The concept …

Childbirth And Control Behind Bars: A Descriptive Qualitative Analysis Of The Maternal Perception Of Control In Women Who Have Given Birth While Incarcerated, Lorin Raines

Dissertations

The perception of control during childbirth has been widely studied in various setting and groups. Many factors have been found to aid or impede the perception of control for birthing women. Significance of that perception of control during childbirth has also been measured in past studies. This descriptive qualitative study advances the knowledge of the perception of control during childbirth and examines a population that has thus far been excluded. Four previously incarcerated women participated in semi-structured interviews about their experience of giving birth while incarcerated and their perception of control during that time. The women were from diverse backgrounds …

Utilization Of Asthma Guidelines In Primary Care, Kate R. Miller

Dissertations

Background: Chronic lower respiratory disease, including asthma, is the fourth leading cause of death in the U.S. Financially, asthma accounts for approximately 54 billion dollars in healthcare spending annually. The National Heart Lung and Blood Institute [NHLBI] established guidelines to reduce impairment and to reduce future asthma attacks.

Purpose: This Quality Improvement (QI) pilot implemented the Asthma Control Test (ACT) and the Asthma Action Plan (AAP) per NHLBI guidelines. This project aimed to increase provider use of the ACT and AAP to 50% in patients with a diagnosis of asthma over one month.

Methods: A convenience sample of six adult …

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 …

Screening And Referring For Postpartum Depression In Pediatric Primary Care, Melissa Harkins

Dissertations

Problem

Postpartum depression (PPD) can lead to increased risk of child abuse, delays in infant development, and increased medical costs (Earls et al., 2019). The American Academy of Pediatrics (AAP) recommends all mothers of infants 0-6 months be screened for PPD during well-child visits. Despite these recommendations, many pediatric offices have no PPD screening process.

Methods

This quality improvement project utilized a standardized tool to screen mothers of infants 0-6 months for PPD during their infants’ well-child visits. Mothers who screened positive for PPD were offered referrals to treatment resources and given the opportunity to participate in two follow-up telephone …

Improvement In Primary Care Identification Of Trauma Symptoms Of Foster Care Children, Crystal Lucas

Dissertations

Introduction: Exposure to adverse childhood events (ACEs) is common in foster children. Primary care providers are ideally positioned to advocate for foster care children through early identification and treatment of trauma-related symptoms and diagnoses during routine well-child assessments.

Purpose: This quality improvement project sought to institute a standardized trauma assessment instrument, the Childhood Behavioral Checklist (CBCL), to determine if there was an increase in the identification of trauma-related symptoms and diagnoses along with an increase in the rate of referral to mental health care (MHC).

Method: This quality improvement project used a descriptive, observational design to complete retrospective and prospective …

Sustainability Of An Outpatient Antibiotic Stewardship Program, Kristin Smith

Dissertations

Abstract

Problem: Antibiotic stewardship is an effort to evaluate and improve the use of antibiotics by providers and patients. Antibiotic stewardship programs (ASPs) promote the appropriate use of antibiotics. There is increasing evidence that supports the use of antibiotic stewardship programs in reducing antibiotic prescribing rates while continuing to maintain safe patient care. Research supports approaches with multiple interventions and ongoing commitment to antibiotic stewardship. However, information regarding long-term sustainability of antibiotic stewardship programs is lacking. The purpose of this quality assurance project was to assess long-term sustainability of a previously implemented ASP promoting appropriate prescribing of antibiotics for the …

Tailoring Violence Prevention Programming To A Critical Care Area, Jaime Campbell

Dissertations

Abstract

Problem: Rising rates of violence in health care environments signal a need for health care workers, specifically frontline nurses, to be trained in effective de-escalation management skills. Since January 2017, there has been an increase in the number of patients categorized as aggressive with more violent patient events taking place at a selected midwestern hospital facility in the critical care department, particularly the intensive care and transitional care units.

Methods: Using a pre-post design, this project compared nurses’ verbal de-escalation skills using the English Modified De-escalating Aggressive Behaviour Scale (EMDABS) to determine effectiveness of de-escalation strategies in simulated scenarios …

Effect Of Standardized Nurse Teaching On Patient Experience Using Cahps®, Julie Hake

Dissertations

Abstract

Purpose: This quality improvement (QI) project aimed to determine if a standardized nurse teaching approach improved patient understanding of diagnosis and treatment as it relates to women diagnosed with a pelvic floor disorder (PFD) after receiving a standardized nurse education (SNE) session in an urban tertiary care Urogynecology practice.

Methods: Females aged 18 and older with a newly diagnosed PFD and prescribed PFPT for the first time who agreed to receive the SNE and complete the CAHPS® survey were included in the project. Patient perception of PFPT was assessed via phone interview utilizing the Consumer Assessment of Healthcare …

Implementing A Three-Minute Foot Exam For Diabetic Patients In Primary Care, Emilee Laster

Dissertations

Problem- One in four U.S. Veterans have Diabetes Mellitus, and one in four U.S. Veterans with diabetes will develop a diabetic foot complication. There is currently no protocol for healthcare providers to perform foot screenings on diabetic patients at each visit. Utilizing a foot screening at each visit for high risk diabetic patients may help to recognize problems sooner, making treatment easier and less aggressive.

Methods- This quality improvement initiative was a retrospective and prospective record review before and after evidence based three-minute foot exams were implemented. A convenience sample of 50 patient medical records were reviewed to collect demographical, …

Comorbidity And Quality Of Life Of Hiv-Positive Adults Living In Supportive Housing, Rose Sharp

Dissertations

Problem: Life expectancy for people living with HIV significantly increased with widespread use of antiretroviral therapy, resulting in population increases in comorbidity prevalence. The increased burden of living with both HIV and comorbidities lowers health-related quality of life (HRQoL).

Methods: Using a descriptive, correlational, cross-sectional design, a convenience sample of HIV-positive adults was selected from seven supportive housing communities. Comorbidities were assessed using a modified Self-Administered Comorbidity Questionnaire, and HRQoL using the Patient-Reported Outcome Measurement Information System Scale v1.2 – Global Health.

Results: A sample of 17 (N = 17) adults reported a mean of 4.2 (SD = …

Diet Behaviors, Physical Activity, And Sociodemographic Factors In A Sample Of Racially Diverse Adults: A Secondary Analysis Of Nhanes (2017-2018) Data, Fatemeh Choupani

Dissertations

Background: The prevalence of obesity is increasing among adults in the United States and is related to a high risk to health. Obesity has been linked to lifestyle behaviors such as diet behaviors and physical activity.

Purpose: This study aimed to determine if an association exits between foods prepared outside of the home, walking or biking, vigorous/moderate recreational activities, sociodemographic factors and the outcomes, body mass index, percentage of body fat, and waist circumference.

Method: A secondary analysis was conducted using data from 3942 adults from the U.S. aged 20 years, as recorded in the National Health …

The Experience Of Early Mobility After One Week Of Hospital-Acquired Deconditioning, Lila S. Moersch

Dissertations

Abstract

Older adults who are hospitalized spend most of their time in bed. Prolonged bed rest and immobility in older adults may result in deconditioning of the muscles, leading to a loss of muscle mass and strength. The loss of muscle mass results in weakness and reduced physiological functioning post-hospital discharge. Immobility is especially problematic in older adults who naturally lose muscle mass and strength due to the aging process. Older adults who experience weakness post-hospital discharge face challenges with mobility. The purpose of this study was to describe the early mobility experiences of adults who are 60 years old …

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 …

The Relationship Among Perfectionism, Perceived Stress, And Coping In Baccalaureate Nursing Students, Amanda Finley

Dissertations

Perfectionism in nursing students is an understudied problem that may affect student and workforce success. Perfectionism has been linked to increased stress and less effective coping styles, as well as depression, anxiety and other psychological alterations. However, it has rarely been studied in nursing students. Studying perfectionism in this population is important because it may increase the likelihood that new nurses will struggle with the stress of practice and it could be a significant factor in early career attrition. The purpose of this descriptive, correlational study was to gain a better understanding of the incidence of perfectionism in a nursing …

Chronic Pain, Sleep Disruption, And Work Performance In The Military, Jeffrey Ransom

Dissertations

Abstract

Background and Significance: Managing pain is a challenge for many organizations, including the U.S. military. The added complication of managing sleep disruption compounds the issue. Examining pain and sleep disruption in the context of work performance within the military is critical to understanding the impact of these conditions on our nation’s fighting forces.

Purpose: Examine the associations of chronic pain and sleep disruption in the context of work performance among active duty military service members.

Research Aims: 1) Describe sociodemographic characteristics, military service characteristics, clinical characteristics, and work performance of active duty service members, 2) Examine relationships between these …

Bridging The Gap In Primary Care Of Inflammatory Bowel Disease (Ibd) Patients, Deanna Dial

Dissertations

Abstract

Problem. Patients in rural or medically underserved areas (MUAs) with inflammatory bowel disease (IBD) have limited access to primary care preventative services, making them even less likely to obtain preventative care, placing them at even greater risk for adverse health outcomes.

Methods. A two-phase retrospective chart review utilizing a convenience sample of patients diagnosed with IBD from a privately-owned gastroenterology office to evaluate the effectiveness of increasing preventative screenings for IBD patients. The first review included 53 patients seen from January to April 2019. A preventative screening

evaluation tool (PSET) was developed based on literature recommendations, including the American …

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 …

Nurse Practitioner Student Confidence And Competence In Common Women's Health Diagnostic Procedures, Jessica Cowan

Dissertations

Problem: In areas with limited health resources, such as Guatemala, cost-effective and reliable methods for sexually transmitted infection and cervical cancer screenings are needed. The purpose of this Quality Improvement (QI) project was to develop standardized training in Vaginal Wet Mount (VWM) preparation and cervical cancer screening using Visual Inspection with Acetic Acid (VIA) for Nurse Practitioner students who traveled to Guatemala for a week-long global immersion experience.

Methods: This was a QI project with a prospective descriptive design utilizing a purposive sample of 10 University of Missouri-St. Louis Nurse Practitioner students who traveled to Guatemala on medical mission trip …

Diversity In Pre-Nursing Majors And Nursing Program Applicants, Christel Fehr

Dissertations

Problem: The population of the US has become increasingly ethnically diverse. This diversity has not been reflected in the nursing workforce with approximately 70% being Caucasian and 85% being female, resulting in a disparity in healthcare delivery by minorities. The purpose of this project was to perform an analysis of race, ethnicity, and gender diversity in undergraduate nursing applicants at a rural midwestern university.

Method: A retrospective review of nursing applications, enrollment reports, and graduation rates were examined for three academic years.

Results: 326 students (N=326) applied to the nursing program from Fall 2016 through Spring 2019. Of …

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 …

The Effects Of High Dose Intravenous Vitamin C In Cancer Patients, Bankole Aluko

Dissertations

Problem: Currently used standard treatments (Chemotherapy, radiation) in cancer patients are generally accompanied with side effects, which may include pain, nausea, vomiting, fatigue, and chemotherapy-induced peripheral neuropathy (CIPN) during and after completion of treatments. High dose IV C may improve the anti-cancer action of chemotherapeutic agents by reducing side effects of fatigue, pain, nausea and vomiting and boosting immune cell functioning, and inhibiting angiogenesis (Mikirova, Casciari, & Hunninghake, 2019).The purpose of this quality improvement project was to explore whether high dose intravenous vitamin C (IV C) prevented major side effects that frequently occur with standard treatments in cancer patients and …

A Strategic Plan To Thread Genomics Competencies Into Undergraduate Curriculum, Holly Mathis

Dissertations

Problem: Genomics in undergraduate nursing education has experienced slow adoption in the United States. Various approaches have been proposed but do not address barriers to successful implementation.

Methods: A strategic plan was developed to increase the amount of genetics and genomic content in the curriculum of an undergraduate nursing program. A gap analysis was performed on the curriculum revealing a paucity of content. A SWOT analysis informed the strategic plan, which included a faculty education program using the ANA/ISONG’s Essentials of Genetic and Genomic Nursing: Competencies, Curricula Guidelines and Outcome Indicators (2^nd ed.) (2009) as a foundation.

Results: Faculty …

Impact Of The Hester Davis Fall Risk Scale On Inpatient Falls, Amelia Payne

Dissertations

Problem: During a three month period in 2018, a rural acute care facility experienced a fall rate of 3.4 falls per 1,000 patient days. The aim of this clinical scholarship project was to implement the Hester Davis Fall Risk Scale (HDFRS) for adult inpatients in a rural acute care facility.

Methods: Utilizing the Find, Organize, Clarify, Understand, Select- Plan, Do, Study, Act (FOCUS-PDSA) model, the HDFRS was implemented and evaluated using a pre and post design to determine its impact on falls per 1,000 patient days and falls with injury per 1,000 patient days. The method of evaluation was a …

Evaluation Of Sleep Hygiene Checklist For Delirium In An Intensive Care Unit, Ying Wei

Dissertations

Abstract

Problem: Delirium is a severe complication brought on by sleep deprivation that could increase mortality and prolong intensive care unit (ICU) stays in critically ill patients. This project aimed to develop and implement a sleep hygiene checklist to decrease the incidence of delirium in a Medical Intensive Care Unit (MICU).

Methods: This study used a pre-post design to compare the incidence of delirium pre-and post-implementation of the sleep hygiene checklist. Forty-four patients and thirty-six patients were recruited for the pre-and post-intervention groups, respectively.

Results: The result of this study demonstrated use of a sleep hygiene checklist could decrease the …

Utilizing Wellness Champions As A Faith-Based Initiative For Mental Health Promotion, Tracy M. Webster Cooley

Dissertations

Abstract

Purpose: This program evaluation project evaluated the effectiveness of mental health training and support provided to wellness champions affiliated with a behavioral health organization. This project sought to gain a better understanding of how clergy and laypersons acting as wellness champions in predominately African-American faith-based organizations perceive they create an atmosphere to decrease stigma and increase mental health promotion and wellness when receiving education and training on mental health.

Methods: A descriptive project using a program evaluation design to evaluate the effectiveness of the training of 122 wellness champions from faith-based organizations received from a behavioral health organization …

Utilizing High Flow Oxygen Therapy In Infants With Bronchiolitis, Sarah Ulses

Dissertations

Problem Bronchiolitis is the leading diagnosis of hospitalizations for children under one-year. The purpose of this study was to evaluate the effectiveness of supportive high-flow oxygen (HFO) therapy for infant patients requiring more than 2L/min nasal cannula (NC).

Methods An observational, descriptive design with convenience sampling of infants aged one-year or less, hospitalized with bronchiolitis and requiring HFO therapy. Comparisons were done between 2019 when no HFO was allowed on the general unit and in 2020 when HFO was allowed.

Results Of 28 patients (N = 28), 13 (n = 13) were in the 2019 cohort and 15 …

Evaluation Of A Type 2 Diabetes Mellitus Care Coordination Program, Carrie Smith

Dissertations

Abstract

Purpose: This Quality Improvement (QI) project evaluated the impact of an existing Diabetes Care Coordination (DCC) program at an urban clinic for clients with no health insurance in the Midwest. Diabetes related indicators of those enrolled in the DCC program and client reported barriers were documented over a 19 month period.

Sample: Clients included were 18 years and older, with no insurance, having the diagnosis of Type 2 diabetes mellitus, and were enrolled in the DCC program within the first six months of the program's initiation.

Methods: A retrospective chart review of 24 clients recording diabetes related outcome indicators …

Multidisciplinary Team Approach Effect On Pediatric Severe Asthma, Lila Kertz

Dissertations

Problem. Children with severe asthma are more likely to be non-adherent with their prescribed medications, often related to barriers. A holistic assessment of these patients has been suggested, but is not typically performed in most pediatric asthma clinics. The purpose of this project was to evaluate the effects of severe pediatric asthma clinic services designed to perform holistic assessments and provide comprehensive care.

Methods. An observational, descriptive design was used to evaluate the Severe Asthma Clinic for Kids (SACK) created in 2013 using a retrospective database review. A convenience sample of data collected on all children treated in the clinic …

Compassion Fatigue And The Emergency Department, Alexandra Myers

Dissertations

Problem The emergency department (ED) is a high-stress environment. Nurses exposed to this stress for prolonged periods are subject to compassion fatigue (CF). The purpose of this quality improvement project was to identify and reduce the level of CF in ED nurses by implementing Real Time Transformative Response^© (RTR). RTR^© is a technique that uses combinations of neurofeedback response awareness, biofield therapy intervention, and clearing of unwanted energy.

Method A purposeful sample of ED nurses working at a moderately-sized, suburban, Midwestern hospital ED who were scheduled to work 24-hours or more per week completed a Professional Quality of …