Standardized Screening For Peripheral Artery Disease In Primary Setting, Tamara Tomlin

Dissertations

Problem: Peripheral artery disease (PAD) affects eight million Americans and is the third leading cause of death in the U.S. in people 60-85 years of age. Veterans are at a 45% greater risk to develop PAD than non-veterans. Left untreated, PAD can progress to hospitalization for revascularization, amputation, or death. The American Heart Association (AHA) recommends using a standardized screening tool for the diagnosis of PAD; however, a lack of standardized screening is problematic in veterans receiving proper intervention.

Methods: This quality improvement (QI) project utilized a descriptive, observational design. The American Heart Association (AHA) screening tool was administered by …

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 …

Strategies Exemplary Mental Health Leaders Use To Stay Grounded While Working With Veterans, Audrey Dangtuw

Dissertations

Purpose. The purpose of this explanatory mixed method study was to identify and describe what exemplary mental health leaders in Puget Sound area mental health facilities serving veterans do to maintain their physical, emotional, intellectual, social, vocational, and spiritual health based on the six dimensions of Rosen's (2014) healthy leader model.

Methodology. An explanatory mixed methods approach was selected to allow the triangulation of data to increase the validity of the findings. The study analyzed quantitative surveys to identify how exemplary mental health leaders rate their use of grounded leadership strategies and qualitative semi-structured interviews to identify strategies exemplary mental …

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, …

Race-Based Trauma Care Training For Veteran’S Health Administration Nurse Practitioners, Vanessa Loyd

Dissertations

Abstract

Problem: Trauma informed care has become a priority for persons exposed to psychological, physiological, emotional consequences as a result of traumatic experiences. Veterans are from different cultures, including gender, race, religion, sexual orientation and other social groups. The Veterans Health Administration (VHA) is responsible for the health of this culturally diverse patient population. Healthcare providers without any prior military experience may experience difficulty obtaining an accurate history and physical exam due to the military’s cross-cultural environment. The project aim was to increase confidence and competence in race-based trauma care by incorporating training into a new acute care fellowship …

Traumatic Brain Injuries: A Telehealth Alternative For Veterans, Jessica Dickman

Dissertations

Problem: Traumatic Brain Injuries (TBI) are known as the signature wound of veterans serving in Operation Enduring Freedom (OEF) and the Operation Iraqi Freedom (OIF). After the initial TBI diagnosis, outpatient TBI follow-up rates are reported to be approximately 9% less in the Veteran Healthcare Administration (VA) system when compared to the private sector. The purpose of this quality initiative was to decrease the rate of missed appointments among OEF/OIF veterans using a telehealth alternative.

Methods: The Plan-Do-Study-Act (PDSA) method was used to implement a consistent process for the telehealth visit option. A retrospective medical record review over the same …

From War To Home: The Systematic Issues Operation Enduring And Iraqi Freedom Veterans Face Transitioning With Ptsd, Tiffany D. Ware

Dissertations

Purpose: The purpose of this phenomenological study was to describe the perceptions of Operation Enduring and Iraqi Freedom veterans with PTSD, who are transitioning from active duty to civilian life, regarding their participation in the Disabled Transition Assistance Program.

Methodology: The methodology for this research study will be qualitative from a phenomenological perspective. When thinking of research as it pertains to qualitative methods, it is appropriate to use when a researcher is trying to study the lived experiences of individuals (Flipp, 2014; Patton, 2015). This method will describe perceptions of Operation Enduring and Iraqi Freedom veterans with PTSD, who are …

Improving Veteran Access To Heart Failure Specialty Care: A Change Model Project, Mark Bird Whelchel

Dissertations

Background: Many Veterans Health Administration (VHA) facilities have cardiac services, but not all VHA centers offer heart failure care. Viable alternative models exist to traditional outpatient treatment by physicians, such as Tele-medicine consultations, the use of nurse practitioner run clinics, and the use of models such as Specialty Care Access Network-Extension for Community (SCAN-ECHO) and site specific contracted physician services models. These have the potential to improve Veteran access to care. Objective: The purpose of this change project was to conduct a needs assessment survey, in joint effort with the Hershey Medical Center Heart and Vascular Institute, to identify barriers …

Access And Barriers To Care During Transition From Active Duty To Veteran Status In Veterans With Diabetes: A Look At Health Literacy, Change, And Ongoing Diabetes Self-Management Education, Mark R. Malebranche

Dissertations

Background and Rationale: Transition from active duty to veteran status may be a challenging time, especially for veterans with diabetes. These veterans face multiple changes that can cause distress. Most veterans with diabetes have type 2 diabetes, however a diagnosis of type 1 diabetes on active duty is cause for discharge for active duty.

Purposes and Aims: The purpose of this study was to describe the transition experience of veterans diagnosed with diabetes while on active duty from active duty to veteran status. The study describes barriers and facilitators to healthcare and diabetes self-care management. The four aims of the …

Efficacy Of Mantram Repetition Program On Sleep In Veterans With Posttraumatic Stress Disorder, Lindsay Cosco Holt Phd

Dissertations

Posttraumatic Stress Disorder (PTSD) affects over seven million (3.5%) of the US adult population. In 2011, 476,515 veterans were currently seeking treatment for PTSD. Statistics show that 87% of veterans with PTSD report sleep disturbances and 52% experience frequent nightmares, making sleep the second most common reason why veterans seek mental health care upon return from deployment (Germain et al., 2006). Studies have sought to find a link between PTSD and sleep, and the importance of sleep in the recovery process, but there is a gap in the research on sleep disturbances and interventions for improvement in veterans with PTSD. …

Acupuncture For Sleep Disturbances In Veterans With Post Traumatic Stress Disorder, Heather C. King Phd

Dissertations

Post Traumatic Stress Disorder (PTSD) has emerged as a significant problem among Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans. Disturbed sleep is one of the most frequently reported symptoms among OEF/OIF veterans with PTSD. PTSD itself is impairing, but the burden of this disorder is likely heightened when accompanied by sleep disturbances. Sleep disturbances have been associated with a 75-90% increased risk of co-morbid conditions, increased levels of depression and anxiety, daytime sleepiness and fatigue, reduced psychomotor performance, diminished work productivity, and decreased quality of life. These consequences of disturbed sleep emphasize the critical need for additional evidence based therapies …

Toward A Model For Predicting Depression Among Veterans, Nita Aurora Magee-Cornelius

Dissertations

Major depression, identified as a leading cause of disability in the United States, is often first diagnosed by primary care providers. This disability is associated with increased morbidity, mortality, and a lower quality of life. With approximately one in every three veteran diagnosed with depression and the rate of suicide increasing in the United States military (Department of Veterans Affairs, 2009), the Patient Health Questionnaire-2 items (PHQ-2) can be instrumental in identification and monitoring of depressive symptoms. The purposes of this retrospective study were to determine the prevalence of depression, as measured by the federally mandated PHQ-2 in the VA, …

Health Literacy, Cognitive Impairment, And Medication Adherence In Veterans With Heart Failure, Lee Ann Hawkins Phd

Dissertations

Background: Heart failure (HF) affects 5.8 million people in the United States, costly in terms of patient mortality and morbidity as well as healthcare dollars. One important manifestation of poor HF outcomes is the excessive admission-readmission cycle. Non-adherence to medication is responsible for the majority of HF readmissions. Identification and intervention for key factors contributing to poor medication adherence is critical to improving outcomes. Two such factors prevalent in persons with HF are cognitive impairment (CI) and poor health literacy (HL). There is a paucity of tested interventions designed to improve medication adherence by addressing underlying CI or HL. A …