Public Health Commons^™

Implementation Of Lymphedema Education Toolkit For Nurse Coordinators, Heather Gee

Master's Projects and Capstones

Problem: Lymphedema is a chronic condition that develops secondary to cancer treatments such as chemotherapy, radiation, and surgical removal of affected lymph nodes. This swelling in patient’s limbs can cause discomfort and limit mobility, however lymphedema is often not detected until later stages, delaying treatment and patient education.

Context: This quality improvement project was conducted at Hospital S Women’s Cancer Center, an outpatient center specializing in advanced treatments for breast and gynecological cancers. This center has a multidisciplinary team focusing on both the medical and surgical aspects of oncology treatment.

Interventions: An evidence-based lymphedema education toolkit was created for nurse …

Building Trust To Extinguish Burnout: A Qualitative Study Of Hospital, State, And Federal Policies That Impact Pediatric Nurse Burnout In Connecticut, Cecelia Angelica Morello

Senior Theses and Projects

This thesis explores how federal and state governments, as well as individual hospitals, respond or fail to respond to pediatric nurse burnout. The problem of nurse burnout is not new, and can cause nurses to make mistakes on shift, experience increased anxiety and depression, and increase risk of patient death or injury. Solutions to burnout in healthcare workers have been organized at the hospital, state, and federal government level. However, this thesis examines a lack of research on pediatric nurse burnout more specifically. After reviewing the national landscape of hospital-based solutions, short-term policy solutions, and long-term policy solutions, I examine …

Impact Of Medicaid Redetermination On Underserved Populations In Region 7 States: A Review, Brianna Parr

Capstone Experience

When the COVID-19 Public Health Emergency ended in May of 2023, Medicaid began the process of redetermination across the states and returned to its original eligibility rules. Because of this, the healthcare status of many Americans was affected, resulting in the loss of healthcare coverage for millions of people. Of those who have lost coverage, children make up almost half of the total. This paper assesses the negative effects of Medicaid redetermination on children and other underserved populations in communities across the four states in Region 7 (Nebraska, Iowa, Missouri, and Kansas) and identifies programs that these states can implement …

Addressing Equitable Access In A Safety-Net Hospital System: An Implementation Framework, Hillary Alycon

Dissertations: Doctor of Public Health

Acute care organizations face a significant challenge in effectively implementing health equity programs, particularly in rural areas where guidance is often lacking. Despite abundant literature focusing on health outcomes, there remains a noticeable dearth of published data on implementing health equity initiatives. In response to this gap, I present a comprehensive analysis that utilizes readily available, open-sourced data to address this critical issue.

A thorough assessment of the demographic characteristics of acute care facilities within the catchment regions was conducted based on data from reputable sources such as the US Census Bureau, the American Community Survey, and the County Health …

Implementation Of A Standardized Suicide Screening Process In A University Student Health Clinic: A Quality Improvement Project, Addie Grace Strong, Kathryn Dambrino, R. David Phillippi, Linda Wofford

DNP Scholarly Projects

Background: Suicide is a leading cause of death among college age students, prompting the need for evidence-based screening tools like the Columbia Suicide Severity Rating Scale (C-SSRS) to enable early detection and timely intervention. Inconsistencies in suicide screening may pose a risk of missed intervention opportunities. This Doctor of Nursing Practice project specifically aimed to improve the quality and consistency of suicide screening in a university student health clinic by implementing the C-SSRS tool into the clinic workflow during mental health appointments. Methods: Employing a quality improvement framework, this scholarly project followed the Institute for Healthcare Improvement Model for Improvement …

Assessing The Types Of Juvenile Detention Medical Issues: A Focus On Florida, De’Angelo Dean

MUSC Theses and Dissertations

The justice system for young people in the United States has been a source of worry as more people acknowledge the possible adverse outcomes of involvement in the justice system during adolescence. Involvement with law enforcement can lead to various difficulties for young people, such as heightened susceptibility to psychological problems, interruptions in their education, and reduced prospects for achievement in the future. Hence, it is crucial to understand the interplays between the health care for juveniles referred by courts or law enforcement for hospital care to identify opportunities for process and outcome improvements. The interaction between juveniles and the …

Effectiveness Of Antibiotic Stewardship For Healthcare Providers At Urgent Care Clinics, Helen T. Adewole

Electronic Theses and Dissertations

Antibiotics have revolutionized modern medicine; however, the overuse in urgent care and primary care significantly contributes to the global burden of infections resistant to available antimicrobial medicines. Approximately 30% of the antimicrobials prescribed in acute care settings are unnecessary. Patient demand for antibiotics has seemingly skyrocketed following the recent COVID-19 pandemic. Practitioners must be knowledgeable about antibiotic stewardship initiatives, such as the wait-and-see approach, to reduce antibiotic overuse and improve the trajectory of antibiotic resistance and patient health outcomes. The gap in practice was the limited awareness of scientific evidence-based tools to partner with patients and improve antibiotic prescription patterns. …

Improving Dental Students' Knowledge And Confidence In Treating Tobacco Use, Victoria Pierce

DNP Projects

Background: Tobacco use can lead to numerous chronic health conditions. Healthcare professionals in the dental field are in a unique position to broach this issue with patients. Research shows that dental students do not feel equipped to provide tobacco cessation care, citing lack of education on the subject among their top reasons for this.

Purpose: The purpose of this project was to evaluate changes in dental students’ knowledge and confidence related to treating tobacco use after participation in an educational intervention about the 5A’s, behavioral counseling, and first-line prescription medications.

Methods: This quality improvement initiative utilized a quasi-experimental survey design …

Empirical Insights Into Survivorship Care: A Cross-Sectional Study Of Coc Accredited Hospitals In Kentucky, Amanda M. Beckett

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

ABSTRACT

Background:

Cancer survivorship care programs play a vital role in supporting cancer survivors and improving their quality of life. Understanding the landscape of survivorship and the potential barriers is key to optimizing care delivery.

Methods:

The primary purpose of this cross-sectional study was to explore existing cancer survivorship care programs offered by Commission on Cancer (CoC) accredited hospitals in Kentucky. Data from the Markey Cancer Affiliate Network (MCCAN) from 2022 through 2023 was analyzed. Variables included hospital characteristics such as rural code, types of survivorship services offered, and reported barriers to these services.

Results:

Analysis of n=19 CoC facilities …

Assessing Social Determinants Of Health In Primary Care, Vicki Carpenter

Doctoral Projects

The social determinants of health encompass the various circumstances and environments in which individuals reside, develop, labor, and experience aging (Social Determinants of Health, 2022). These variables significantly contribute to the existence of health inequities and disparities within populations. In order to effectively mitigate health disparities, it is imperative to consider the various determinants that influence health outcomes, as this consideration is crucial for advancing the goal of achieving health equity. This public health concern encompasses multiple sectors within our society, necessitating the collaboration of various organizations and communities to effectively address and mitigate its impact.

The fundamental …

Nurse Initiated Standing Orders: A Process Improvement At An Emergency Department In Interior Alaska, Justin D. Melberg

Capstone Experience

Emergency Departments (EDs) are a valuable and limited public health resource. In addition to treating acute medical emergencies, EDs bridge the gaps in urgent care and primary care accessibility, operating twenty-four hours a day, seven days a week, providing care regardless of an individual’s ability to pay. EDs across the country operate at or above capacity regularly, and overcrowding is projected to increase due to decreased facilities and available inpatient beds. Innovative measures are necessary to increase patient throughput and decrease length of stay while maintaining quality care. Nurse initiated standing orders, also known as nurse driven protocols, standing orders, …

Assessing Virtual Versus In-Person Experiential Learning And Medical High-Fidelity Simulation In Medical Student Pediatric Clerkship Training, Andrew Mitchell Berry

Electronic Theses and Dissertations

Simulation and experiential training have been incorporated into medical school training for decades. The utilization of medical simulations has become an invaluable tool in healthcare education and training. However, circumstances such as limited resources, geographical constraints, or global health crises may hinder the feasibility of conducting in-person medical simulations. In these scenarios, virtual medical simulations emerge as a compelling alternative. While there are many ways to accomplish experiential-based learning, many faculty and students feel Socratic learning styles provide the best learning experience.

As medical students had just finished a predominantly virtual preclinical year due to the COVID-19 pandemic, the research …

A Case Study Of The Political Determinant Of Health On The Public Health Crisis Of Malaria In Nigeria, Bisola M. Olumegbon

Electronic Theses and Dissertations

Abstract

Globally, there were about 229 million cases of malaria in 2022. The sub-Saharan African region accounted for 92% of the reported cases and 94% of deaths. Nigeria had the highest number of malaria cases and deaths, representing 27% of global cases. This scholarly project was a case study guided by the political determinants of health. Triangulation of data using thematic analysis was used to identify the political determinants of malaria in Nigeria and to understand how the concept of interaction contributes to the persistence of the disease. The analysis involved a deductive and inductive approach based on the literature …

Sex And Gender Differences In Arthritis Health Information, Tania Al-Jilawi

Electronic Thesis and Dissertation Repository

Arthritis is a common disorder that may result in pain and inflammation, making it challenging to move or continue being active. Arthritis comes in a variety of forms. The two studies of this thesis aimed to identify the influence of intersectionality, especially sex and gender, in arthritis. The first study, a structured review, evaluated the inclusion of sex/gender and intersectional identities in patient resources of three arthritis societies: the Canadian Arthritis Society, the American Arthritis Foundation, and the National Rheumatoid Arthritis Society. The appraisal tool, the Sex/Gender and Intersectional Considerations in Patient/Consumer Health Information Appraisal Tool was used to evaluate …

Exploration Of The Implementation Of An Integrated Electronic Laboratory Information Management System On Quality Diagnostics Service Indicators At A County Level Public Hospital In Western Kenya., Kelly Allen

Capstone Collection

Underinvestment in pathology and laboratory capacity caused by low visibility in research and in prioritization by public health leaders results in limited effective healthcare coverage and an estimated 1.1 million premature deaths annually in Low-and-Middle-Income Countries. Kenya’s public health laboratories provide a median 41% of the Essential Diagnostic List to their patients and in Kisumu County, as much as 44.2% of the population has little to no access to essential diagnostics. The government of Kisumu implemented the county Health Laboratory Strategic Plan 2018-2022 to address this public health challenge. Little information exists on the effectiveness of these initiatives and the …

Improving Access To Cardiac Catheterization, Sunitha Dharman

Student Scholarly Projects

The American Heart Association lists cardiovascular disease as the underlying cause of death for 874,613 people who lost their lives in 2019 (Tsao et al., 2022). On average, someone in the United States has a myocardial infarction every 40 seconds, and someone dies of a stroke every 3 minutes and 30 seconds. Studies support coronary artery disease as a significant contributor to cardiac arrest in a non-hospital setting (Yannopoulos et al., 2019). The authors provide evidence supporting the importance of early cardiac catheterization. There is a 10-15% survival rate with a higher level of functioning compared to delayed or no …

Review Of The Literature: Analysis Of The Effectiveness Of Mobile Integrated Health - Community Paramedicine Programs In Reducing Pre-Hospital Ems Calls And Transportations, Annika N. Schultz

Doctor of Medical Science (DMSc)

Pre-hospital Emergency Medical Service (EMS) systems, including fire departments and ambulance transport services, are increasingly overburdened with high call volumes and unnecessary utilization of services leading to provider burnout, depletion of resources and rising healthcare costs. Many local EMS systems have recognized a need for a more sustainable solution to help reduce the number of unnecessary 9-1-1 calls and transportation to the Emergency Department (ED). Local agencies are beginning to expand the role and scope of practice for paramedics through programs referred to as Mobile Integrated Health – Community Paramedicine (MIH-CP). This new branch of medicine aims to provide patient-centered …

Enhancing Adherence To Best Practice Guidelines Related To Pressure Injury Prevention In The Operating Room At A Children's Hospital During Comprehensive Dental Procedures., Alyce Bailey Seaver

Doctor of Nursing Practice Papers

Background: 1,600,000 patients develop a hospital-acquired pressure injury every year, and 23% of these originate during surgery. Research has demonstrated that the incidence of hospital-acquired pressure injuries developing during surgery has risen over the past 5 years. This rise has been attributed to nurse circulators exhibiting poor knowledge regarding best practices for intraoperative patient positioning and intraoperative documentation that does not follow standards of care.

Purpose: This quality improvement project aimed to enhance circulator knowledge on best practices for intraoperative patient positioning and improve documentation of intraoperative patient positioning in the electronic medical record to comply with standards of …

Hypertension: Care Management Program And Medication Adherence, Courtney Montgomery

Student Scholarly Projects

Practice Problem: Medication adherence is a major concern in healthcare as it is a contributing factor to uncontrolled hypertension and resistant hypertension. Uncontrolled hypertension can lead to strokes, heart attacks, kidney failure, and even death.

PICOT: The PICOT question that guided this project was in Medicare Advantage members with hypertension located in Kansas, who were admitted to the hospital or emergency room identified by stratification (P), does care management utilization using hypertension clinical guidelines (I), compared to the stand-alone hypertension clinical practice guideline (C), improve medication adherence (O) over 10 weeks (T)?

Evidence: Hypertension is one of the leading preventable …

Establishing A Routine Process Of Medication Reconciliation In A Rural Primary Care Clinic To Address Unnecessary Polypharmacy In Patients 65 And Older, Jessica Kirkwood-Harp

Doctor of Nursing Practice Projects

Background: Medication safety by reducing the proportion of older adults who use inappropriate medications is a Healthy People 2030 goal (Office of Disease Prevention and Health Promotion, n.d.(a)). The research for this proposal supported an established medication reconciliation (MR) to reduce errors and adverse drug events (ADEs). Consistent MR is essential for patient safety and positive patient outcomes in rural outpatient primary care clinics, as these patients possess multiple comorbidities.

Purpose: This Doctor of Nursing Practice (DNP) quality improvement project (QIP) established a routine MR process within a rural primary care clinic with reduced unnecessary polypharmacy and decreased risk of …

Exploring The Experience Of Disclosing In The Workplace, Jillian Auger

Electronic Thesis and Dissertation Repository

An alarming rate of workplace violence/harassment is observed each year, with negative outcomes that affect the organization (i.e., financial loss) and those directly involved (i.e., job loss, financial strain, fear of being blamed, being labeled a ‘troublemaker’). The literature indicates that, for many victim-survivors, there is little hope for positive outcomes following a disclosure of workplace violence/harassment. In fact, some studies show that negative reactions to disclosure can compound and intensify the impact of violence/harassment on psychological functioning. However, minimal research has been devoted to the experiences of victim-survivors regarding the outcomes of a disclosure. Utilizing virtual semi-structured interviews, the …

Feasibility Of Family Focused Obesity Screening In Primary Care, Adrianne Griffiths

Doctor of Nursing Practice Final Manuscripts

Background: Obesity is associated with serious medical conditions including diabetes, hypertension, and heart disease. It also contributes to decreased productivity at work and school, financial strain, and reduced quality of life.

Purpose of Project: To address this problem, a nurse practitioner-led screening and intervention program was piloted at a primary care clinic in southern San Diego. The tool provides a standardized method for screening individuals and their families for nutrition and physical activity deficits associated with obesity, as well as appropriate and effective interventions to prevent and manage obesity.

Methods: The Family Nutrition and Physical Activity (FNPA) screening tool is …

Using Drama Therapy To Foster Peer Support Among Nurse Leaders, Chyela Rowe

Expressive Therapies Dissertations

This study explored the use of drama therapy to support the social-emotional experiences of nurse leaders at a mid-sized regional hospital system in the Southeastern United States. Nurse leaders have experienced profound changes to their work environments in recent years and burnout has been at an all-time high among healthcare workers globally. Organizational supports for nurses and nurse leaders are both inadequate to meet the needs and under-resourced. The research questions explored 1) whether the drama therapy peer support initiative improved outcomes and 2) whether there was a significant relationship between measures, and 3) what nurse leaders described as facilitators …

Exploring The Relationship Between Nurse Supervisor’S Servant Leadership Behavior And Nursing Employee’S Self-Assessment Of Engagement And Burnout In Nigeria, Michael Otuwurunne

Seton Hall University Dissertations and Theses (ETDs)

Burnout is a problem among workers in Nigeria, especially among nurses (Ozumba, & Alabere, 2019). This study examined whether there was a significant relationship between the employee perception of the servant leadership behaviors of the nurse supervisor and the employee’s self-rating of burnout: exhaustion and disengagement, and servant leadership behaviors of the nurse supervisor, and engagement: vigor, dedication, and absorption. Exhaustion refers to an intensive physical, affective, and cognitive strain while disengagement refers to the distancing of oneself from one’s work, and experiencing negative attitudes toward the work object, work content, or one’s work in general (Demerouti et al., 2001). …

Medical Interpreters' Work Impact On Their Lives: Understanding Medical Interpreters' Work Experience, Nicholas M. Herrarte Smith

Senior Honors Projects, 2020-current

Medical interpreters in the US are crucial health workers that specialize in facilitating communication between non-English-speaking patients and English medical professionals. Although much research has been done regarding the positive impact of professional medical interpreters on LEP (limited English proficient) patients' health, it is less known how medical interpreters’ lives are impacted in this line of work. Thus, this study was aimed at gaining a better understanding on the impact that this line of work has on the lives of medical interpreters. For this study, a survey was created with questions regarding demographics, interpretation’s certification process, interpreter’s satisfaction/experience, and mental …

How Medical Cannabis Took Root In Mississippi, Loral Winn

Honors Theses

How Medical Cannabis Took Root in Mississippi

(Under the direction of Dr. Iveta Imre)

How Medical Cannabis Took Root in Mississippi is a multimedia journalism piece that follows the timeline of medical cannabis’ legalization in Mississippi through the lives and lenses of characters from each sector of the medical marijuana industry. Written in a journalistic style with hints of narrative methods, the article tells the story of medical cannabis advocates, current patients, state registered practitioners, dispensary owners and employees, and a family-owned cultivation facility while also providing concrete evidence and facts about the legislation and regulations included in the state’s …

Regulatory Implications Of Inadequately Designed Pimavanserin Drug Trials Published With Risk Of Bias On Expedited Regulatory Approval Processes, Benson Law

Electronic Thesis and Dissertation Repository

The objective of this retrospective critical appraisal study was to determine if the trials submitted to the Food and Drug Administration for the expedited approval of pimavanserin was of sufficient methodological quality to ascertain its safety and efficacy. After the general metrics of the trials were assessed, the Risk of Bias 2 tool and the PRagmatic Explanatory Continuum Indicator Summary tool were employed to evaluate the risk of bias and the design suitability of the trials. This study suggests that the decision to approve pimavanserin for the treatment of Parkinson’s Disease Psychosis failed to meet the threshold of evidence normally …

The Effects Of Peers For Young Adults On Anxiety And Quality Of Life For Young Adults With Autism Spectrum Disorder, Alysha Cecile Dagg

Electronic Theses and Dissertations

Social skills deficits as well as comorbid anxiety are two characteristics commonly experienced by people with Autism Spectrum Disorder - Level 1 (ASD-1; American Psychiatric Association, 2013). These characteristics are also both contributors to a lower quality of life for young adults (Smith et al., 2019). The current study aimed to identify how the quality of life and anxiety are affected by social skills intervention, specifically the PEERS® for Young Adults program (Laugeson, 2017). PEERS® for Young Adults is an evidence-based social skills intervention intended to support individuals with ASD-1 (Laugeson, 2017). Prior research has demonstrated its success in both …

A Realistic Path Towards A More Affordable Healthcare System For The United States, James Loome

Honors Theses

This study was performed in order to try to discover ways in which the American healthcare system can improve and become more affordable for its citizens. The main focus was to see how implementing a universal healthcare system could benefit the United States. I analyzed aspects of many different universal healthcare system structures and chose aspects that I think should or should not be included in a revised version of the US healthcare system. There was a strong focus on the aspects of Japan and Costa Rica’s healthcare systems. I also pointed out weaknesses in the US healthcare system that …

Medication Errors In Pediatric Care And Preventative Solutions, Tyler Tidwell

Political Science Undergraduate Honors Theses

The research presented extensively examines previous reports covering pediatric medication errors (PMEs). Utilizing specific studies into the frequency and types of medication errors along with public surveys and policy discussion, the data and suggestions here provide commentary on the scope of PMEs, suggested institutional reform, and most importantly, legislative recommended action necessary to stymie the tide of PMEs. A significant portion of the research contained fixates on the literature review to provide ample familiarity with the background and scope of PMEs, but the subsequent sections will discuss their implication. After providing details on the magnitude of the issue, regulatory and …