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A Quality Improvement Project To Reduce The Incidence Of Clostridium Difficile Infection Through Implementation Of Evidence-Based Terminal Clean Procedures, Tamara Cook

Theses and Dissertations

Hospital-acquired infections (HAIs) are a huge economic burden and threat to patient health and outcomes. Clostridium difficile is the most common HAI. Effective hand hygiene and proper environmental cleaning procedures are significant to preventing the spread of C. difficile infections. The research question used to guide this project is: Does the use of a monitoring system for post C. difficile isolation terminal clean procedure reduce the rate of hospital-acquired C. difficile in the acute care population? A thorough organizational assessment was performed and directed this project to identify causes that may contribute to the recurrences of C. difficile infections. The …

The Relationship Between Religiosity And Depression Among Sampled Kenyans In The Twin Cities Metro Area, Dorcas Waite

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this study was to assess whether there is a relationship between the self-reported level of religiosity and the self-reported level of depression among sampled Kenyans in the Twin Cities Metro Area, in Minnesota. The sample consisted of 63 individuals who were members or visitors at Destiny Faith Ministries and United Seventh-Day Adventist Church.

Results showed that 98.4% (n=60) of participants identified themselves with a specific religion, 90.4% (n=57) scored 40 and above on the religiosity scale, which indicated strong religiosity. Majority of participants (66.8%, n=42) indicated that they had been bothered for several days by at least …

Bridging Public Health And Clinical Practice: A Pilot Of The Cdc’S Stopping Elderly Accidents, Deaths, And Injuries (Steadi) Fall Risk Screening And Prevention Program In An Academic Medical Center Family And Community Medicine Clinic, Carolyn C. Shammas

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

Background: Fall-related morbidity and mortality in the older adult population is a pressing public health problem both nationally and in Kentucky, which has a fall rate above the national average. Implementation of the CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall prevention program, offers an opportunity to effectively reduce falls, fall-related injuries and associated costs. The implementation process also serves to foster cooperative interdisciplinary and interdepartmental relationships within health care systems, and bridge public health and clinical practice.

Purpose:The capstone describes and evaluates a pilot of STEADI at the University of Kentucky’s Family and Community Medicine (UKFCM) …

The Use Of Seclusion And Restraints In The Inpatient Psychiatric Hospital Setting: A Systematic Review Of The Literature, Angela M. Kaucic

Williams Honors College, Honors Research Projects

The use of seclusion and restraint (S/R) is a practice that has been shown to be potentially harmful to patients on a physical and emotional level. This review examines 20 research publications in order to address the attitudes of staff and service users regarding use of this intervention, as well as to explore how use of alternative behavioral and environmental modification interventions compares to standard nursing care in terms of S/R prevalence. The review found that there are many viable interventions alternative to S/R that are more palatable to patients and nurses. Variability of interventions addressed in the included studies …

Assessment Of The Implementation And The Achievements Of The 3d Approach Within Senegal’S National Family Planning Action Plan (Nfpap), Fatou Mbow, Nafissatou Diop

Reproductive Health

Senegal’s 2012–2015 National Family Planning Action Plan (NFPAP) is based on the 3D approach (Democratization, Demedicalization, and Decentralization). As the plan came to an end and a new one was being developed, the Evidence Project/Population Council conducted a study to document the implementation and achievements of the 3D approach in relation to the NFPAP. This brief offers highlights of the study which used a desk review and qualitative research. It describes lessons learned from the implementation of the approach, and shares good practices that can be adopted by other countries, particularly those of the Ouagadougou Partnership. Finally, the study provides …

Development Of Health Education Materials To Prevent Sexually Transmitted Infections Among University Of Southern Maine Students, Lily Parenteau

Muskie School Capstones and Dissertations

The purpose of this project was to develop health education materials that can be used to educate college students about the risks, symptoms, and prevention measures associated with chlamydia and gonorrhea infections, as well as provide information about current disease information in the state of Maine.

Organizational Learning In A Cardiac Intensive Care Unit: A Learning History, Bret Lyman, Kalene M. Ethington, Carly King, Jonathan D. Jacobs, Hayley Lundeen

Faculty Publications

Introduction: Providing high-quality care to every patient is challenging, particularly in critical care units (CCUs). However, this standard can be achieved through organizational learning. Unfortunately, the process of organizational learning in CCUs is not well understood.

Objective: The objective of this study is to describe the developmental progression of a cardiac intensive care unit (CICU) to reach its current state of reliably excellent clinical performance.

Methods: The method selected for this study was a learning history. A total of 43 individuals with experience working on the CICU participated in small group interviews. Participants included nurses, surgeons, unit clerks, administrators, nursing …

Hospital Administrators' Strategies For Reducing Delayed Hospital Discharges And Improving Profitability, Sheree Boyd

Walden Dissertations and Doctoral Studies

Inefficiencies in leadership and limited leadership strategies in hospitals contribute to delayed hospital discharges and an increased financial burden on a hospital. Three administrators from 2 hospitals who are part of a hospital conglomerate in Chicago, Illinois were selected for interview in this qualitative multiple case study to explore how hospital discharge strategies reduce delayed hospital discharges and improve profitability. Contingency was the primary theoretical theory for this study. The purposive sampling consisted of the selections of individual who were knowledgeable and had experience to organize, manage, and implement processes in an organization. Data collection occurred using face-to-face semistructured interviews, …

Initial Findings Of A Medicare Annual Wellness Visit Program, Hesper B. Nowatzki

Walden Dissertations and Doctoral Studies

Despite the emphasis of benefits on preventive health, many older adults are not receiving the recommended age specific, evidence based screenings and vaccinations. The Medicare Annual Wellness Visit (AWV) is designed to address modifiable risk factors with aging adults and close gaps in care not captured in routine office visits. Although a free Medicare benefit to patients, and a reimbursable service to health care providers, participation in the AWV is low nationwide. The purpose of the project is to introduce an AWV program to a rural health clinic in Northwest Illinois that has a population consisting of over 25% of …

Leadership Strategies For Addressing U.S. Pharmaceutical Drug Shortages And Supply Chain Disruptions, Adrian Grant Scioli

Walden Dissertations and Doctoral Studies

Health care providers in the United States expend more than $400 million in unnecessary direct costs annually managing the effects of widespread drug shortages. Based on the theory of complexity and complex adaptive systems, the purpose of this exploratory multiple case study was to identify the strategies that health care pharmaceutical procurement leaders from the Eastern region of the United States use to address widespread drug shortages. Data were collected from 5 semistructured interviews with pharmaceutical procurement leaders, recorded field notes, and a review of public documents from company websites. Data analysis included deductive and open coding techniques. Emergent themes …

Alleviating Discharge Confusion For Older Patients Using The Teach-Back Method, Tracey Marie Haire

Walden Dissertations and Doctoral Studies

Discharge instructions and medication directions can be overwhelming for older adults, which can lead to potential medication errors, noncompliance, readmissions, and patient safety concerns. At a specialty lung clinic, the goal is to improve patient safety and to decrease the chance of errors by standardizing the discharge process via a Teach-Back education policy and protocol. Without consistency, there is a potential for mistakes and misunderstandings. The Agency for Healthcare Research and Quality (AHRQ) and the Institute for Healthcare Improvement (IHI) considers the Teach-Back discharge method as best practice and should be considered universal practice among health care workers. Using the …

Learning And Working Together: Invoking Systems’ Change Through Inter-Organizational Collaborative Principles And A Learning Community Framework, Brandon Hey

Theses and Dissertations (Comprehensive)

Local communities face significant challenges such as increased inequality, immigration, and global climate change. In order to address these challenges whole cities have to innovate and learn together. In this thesis, I introduce the Learning Community (LC) model, a new way of collaborating and creating collective impact that emphasizes learning, alongside collective impact, as a central strategy to addressing complex social challenges. In a LC, members value the continuous pursuit of knowledge, feedback, and experimentation as well as the flow of information and resources between academic institutions and practice groups. The value of learning is built into key structures …

Introduction Of A Comprehensive Modified Early Warning Scoring System In A Large Rural Hospital, Beth A. Meade

DNP Projects

PURPOSE: To develop and test a comprehensive modified early warning scoring (MEWS) system for use on two medical-surgical-telemetry units in a large rural hospital in northeastern Kentucky; to educate and train nursing staff in utilization of a new MEWS system and early identification and management of clinical deterioration; and to determine nursing satisfaction regarding education, training, and use of a new MEWS system.

BACKGROUND: Adult medical-surgical patients are at risk for clinical deterioration. Rapid response systems and MEWS systems are strategies that have been employed to assist nursing staff in early identification and management of clinical deterioration. Testing of a …

Home Healthcare And Performance: Development And Application Of A Typology For Home Health Agencies, Ronique Nechelle Evans

All ETDs from UAB

This three-paper dissertation sought to examine the existence of strategic groups in the home health industry, the application of Porter’s generic strategies (cost leader, differentiator, “stuck-in-the-middle” and both cost leader/differentiator) in identifying these groups, and the association of group membership with agency performance. The findings of this study will provide researchers and managers with a highlight of the current strategic makeup of the home health industry and its relationship with quality and financial performance. The results of this dissertation provide some evidence that strategic groups do exist in the home health industry and can be described along the basis of …

Interprofessional Education: Theoretical And Practical Considerations For Occupational Therapy Educators, Mary K. Arvin, Lorrie A. George-Paschal, Jennifer S. Pitonyak, Sandee M. Dunbar

Journal of Occupational Therapy Education

Interprofessional education (IPE) is an integral part of occupational therapy education as programs across the United States incorporate IPE into existing courses and develop new, innovative curricula. The American Occupational Therapy Association (AOTA) Commission on Education (COE) proposed in its 2015 position paper on IPE in occupational therapy curricula, that IPE is imperative for effective and ethical practice in today’s healthcare environment. Through participation in a Scholarship of Teaching and Learning program focusing on IPE, the authors examined broad constructs and practical implementation of IPE in occupational therapy education. As occupational therapy educators explore opportunities to collaborate with a diverse …

Evaluation Of A Gender-Relevant Physical Activity After-School Program, Vianay Lopez

Open Access Theses & Dissertations

Background: Physical activity rates have decreased in the past 30 years. Physical activity rates decline further among girls as they reach adolescence, yet studies suggest girls are more inclined to participate in moderate-to-vigorous physical activity (MVPA) while among peers. When in close social networks, girls who have more physically active friends report being more active themselves. Several mentor-based programs throughout the United States have increased physical activity among preadolescent girls, indicating that gender-relevant physical activity programs may reverse their declining rates of physical activity.

Purpose: To evaluate if participation in a gender-relevant physical activity after-school program influenced participants' aerobic fitness, …

A Systems Approach To Moral Distress In Long Term Care, Margaret Lemley

Electronic Theses and Dissertations

Abstract: The question that this dissertation seeks to answer is whether or not a Systems Approach to Moral Distress can serve to positively address issues of moral distress within the Long-Term Care setting. Because moral distress has largely been understood as a phenomenon of the individual, efforts to address and reduce incidents of moral distress have focused almost entirely on the individual and his or her reaction to specific triggers. Building upon the existing literature this dissertation argues that previous efforts to understand moral distress within the healthcare setting have been limiting in two very important aspects. The first …

Prevalence And Factors Associated With Sexual Activites Among High School Students In Kendal Regency, Indonesia, Ekha Rifki Fauzi

Chulalongkorn University Theses and Dissertations (Chula ETD)

Background: The risk of sexual activities among adolescents is high in globally. Unwanted pregnancy, sexual transmitted infections, and HIV are still the big problem in adolescents. This study was involved to exam the prevalence and factor associated with sexual activities among high school students. Methods: A cross-sectional study was conducted around 145 male students and 315 female students. The total populations was 460 students with multistage random sampling technique. A self-reported questionnaire was used including Illustrative Questionnaire for Interview-Surveys with Young People, Sexual Activity Scale and Sex Education Inventory. Descriptive statistics, Chi-square test, and multivariate logistic regression were used to …

Developing Psychiatric Nursing Competencies On An In-Patient Hospital-Based Psychiatric Unit, Beverly J. Sedlacek

Doctor of Nursing Practice Projects

Problem Statement

Offering staff development training for psychiatric nurses has not kept pace with the advances in psychiatric knowledge and skills in nursing. Purpose: The purpose of this quality improvement doctor of nursing (DNP) project was to implement a competency-based staff development program on a community hospital-based inpatient psychiatric unit to determine if the psychiatric/mental health nursing knowledge, nurse patient relational skills, and attitudes of the nurses would improve or change.

Methods

A mixed method of quasi-experimental, non-randomized pre-test/post-test and semi-structured interview design was used, which utilized a convenience sampling approach. Data were collected in two phases. Three domains of …

Be Well: A Systems-Based Wellness Intervention Using Mindfulness In The Workplace – A Case Study, Kate M. Levett, Sharyn Coughlan, Sharon Longridge, Violet Roumeliotis, Jon Adams

Medical Papers and Journal Articles

Introduction: Healthy work environments are essential in determining improved well-being of Australians. Job stress has been identified as a significant factor in psychological distress. This study evaluated the effect of introducing a systems-based workplace wellness programme using mindfulness in the workplace.

Methods: The programme ‘Be Well’ was introduced as part of a systems-based approach to workplace health promotion, and evaluated using sick leave as a proxy for workplace stress, and the stress satisfaction offset score to determine the degree of change in stress and satisfaction.

Results: There was significant reduction in sick leave (2014 vs. 2012) (p<.001), and significant improvement in stress satisfaction offset score (p<.05). Logistic regression analysis identified the programme components most predictive of reduced stress and higher job satisfaction.

Conclusion: The impacts …

The Soldier 360°Orgram: Strengthening Combat-Exposed, Noncommisioned U.S. Army Officers' Interpersonal Sensitivity, Anne Harper

Walden Dissertations and Doctoral Studies

Interpersonal sensitivity is a foundational component of interpersonal relationships. It encompasses an individual's self-concept and self-identity, which are formed as the individual develops. An individual's self-concept develops from the norms and mores of his or her society. Soldiers in the U.S. Army have been trained to form a repurposed self to engage in combat and work in combat-focused jobs. The consequence of this training in many cases has been diminished interpersonal sensitivity that has been detrimental to their interpersonal relationships. The Soldier 360° course is a comprehensive treatment program that takes a holistic approach to providing soldiers with self-empowering tools …

Hourly Rounding: A Fall Prevention Strategy In Long-Term Care, Robyn Mitchell

Walden Dissertations and Doctoral Studies

Falls and injuries related to falls are some of the most common and costly incidents that occur in the long-term care environment. Purposeful hourly rounding is a proactive way for nursing staff to identify patient needs and demonstrate positive fall prevention outcomes. This project examined a process improvement endeavor of a long-term care unit that experienced an increase in the number of falls over 3 months. The purpose was to evaluate whether staff education and implementation of an evidence-based hourly rounding program would affect the number of patient falls. The Johns Hopkins nursing evidence-based conceptual model, Kurt Lewin's change model, …

“Mental Health Day” Sickness Absence Amongst Nurses And Midwives: Workplace, Workforce, Psychosocial And Health Characteristics, Scott Lamont, Scott Brunero, Lin Perry, Christine M. Duffield, David Sibbritt, Robyn Gallagher, Rachel Nicolls

Research outputs 2014 to 2021

Aim

To examine the workforce, workplace, psychosocial and health characteristics of nurses and midwives in relation to their reported use of sickness absence described as ‘mental health days’.

Background

The occupational stress associated with the nursing profession is increasingly recognized and nurse/midwifery absenteeism is a significant global problem. Taking a ‘mental health day’ as sickness absence is a common phenomenon in Australian health care. No previous studies have empirically explored the characteristics of nurses and midwives using such sickness absence.

Design

Online cross-sectional survey.

Methods

Survey comprising validated tools and questions on workplace and health characteristics was distributed to nurses …

Decreasing Primary-Care-Related Emergency Department Visits In The Hispanic Population Using Patient Navigators, Arthur Dominguez Jr.

Walden Dissertations and Doctoral Studies

Primary-care-related emergency department (PCR-ED) visits by Hispanic patients enrolled in a not-for-profit Medi-Cal and Medicare health plan resulted in longer wait times in the emergency department (ED) at a regional medical center in Southern California. This congestion decreased access for those with true emergencies, created capacity issues, increased ED length of stay, and resulted in potential safety risks. This project focused on decreasing PCR-ED visits in the Hispanic population using patient navigators in Southern California. Applying the health belief model and Lippitt's theory of change, this doctoral project involved the creation and implementation of a culturally appropriate, population-specific patient navigator …

Unintended Pregnancies Among Married Women In Sindh Pakistan: Role Of Lady Health Workers, Sumera Aziz Ali, Unaib Rabbani

Community Health Sciences

Background: Unintended pregnancies, which pose substantial risks to both mothers and children, account for 24% of all pregnancies in Pakistan. Door to door visits and service provision by lady health workers (LHWs) may be related to the reduction of such pregnancies, particularly in rural areas. This study aimed to determine the association of knowledge about Lady Health Visitors (LHWs) and door to door visits by LHWs with unintended pregnancies among rural women.
Methods: We conducted a community-based, nested case-control study of 800 pregnant women, identified from the database of an active surveillance mechanism, which registers and follows all pregnant women …

Relationships Between Interprofessional Teamwork And Clinical Management Of, Jacqueline G. Stephens

Walden Dissertations and Doctoral Studies

Diabetes mellitus (DM) is a highly prevalent chronic disease that affects 29 million people in the United States including over 2 million veterans who receive care through the Veterans Administration. Patient-aligned care teams (PACTs) are an interprofessional teamwork system designed to improve outcomes of chronic illness, but empirical explorations of the efficacy of the PACTs have been insufficient. Utilizing the chronic care model, the purpose of this retrospective study was to determine if PACTs have been efficient in the diabetic management of veterans receiving care through a Southeastern VA. Medical records for 114 veterans with type 2 DM were randomly …

Engagement Strategies To Reduce Registered Nurse Turnover In Hospitals, Robert Neeley

Walden Dissertations and Doctoral Studies

Skilled and experienced registered nurse employees are critical to the organizational success and stability of hospitals, but an annual average registered nurse turnover rate of 14% can result in financial losses of millions of dollars annually for the typical hospital in the United States. The purpose of this multiple case study was to explore the engagement strategies hospital nurse managers use to retain registered nurses. The study population included 8 nurse managers employed by hospitals in West Central Florida who have successfully implemented engagement strategies to retain registered nurses. The conceptual framework for the study was based on systems theory …

Leadership Attributes And Behaviors As Predictors Of Organizational Resilience In Academic Health Care Systems, Patti Lynn Besuner

Walden Dissertations and Doctoral Studies

Research intentionally addressing how leadership attributes and behaviors collectively contributed to the socioecological perspective of organizational resilience were not found. This is a problem for organizations who must hire without benefit of how a collective leadership effect might influence their psychological capital. The purpose of this study was to explore whether or not self-efficacy, psychological empowerment, personal resilience, and leadership style were associated with or predicted organizational resilience among clinical managers in an academic medical center setting. Metatheory of resilience and resiliency was used to frame the study. A quantitative correlational design was used. Self-reported data was collected via the …

Implementation Of A Standardized Multifactorial Fall Prevention Program In A Rehabilitation Facility, Shanetta Monique Ancrum-Lee

Walden Dissertations and Doctoral Studies

One and a half million people are currently living in residential care facilities; as the baby boomer generation ages, this number will increase to 3 million. Approximately 3 out of 4 residents of these facilities fall each year, and 10% to 20% of those falls result in serious injuries such as fractures, disability, and a decreased quality of living. The BOUNCE Back fall initiative is a multifactorial program that uses a systematic approach starting on admission and to re-evaluate a resident following a fall. Nursing and therapy uses the Morse Fall Scale and the Elderly Mobility Scale to assess and …

Perceptions Of Community-Based Participatory Research From Community And Academic Members, Ivonne G. Kanko

Walden Dissertations and Doctoral Studies

Community-based participatory research (CBPR) is an increasingly popular form of public health research. However, little is known about the application of CBPR and the levels of involvement for partners in specific phases of the partnership. This phenomenological study addressed the application of CBPR from the perspectives of 7 academic researchers and 6 community members experienced in CBPR. Arnstein's ladder of citizenship participation and the community coalition action theory provided the framework for the study. Semi-structured interviews addressed participants' levels of involvement in the CBPR process, as well as challenges, concerns, successes, and recommendations for improvement. Interview transcripts were analyzed by …