Digital Commons Network^™

Emergencies: Risk And Personal Preparedness Measures, Charleen C. Mcneill

Nursing Theses and Dissertations

Personal emergency preparedness efforts that increase the resiliency of individuals and communities and decrease the risk for poor outcomes after an emergency are increasingly of interest to health care leaders, policy makers, and governmental entities. The limited capacity for external aid to provide relief in the first 72 hours after an emergency dictates that individuals and communities become prepared to sustain themselves for this initial period. Failure to prepare for an emergency can result in a multitude of negative outcomes. Those who are economically vulnerable are particularly at risk, including a high risk for negative health outcomes. An initial review …

The Effect Of Shared Medical Appointments And Education On Hemoglobin A1c Levels, Gina L. Moore

Evidence-Based Practice Project Reports

Type II diabetes affects millions of people worldwide. Approximately 25.8 million or 8.3 percent of the United States (U.S.) population has type II diabetes. The number of adults in the United States developing diabetes has been projected to double by the year 2030 (World Health Organization, 2013). Diabetes is the leading cause of kidney failure and blindness, as well as the major cause of heart disease and stroke which is the 7th leading cause of death in the U.S. The purpose of this evidence-based project was to determine the effects of education during shared medical appointments with type II diabetic …

Microbial Exposure And Asthma: Applying Strachan’S Hygiene Hypothesis To Nursing Practice, Elisabeth M. Campbell

Senior Honors Theses

The incidence of asthma has risen significantly in recent decades. Asthma is a complex disease process affected by multiple factors including environmental exposure, genetics, epigenetics, and lifestyle. In 1989, the hygiene hypothesis was proposed based on Strachan’s findings suggesting increased exposure to microbes may have protective benefits against allergic rhinitis and eczema. Since that time, research in this arena has exploded as investigators seek to establish a causal link between increased microbial exposure and decreased incidence of allergic disease. The aim of this literature review is to synthesize the current research regarding Strachan’s hygiene hypothesis and identify the nursing implications …

Motivational Interviewing Education For San Mateo County’S Adolescent Healthcare Providers: Focus On Healthy Diet And Physical Activity, Emilie J. Gruhl

Doctor of Nursing Practice (DNP) Projects

Motivational interviewing has been endorsed by San Mateo County as an evidence-based effective form of behavior change counseling. Eighty percent of pediatric healthcare providers in San Mateo County have been trained in motivational interviewing, however 70% of the providers use it less than 50% of the time. The goal of this project was to reeducate the adolescent providers of San Mateo County in motivational interviewing with an emphasis on individualized training and feedback, directed toward healthy diet and exercise. Results of the quality improvement project showed an average 2.5-point increase in provider confidence on a zero to ten-point scale, and …

Effects Of An Osteoporosis Educational Intervention: Knowledge And Self-Efficacy Of Prevention In Young Adult Collegiate Females, Valerie A. Bollenbacher

Evidence-Based Practice Project Reports

Osteoporosis is a silent and potentially debilitating chronic illness. In 2012, the CDC reported that 4.5 million women over the age of 50 were diagnosed with osteoporosis in the United States. Within the next 20 years, 41 million women worldwide are projected to have osteoporosis. The annual financial burden of osteoporosis is estimated to be 19 billion dollars. The objective of this evidence-based practice project was to answer the clinical question: In young adult collegiate females, how does an osteoporosis educational intervention compared to current education effect osteoporosis knowledge and self-efficacy of osteoporosis prevention over a one-month time period? The …

The Effect Of Patient Reminders On Osteoporosis Screenings, Billie-Ann Black

Evidence-Based Practice Project Reports

Osteoporosis is characterized by reduction of bone mass and compromised bone strength, resulting in an increased fracture risk. Since a reduction of bone mass has been shown to be predictive of future fracture risk, prevention strategies target screening those patients at risk for decreased bone mass by using bone mineral density (BMD) dual energy x-ray absorptiometry (DXA) scans. Current national guidelines recommend that all women 65 years and older undergo BMD testing using central DXA every two years. Despite these recommendations, women age 65 years and older still do not participate in this screening. Greater rates of osteoporosis screening could …

Effects Of A Parish Based Heart Healthy Education Program, Kristin A. Kilinski

Evidence-Based Practice Project Reports

Cardiovascular disease is the leading cause of mortality and morbidity in the United States. Some risk factors for cardiovascular disease can be modified which include: diet; physical activity; smoking; hypertension; diabetes; and weight. Various national programs, such as “Go Red for Women” and “Let’s Move,” have been implemented to address this growing epidemic. Community programs are needed as an adjunct to these national initiatives. Thus, a parish based cardiovascular disease educational program would provide for a unique socially and spiritually supportive environment for education at the community level. Research findings indicate that parish based educational programs are effective in increasing …

The Effects Of Education On Cardiovascular Disease Knowledge, Lauren A. Ostrowski-Winkler

Evidence-Based Practice Project Reports

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality for adults in the United States. The three main risk factors for the development of CVD include hypertension, high cholesterol, and tobacco use; these factors are largely prevented or reduced through lifestyle modifications. Researchers indicate that knowledge of CVD mortality has been linked with individual action to reduce one’s CVD risk. Researchers have also indicated that segments of our underserved society, particularly those with the highest CVD mortality rates, are also the least knowledgeable about CVD and their own personal risk. These risk factors were a concern within the …

Dopaminergic Genetic Contributions To Obesity In Kidney Transplant Recipients, Ashley Grimes Stanfill

Theses and Dissertations (ETD)

Background: Kidney transplant recipients are a population who experience a high likelihood of gaining a significant amount of weight (between 6 and 13 kilograms) during the first year after transplantation. However, not all kidney transplant recipients gain weight. Studies have found little difference in physical activity and nutritional intake among those who do and do not gain weight. Immunosuppressant medications have also not been shown to play a substantive role in post-transplant weight gain. Additionally, although some studies have shown that age, gender, and race can influence weight gain, this information does not fully capture the observed variance. These observations …

Screening Asymptomatic Women For Cardiovascular Risk, Kathryn Nelson-Murphy

Evidence-Based Practice Project Reports

Cardiovascular disease (CVD) has long been recognized as a significant health problem in the U.S., and is the leading cause of preventable death in women, collectively causing about one death per minute (Caboral, 2013). A myriad of modifiable risk factors including dyslipidemia, hypertension, smoking, obesity, and type II diabetes are associated with 80-90% of CVD morbidity and mortality. Despite sobering statistics, valid risk prediction screening tools, and national preventive guidelines, adequate screening in clinical practice settings is sadly deficient. An evidence-based practice project was designed and implemented at a large OB/GYN practice in southern Ohio to address this identified gap …

Honor The Molst, Teresa Guarino

Senior Honors Projects

End of life is a topic many people would rather avoid discussing. Even many healthcare providers are uncomfortable with the topic, and they are at the front line in terms of providing information to patients about their care options. Nevertheless, it is a topic of utmost importance. Regardless of what one values and what choices have been made, preferences and desires at the end of life should be honored. This was the aim of documents such as advanced directives, living wills, and durable power of attorneys for healthcare, but they have been found to not be consistently honored. Seeing this …

The Effect Of A Group Lifestyle Coaching Model On Hba1c And Psychosocial Constructs In Low-Income Patients With Type 2 Diabetes, Lillian Tryon, D.N.P.

Faculty Works

The epidemic of diabetes and its complications is concerning, and new approaches need to be explored for fostering better patient outcomes in a cost effective way. This exploratory study examined the effectiveness of a group coaching model on glycemic control, diabetes knowledge, diabetes empowerment, and diabetes self-management compared to usual care or participation in a 90-minute diabetes education class. A convenience sample of 34 patients with type 2 diabetes mellitus was recruited at a clinic providing services to the uninsured. Participants self-selected into the coaching group (n= 12), class group (n = 10), or control group ( …

Promoting Behavior Changes In Patients With Type 2 Diabetes Through Shared Medical Appointments, Shonda Lanette Williams

Doctoral Projects

Diabetes Mellitus (DM) is a chronic disease that affects many individuals in the United States. It was reported that a total of $245 billion is spent annually on both direct and indirect health care costs associated with the treatment of diabetes and diabetic related complications. Diabetes related complications can be prevented or delayed if proper education is done and individuals are willing to practice positive behavior changes and self-manage their disease. The purpose of this doctoral capstone project was to promote behavior changes in patients with diabetes through diabetes self-management education (DSME) in shared medical appointments (SMAs).

This project was …

An Evaluation Of Northwest Arkansas Elementary School Nurses' Perceptions Of Their Role In The Management And Prevention Of Obesity, Margaret Shay Strobel

The Eleanor Mann School of Nursing Undergraduate Honors Theses

The purpose of this study was to investigate the roles and perceptions of elementary school nurses in the management and prevention of childhood obesity within the school environment. An emailed online survey was distributed to school nurses of 35 elementary schools located in Washington County in Northwest Arkansas. The survey used for this study contained 42 questions and was an adaptation of the Minnesota School Nurse Survey, which was developed by Dr. Martha Y. Kubik. The study sample consisted of all school nurses employed by the Elkins School District, Farmington School District, Fayetteville School District, Greenland School District, Lincoln School …

Solving The Obesity Problem One Bite At A Time: A Review Of Interventions, Sally Catherine Davis

Honors Theses

Resource limitations contribute to obesity in southern rural populations. An examination of published research provides evidence related to factors that lead to obesity and to related health consequences. Resource limitations in southern rural areas include a lack of access to healthy foods, a lack of safe areas to exercise or fitness equipment, and a lack of funding to promote the hiring of adequate numbers of healthcare workers to implement prevention programs and treat obesity related diseases. An investigation of obesity rates in Mississippi and Louisiana demonstrate that high rates of obesity exist. Through an exploration of published interventions in both …

Interventions For Childhood Obesity: Evaluating Technological Applications Targeting Physical Activity Level And Diet, Jessica Dipietro

HIM 1990-2015

Overweight and obese children have increased risks for multiple preventable diseases and conditions which can impair their physiological health and significantly increases the overall cost of their healthcare. Free mobile applications and technology for weight loss, dietary tracking, and physical activity may be quite useful for monitoring nutritional intake and exercise to facilitate weight loss. If so, nurses are well positioned to recommend such tools as part of their efforts to prevent childhood obesity and help children and parents better manage childhood obesity when it is present. However, there are no guidelines that nurses can use to determine what applications …

Factors Associated With Physical Activity In Kindergarten Children, Carol Hammonds

Dissertations and Theses (Open Access)

Background: Reversing obesity is an urgent public health need for children: worldwide, in 2011 more than 40 million children under the age of five were either overweight or obese. Increasing intensity and duration of physical activity is a strategy to aid in preventing and reducing obesity. A minimum of 60 minutes per day of moderate to vigorous physical activity is recommended for children. School settings, such as full-day kindergarten, where 74% of children in the United States are enrolled, provide opportunities for population-based interventions to increase physical activity, yet little objective data exist on current levels of physical activity in …

How Do Black Nulliparous Women Cognitively Construct Birth?, Marianne F. Moore

Dissertations and Theses (Open Access)

A focused ethnography was conducted to determine the cognitive constructions about birth described by nulliparous Black women in an urban area of the Southwestern US; also, during postpartum, how do these women reconcile expectations with the actual birth? Semi-structured interviews were conducted before birth and after birth.

Women, 16 or older, 17 - 33 weeks carrying a singleton fetus and without anomalies or problems like pre-gestational diabetes, NYHA Cardiac Class III/IV, cancer, renal failure, or sickle cell anemia that eliminated vaginal birth were sequentially recruited and sampled in an affiliated ultrasound clinic. Women scheduled for an anatomy scan were approached. …

The Reduction Of Central Line-Associated Bloodstream Infections In Intensive Care Units Through The Implementation Of The Comprehensive Unit-Based Safety Program, Michael Andrew Basinger

UNLV Theses, Dissertations, Professional Papers, and Capstones

Central line-associated bloodstream infections (CLABSIs) are one of the most significant healthcare-associated infections (HAIs) in the Intensive Care Unit (ICU) setting resulting in increased lengths of stay, increased healthcare costs, and higher mortality rates (Institute of Healthcare Improvement [IHI], 2012). Evidence that CLABSIs are largely preventable has created opportunities for healthcare organizations to implement evidence-based bloodstream infection prevention practices to reduce or eliminate these infections (Lissauer, Leekisa, Prease, Thom, & Johnson, 2012). Other efforts to reduce CLABSIs include implementation of safety programs to improve the safety culture in ICUs (Lissauer et al., 2012). One program, the comprehensive unit-based safety program …

Impact Of Cue-Based Feeding Protocol On Premature Infants' Outcomes And Hospital Length Of Stay, Diana Michele Easley Cormier

Doctoral Projects

The project was an oral feeding practice change from traditional, gestational-age/volume-driven feeding progression to developmentally-based, infant-driven feeding progression. The infant-driven (cue-based) feeding protocol was implemented with goals to improve premature infants' feeding outcomes, and decreased the infant's length of hospitalization. The project was designed to implement a cue-based feeding protocol for oral feeding initiation and progression, within the neonatal intensive care unit (NICU) at Community Regional Medical Center (CRMC), and then retrospectively evaluate the impact of the cue-based feeding protocol on feeding outcomes. In order to realize full implementation of a NICU feeding practice change, multiple components, such as electronic …

A School-Based Intervention’S Impact On Children’S Knowledge And Self-Efficacy Related To Physical Activity And Nutrition: A Pilot Study, Katherine Turley Jenkins

Theses and Dissertations

Childhood obesity has become epidemic in the United States. One of the best places to combat this problem is within the school system. The purpose of this study was to examine changes in exercise self-efficacy, science interest, and science knowledge of children who participated in a school-based anatomy and healthy lifestyle intervention called Anatomy Academy. In this pilot study, 212 study participants were recruited from 5th and 6th grade children enrolled in one of three charter schools who participated in our 7-week intervention, Anatomy Academy. Children completed four questionnaires pre and post intervention: (1) a science knowledge questionnaire, (2) a …

The Impact Of The Ohana Mana Challenge On Native Hawaiian And Pacific Islander Children, Kristin Kay Van Tassell

Theses and Dissertations

In this four-week, family-focused pilot intervention study, researchers studied the impact of culturally relevant nutrition and activity sessions on eleven children from eight Native Hawaiian and Pacific Islander (NHPI) families. Mixed methods were used in analysis. In their favorite meal drawings, children included more fruits and vegetables at week four than week one, which was consistent with their self-reported intake of healthy foods that were new to them. From week one to four, mean total scores increased on the nutrition and exercise knowledge exercise questionnaire and the physical activity self-efficacy tool; however, the mean total score decreased on healthy diet …

The Relationship Among School Playground Design And Conditions And Physical Activity Levels In Children, Ipuna Estavillo Black

UNLV Theses, Dissertations, Professional Papers, and Capstones

Almost 20% of children aged 6 to 11 years are obese in the United States, tripling over the last ten years. The rise in childhood obesity challenges nurses in their efforts to improve community health and sustainability. A decrease in physical activity (PA) levels has been associated with an increase in obesity. Schools have been identified as a primary setting to provide children adequate amounts of daily PA, and nurses working in the area of child health promotion can work with schools to provide opportunities for children to increase PA levels. The playground is one environment where children can increase …

The Lived Experience Of Black African Nurses Educated Within The United States, Amy Elizabeth Smith

UNLV Theses, Dissertations, Professional Papers, and Capstones

Despite the unprecedented growth of minority populations in the United States, the nursing profession has remained relatively homogenous. Nursing education has increased the number of minority students entering nursing programs; however, attrition rates for minority nursing students are as high as 85% (Gilchrist & Rector, 2007). As the population grows in diversity, the need for nurses who are fluent in foreign languages and who understand minority values, traditions, and cultural practice will be essential in delivering culturally competent care. Improving the retention of minority nursing students is an important step in increasing the diversity within the nursing workforce.

Although several …

Gestational Weight Gain Patterns, Hope R. Farquharson Phd

Dissertations

Background: Managing gestational weight gain (GWG) remains a global health priority as obesity among women of childbearing age and their children have been linked to excessive GWG. Excessive GWG has been linked to increased rates of cesarean sections, preterm births, hypertensive disorders, gestational diabetes, large for gestational age newborns, postpartum weight retention, long-term obesity for the woman and her children. Conversely, adverse outcomes resulting from weight gain below recommendation could potentially include preterm births, increased rates of neonatal intensive care admission, and newborn morbidity and mortality. Previous studies indicate the need for healthcare providers to help women gain within the …

Delirium Rate And Risk Factors In Palliative Care Outpatients And Caregiver Coping Strategies, Sarah Deur Livermore Phd, Fnp

Dissertations

Background: Delirium causes suffering and in terminal illness undermines important goals to die at home. Improved knowledge about delirium among palliative outpatients can lead to improved patient outcomes through early identification and treatment in the home. Conversely, a missed diagnosis leads to costly hospital admissions, and is the most common reason to seek long-term care placement (Breitbart & Alici, 2008). Medicare stresses the importance by listing it as a common cause of falls among non-reimbursed hospital events. Prior evaluation of outpatient delirium rate was 14% among demented community dwelling elders (Steis, Evans, et al., 2012a). It is hypothesized that frail, …

Factors Associated With Abnormal Weights In Infants In The First Year Of Life: Results From The 2010 National Ambulatory Medical Care Survey, Nikaela R. Larossa

Honors Scholar Theses

Purpose: To examine the predictors associated with abnormal infant weights for lengths in the first year of life as seen in ambulatory care settings.

Data Sources: A secondary data analysis was conducted using the 2010 National Ambulatory Medical Care Survey (NAMCS), in which practitioners documented single patient visits. World Health Organization (WHO) growth charts and recommendations were used to evaluate infant weight for length. Of the total visits, 603 infants were less than one year old, and 595 infants were within the length range of the WHO growth charts. Of the 595 cases, 13.6% were underweight, 5.5% were overweight, 41.2% …

The Health-Related Quality Of Life Of Adults With Down Syndrome, Rebecca Jermyn Graves

Theses and Dissertations (ETD)

Purpose. The purpose of this study was to examine the health-related quality of life (HRQOL) and factors associated with the HRQOL of adults with Down syndrome (DS) as reported by adults with DS and their caregivers. The study was designed to compare measures of HRQOL, health problems, health risks, and health-care utilization of adults with DS based on self-report with those from caregiver-report and to explore associations between HRQOL and health problems, health risks, health-care utilization, adaptive behavior, and demographic characteristics. Background. The life expectancy of individuals with DS has lengthened from approximately 30 years around 1960 to over 50 …

Portion Size Selection In Relation To Hemoglobin A1cs, Brian L. Dixon

Undergraduate Honors Theses

Obesity has been recognized as an increasing issue within our country. Obesity contributes to many health related issues, including type 2 diabetes mellitus. Portion size is a factor that has generated clinical research interest. The aim of this study was to determine if there was a relationship between management of diabetes measured by hemoglobin A1c and portion size selection for type 2 diabetics. In this study, subjects selected portion sizes of four different foods. Data were compared to recent A1c levels. Due to the small sample size, nonparametric statistical analysis was used. The relationship of grain portion weight selection and …

Examining General Versus Condition-Specific Health Related Quality Of Life Across Weight Categories In An Adolescent Sample, Autumn G. Dalton

Undergraduate Honors Theses

Approximately 34% of adolescents are overweight or obese which can be accompanied by physical, psychosocial, and economic consequences. Increasingly, pediatric overweight/obesity research has focused on Health Related Quality of Life (HRQoL) as a health outcome. This study examined differences in HRQoL across weight categories in adolescents, specifically, the sensitivity of using a general versus condition-specific measure. Further, the influence of gender was explored.

Data were extracted from Wave 2 of Team Up for Healthy Living, a school-based obesity prevention program targeting adolescents in Southern Appalachia. Participants (N = 918; 50% Female; 93% Caucasian; 90% 9^th graders) completed …