Digital Commons Network^™

Predicting Access Barriers And Facilitators To Pediatric Specialty Care Among Children With Complex Chronic Conditions, Elisabeth Vestal

MUSC Theses and Dissertations

Children with complex chronic conditions (CCC) face healthcare inequities when accessing pediatric specialty care. Social or economic barriers may exacerbate the challenges faced by families with a child/children with CCC and include increased geographical distance to specialty services, familial poverty, inadequate neighborhood resources, and food insecurity. Understanding how social and economic factors may impact equitable access to care are essential in improving health outcomes for children with CCC. The first manuscript in this compendium is an integrative review focused on the barriers and facilitators of accessing pediatric specialty care for rural dwelling children with CCC. The second manuscript presents a …

Shared Trauma: An Evolutionary Model Concept Analysis In Light Of Covid-19, April Hutto, Phyllis Raynor Phd, Aprn, Pmhnp-Bc, Beverly Baliko Phd, Rn, Pmhnp-Bc

Publications

Shared trauma (ST) is a term historically applied to social work experiences, but other healthcare professionals (HCP) also experience ST. With the occurrence of COVID-19, ST has impacted HCP globally and has led to new discoveries and more questions regarding its scope, impact and duration. This article aims to explore the concept of ST applied to nurses in light of COVID-19 using the Rogers and Knafl Evolutionary Model for Concept Analysis. Further examination and evolution of ‘shared trauma’, particularly during COVID-19, has led to the development of an adapted model to explore the implications of ST on health-related outcomes for …

A Scoping Review Of Substance Use Brief Interventions In Africa, Florence Jaguga, Sarah Kiburi, Eunice Temet, Matthew Aalsma, Mary Ott, Rachel Maina, Cyprian Mostert, Lukoye Atwoli, Juddy Wachira, Gilliane Kosgei

Internal Medicine, East Africa

Background: The burden of substance use in Africa is substantial. Brief interventions (BIs) are a recommended public health strategy for the prevention and early intervention for substance use problems. The objective of this scoping review was to map the literature on substance use BIs in Africa, identify gaps, and provide directions for future research.

Methods: The scoping review was guided by the Arksey O’Malley Framework and the PRISMA-Scoping review (PRISMA-ScR) guidelines. A search of five bibliographic databases (PubMed, PsychINFO, Web of Science, Cumulative Index of Nursing and Allied Professionals (CINAHL) and Cochrane Library) was conducted from inception until 1st November …

Conceptual Considerations For Understanding Resilience In Healthcare Students, Claire Donnellan, Deepthi Chakkittakandy, Christina Lydon

Research outputs 2022 to 2026

Aims: Increasing attention has been given to the concept resilience in the context of healthcare especially during and post the COVID pandemic. Much of the inquiry and evidence reported has focused on promoting or enhancing resilience in healthcare for improving the quality of care and reducing medical negligence. This discursive paper aims to highlight how resilience is conceptualised and identify any potential limitations or gaps in the context of healthcare students, acknowledging considerations for further development and research into this topic. Design and Methods: This discursive discussion draws on relevant theoretical underpinnings from the fields of adjustment and coping psychology, …

How Do Older Adults Define A Good Death? A Scoping Review, Ellen L. Csikai, Quentin R. Maynard

Midwest Social Sciences Journal

A scoping literature review of the concepts of ‘good death’ and ‘dying well’ among older adults was conducted. The purpose was to identify aspects that older adults specifically considered important in defining a ‘good death’. The search revealed five articles published between 2005 and 2019 that met inclusionary criteria for the review. Primary among the views of the older adults in these studies of a ‘good death’ was the desire to avoid being a burden to families; done so by dying pain-free/peacefully (preferably in sleep) and preparing in advance by involving family in decisions and funeral/estate planning. Family support throughout …

Screening, Brief Intervention, And Referral To Treatment For Pregnant Women, Rebekah Feeney

Dissertations

Abstract

Background: In the United States, 10-20% of pregnant women reported using drugs during pregnancy. Current recommendations are to screen for drug use in all patients and provide a brief intervention and referral to treatment. The purpose of this quality improvement project was to evaluate the impact of implementing a standardized screening, brief intervention, and referral to treatment (SBIRT) protocol for first-trimester pregnant patients who are seen in the obstetrical department.

Methods: The Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) screening tool was administered to first-trimester pregnant women, 13-45 years of age, seen in the obstetrical department from …

Postpartum Depression Screening In The Neonatal Intensive Care Unit At A Tertiary Pediatric Hospital, Abbie Bates

Doctor of Nursing Practice Final Manuscripts

POSTPARTUM DEPRESSION SCREENING IN THE NEONATAL INTENSIVE CARE UNIT AT A TERTIARY PEDICTRIC HOSPITAL

By

Abbie Kim Bates

Razel Bacuetes Milo, PH.D. DNP., FNP-C

Background: Postpartum depression (PPD) is a treatable mood disorder with an onset at 1-3 months after childbirth. In the United States, PPD occurs at a rate of 1 in 8 women and as high as 1 in 5 women in parts of the country. In unique populations such as the neonatal intensive care unit (NICU), PPD rates can be as high as 40%. The treatment rate for PPD is 50% with a sizable percentage of …

Paths Initiative: Identifying Potential Sex Trafficking Victims In The Emergency Department Setting, Kayla Mabery

Doctoral Dissertations and Projects

The Physical signs, Appearance, Talk and communication, History and background, and Support and resources (PATHS) education initiative has proven to be a valuable tool in enhancing the identification and support of sex trafficking victims in healthcare settings, particularly in emergency departments. The training led to significant improvements in the participants' knowledge, confidence, and practical application of skills necessary to recognize potential victims. Despite the limitations of limited participant numbers and lack of face-to-face training, the initiative's positive impact underscores the need for continued efforts in this area. By incorporating the PATHS tool into regular professional development programs and standard operating …

Improved Clinical Outcomes Due To Gfr-Based Clinical Interventions For The Prevention And Treatment Of Renal Disease As It Relates To The Veteran Population Managed By A Patient-Aligned Care Team, Sidneca Evangella Hazward

Doctoral Dissertations and Projects

The purpose of this study was to understand if the use of eGFR (CKD-EPI 2021) in the absence of race modification influenced early detection of renal disease for veterans managed by patient-aligned care teams. A retrospective cohort study design was used, analyzing patient data from the Department of Veterans Affairs Medical Center (VAMC). The study included veterans with available serum creatinine, albumin, eGFR, CKD-EPI 2021, etc. measurements and demographic data. The study employed a systematic data review of electronic medical records from 2019 to 2024 and utilized electronic data collection through a computerized patient record system (CPRS) data collection system. …

Reducing The Incidence Of Frequent Hospital Readmissions In Veterans Population, Dasari Reddy

Student Scholarly Projects

Practice Problem: Veterans hospital readmission problems are challenging, specifically in the heart failure department, which severely impacts the patient's health, mortality, family, and quality of life. Frequent readmissions increase the usage cost, hospital budget, and loss of time from providers to other veterans, and failure to meet the key guidelines of the Center for Medicare and Medicaid for improvement.

PICOT: The PICOT question that guided this project was, in veterans with heart failure and one or more frequent hospital readmissions discharged in the last 30 days(P), does the appointment of a dedicated discharge nurse practitioner as a coordinator(I), compared to …

Companion Dogs And Depression, Anxiety, And Posttraumatic Stress Disorder In Adult Icu Survivors: A Scoping Review, Lindsey Nelson, Sue Lasiter, Amanda Emerson

People and Animals: The International Journal of Research and Practice

Intensive care unit (ICU) survivors are at risk for developing persistent psychological sequelae that have been linked to decreased quality of life and increased mortality after hospital discharge. Standardized evidence-based treatments are lacking, mainly focus on physical rather than psychological recovery, and often occur in formal settings. Benefits of human– companion dog relationships have not been explored in the ICU survivor population before. Thus, the purposes of our review were to summarize the literature focused on the influence of companion dogs on depression, anxiety, and posttraumatic stress disorder (PTSD); identify what is known about the potential role companion dogs play …

Patient Experiences With An Mhealth App For Complex Chronic Disease Care: Connections Despite Lack Of Traditional Clinical Interactions, Jenney Lee, Melissa Cheyney, Michael A. May, Marit L. Bovbjerg

Patient Experience Journal

Chronic diseases are costly to treat and burdensome for patients. Mobile health (mHealth) technologies might reduce costs of care and increase patient self-efficacy in chronic disease management, but the patient experience of mHealth is poorly understood. Our objective, therefore, was to evaluate patient experiences with using an mHealth app for complex chronic disease management, within a U.S. population of low-income patients. We used nurse/patient text messages from an mHealth complex chronic disease management tool, and exit interviews from patients, to assess qualitatively Medicaid patients' experiences with a remote monitoring mHealth app. Salient themes about the patient experience included: (1) Visibility …

Navigating Change: Cultivating Faculty Support For Curriculum Revision Through The 4ms Framework, Sarah Dearing

Doctor of Nursing Practice Projects

Public campaigns have increased awareness of Alzheimer’s disease and other dementias, however, education for healthcare providers concerning brain health and appropriate screenings to identify elderly patients at risk is not present. This curricular policy change project outlines the need for faculty buy-in to complete a curriculum change that addresses the lack of geriatric-evidence based education within an Associate of Applied Science in Nursing (AASN) program. Qualitative data identifies the amount of geriatric-evidence based education present in the current AASN curriculum map. Using Lewin’s change management theory (CMT) and the Cognitive-Affective-Social Theory of Learning Environments (CASTLE), an educational module teaching the …

“It Is Like A Curse”. The Lived Experiences Of The Intersection Of Intergenerational Violence, Pregnancy, And Intimate Partner Violence Among Urban Wisconsin Indigenous Women, Jeneile Luebke, Nicole Thomas, Yamikani B. Nkhoma, Angela R. Fernandez, Kaylen M. Moore, Alexa A. Lopez, Lucy Mkandawire-Valhmu

College of Nursing Faculty Research and Publications

Background

Intimate Partner Violence (IPV) is a significant public health concern that disproportionately impacts Indigenous American women more than any other ethnic/racial group in the United States.

Purpose

This study aims to inform the work of nurses and allied health professionals by providing insight into the lived realities of Indigenous women in urban areas and how IPV manifests in the lives of Indigenous women.

Methods

Postcolonial and Indigenous feminist frameworks informed this qualitative study. Using thematic analysis, we analyzed data from semi-structured individual interviews with 34 Indigenous women in large urban areas in the upper Midwest.

Findings

This manuscript discusses …

Barriers To Implementation Of Practice Guidelines In Heart Failure, Mary Geisenhof

DNP Projects

In 2022, the most recent guidelines for care of the patient with heart failure (HF) were released by the American Heart Association (AHA), the American College of Cardiology (ACC), and the Heart Failure Society of America (HFSA). In summary, this group did not recommend fluid restriction for patients with heart failure, unless they are in the end stages of heart failure, and only if fluid restriction may be beneficial (Heidenreich et al., 2022). Despite this recommendation, some providers and nurses continue to restrict fluids. The aim of this DNP project, therefore, was to analyze barriers to implementation of best practices …

Assessing Medical Adherence In A Volunteer Community Health Clinic, Jessica Clark, Matthew Anderson, Janelle L. B. Macintosh, Corinna Trujillo Tanner, Kristen Erekson

Student Works

Purpose: The purpose of this project was to identify the rates of and reasons for nonadherence in medical follow-up care among patients who utilize the Volunteer Care Clinic (VCC).

Background: The VCC is a free outpatient care center for acute medical conditions. The VCC serves uninsured, low socioeconomic residents of Utah County, and many of the patients who come to the clinic primarily speak Spanish. The director of the VCC expressed concern that patients who were assigned medical follow-up care to complete after their visit were not completing these assignments. Nonadherence is associated with increased costs, more hospitalizations, and worse …

Bridging The Gap: Psychopharmacologic Education And Side Effect Screening For Non-Prescribing Mental Health Professionals, Elaine Fitzgerald

Dissertations

Abstract

Problem: The United States is experiencing a growing demand for pediatric mental health support. Surges in mental health diagnoses and psychotropic medication prescriptions have occurred, compounded by a shortage of psychiatric providers. Non-prescribing mental health professionals are well-positioned to recognize psychotropic medication side effects. However, psychologists and counselors lack formal pharmacology education.

Methods: The quality improvement (QI) initiative was guided by the Plan-Do-Study-Act (PDSA) model. The evidence-based psychopharmacologic education for non-prescribers utilized a quasi-experimental pre- and post- test design. Data collected from clinicians included knowledge, confidence, and skill concerning psychotropic medications. The Psychotropic Medication Monitoring Checklist (PMMC) screen clients …

Improving Mental Health Outcomes For Amputees, Zachary Elmore

Dissertations

Problem: depression, anxiety, and other mental health disorders are more commonly diagnosed in the amputee population related to changes in mobility, activities of daily living, and quality of life (Turner et al., 2020.) As the amputation population is projected to reach over 3 million Americans in the next 25 years, additional screening is imperative to identify patients at high-risk for mental health deterioration (Ziegler-Graham et al., 2018).

Methods: this was a project that included screening all patients with the Personal Health Questionnaire for Depression (PHQ-8) meeting the inclusion criteria of being admitted to 7500 Vascular Surgery at Barnes-Jewish …

Neonatal Nurses’ Intention To Stay In The Nicu, Carolyn Penn-Griffin

Walden Dissertations and Doctoral Studies

Neonatal nursing leaders and national health care organizations within the United States are concerned about the recent shortage of skilled and experienced neonatal intensive care unit (NICU) nurses that may reduce the quality of care delivered to NICU patients. NICU nurses are passionate about caring for premature and ill full-term infants and providing educational and emotional support for their parents, some NICU nurses remain in the NICU long-term, yet others contemplate leaving the specialty. The purpose of this qualitative interpretative phenomenological research guided by Martin Fishbein and Ajezen’s theory of reasoned action was to explore the lived experiences of NICU …

Improving Transitions In Care Through Early Discharge Planning: A Quality Improvement Initiative., Sarah Markgraf

Doctor of Nursing Practice Papers

Background: A substantial body of evidence has shown transitions in care are one of the weakest links in healthcare networks, especially for older adults with complex comorbidities. Residents receiving short-term rehabilitation (i.e., rehab) transitioning to home from a skilled nursing facility (SNF) are the most vulnerable in the first 30 days post-discharge for adverse resident events, including avoidable rehospitalization. Avoidable rehospitalizations cost Medicare billions of dollars annually and lead to poor resident outcomes. Early discharge planning in SNFs for short-term stay rehabilitation has decreased rates of avoidable rehospitalizations, improved quality of life in geriatric residents, and improved care partners' perceived …

Reducing Stress And Improving Mindfulness Practices Among Mental Health Professionals Through Guided Meditation., Liara G. Patton

Doctor of Nursing Practice Papers

Abstract

Background: Chronic exposure to psychological stress places mental health providers in a vulnerable position when coping skills are not learned or available. Mental health providers are at risk for both mental and physical illness due to the empathetic demands of their client’s stressors. The deficit in adequate coping skills can cause provider-client relationships to suffer and create an undesirable work environment.

Setting: This project took place in Somerset, KY, at a mental health company called A New Beginnings Achievement Center (ANBAC). Twenty-six employees work at ANBAC, all of whom are involved in providing mental health services to developmentally delayed …

Using Visual Thinking Strategies To Increase Empathy Levels In Inpatient Psychiatric Nurses: A Quality Improvement Project, Katharine E. Harding

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Research indicates that empathy is declining in today’s behavioral health nursing workforce. Purpose: The aim of this quality improvement project was to apply an evidence-based Visual Thinking Strategies intervention to the clinical problem and increase empathy levels from pre-survey measurement among psychiatric nurses. Method: VTS methodology was employed through in-person interviews where participants viewed art-based images pertaining to mental health. Feedback from semi-structured questions was shared among participants. Pre and post-test interventional quantitative data via The Jefferson Scale of Empathy-Health Provider version (JSE-HP) and The Interpersonal Reactivity Index (IRI) instruments were collected. Inclusion Criteria: Participants were voluntarily recruited …

Sexual Quality Of Life In Sexual And Gender Minority Women After Cancer, Heather Schneider Miles

Theses and Dissertations

Sexual quality of life (SQoL) is a critical aspect of well-being, encompassing physical, emotional, and social dimensions. For sexual and gender minority women (SGMW)—lesbian, bisexual, transgender, or queer—cancer presents unique challenges. This dissertation examined the relationships between cancer treatment symptoms, social support, and communication with the cancer care team (CCT) on SQoL among SGMW survivors of breast, gynecological, and colorectal cancers. Quantitative data from 37 participants were collected using PROMIS® measures, assessing demographics, treatment history, post-treatment symptoms, perceived social support, and communication with the CCT. Additionally, in-depth interviews with five participants provided qualitative insights into their experiences and the meaning …

Sex Workers’ Experiences Of Screening For Intimate Partner Violence, Jessica L. Zemlak, Kamila A. Alexander, Deborah Wilson, Randi B. Singer, Joni S. Williams, Susan G. Sherman

College of Nursing Faculty Research and Publications

Objective

To examine experiences of intimate partner violence (IPV) screening among women who sell sex.

Design

A qualitative descriptive study.

Setting

Telephone interviews during the COVID-19 pandemic (June 2020 to October 2020).

Participants

Women aged 18 to 49 years who sold or traded sex for food, drugs, money, or shelter at least three times during the past 3 months before recruitment (N = 22).

Methods

We used individual, semistructured telephone interviews to collect data about participants’ experiences with IPV and IPV screening during health care encounters. We used reflexive thematic analysis to examine these data.

Results

We identified two …

Trauma- And Violence-Informed Empowering Care For Sexual Assault Survivors, L. B. Klein, Jessica Melnik, Kimberly Curran, Jeneile Luebke, Kaylen M. Moore, Ashley Ruiz, Cassilynn Brown, Diara Parker, Isabel Hernandez-White, Kate Walsh

College of Nursing Faculty Research and Publications

Background

Forensic nurse examiners, including sexual assault nurse examiners, provide care for survivors holistically through healthcare, emotional support, connection to follow-up care, safety planning, and, if desired, evidence collection to aid in the prosecution of sexual assault. There is increasing recognition that trauma-informed care must also include an understanding of the impacts of structural violence on minoritized patients to ensure health equity.

Aim

To help address this guidance gap, we expanded Campbell and colleagues' empowering care model using a trauma- and violence-informed care (TVIC) lens.

Methods

We used an iterative discussion-based process that included five joint meetings between a seven-member …

Neonatal Nurses’ Intention To Stay In The Nicu, Carolyn Penn-Griffin

Walden Dissertations and Doctoral Studies

Neonatal nursing leaders and national health care organizations within the United States are concerned about the recent shortage of skilled and experienced neonatal intensive care unit (NICU) nurses that may reduce the quality of care delivered to NICU patients. NICU nurses are passionate about caring for premature and ill full-term infants and providing educational and emotional support for their parents, some NICU nurses remain in the NICU long-term, yet others contemplate leaving the specialty. The purpose of this qualitative interpretative phenomenological research guided by Martin Fishbein and Ajezen’s theory of reasoned action was to explore the lived experiences of NICU …

Lived Experiences, Perceptions, And Caregiving Trajectories Of Family Caregivers Of Youth With Substance Use Disorders (Suds) In Zambia, Ireen Manase Kabembo

Lingnan Theses (MPhil & PhD)

There is unequivocal evidence that family caregivers contribute to healthcare systems worldwide by providing care for persons with chronic illnesses in the home setting. his study explores the lived experiences, perceptions, and caregiving trajectories of 30 family caregivers of youth aged 16-24 diagnosed with Substance Use Disorders (SUDs) in Zambia. Data was collected through in-depth semi-structured interviews, a caregiving timeline, and participant observation and analysed using interpretative phenomenological analysis. Guided by the integrated theoretical framework of positioning theory and the theory of caregiving dynamics, this study offers a new lens for understanding caregiver’s experiences regarding caregiver identity, self-perceptions, interpersonal relationships, …

The Pause: Impacting Moral Distress In Our Caregivers, An Integrative Review, Bethany Corinne Furman

Doctoral Dissertations and Projects

Moral distress is endemic to healthcare in the emerging post-covid era. Moral distress is defined as the knowledge of the correct or ethical action but the repeated inability to act in that manner. First studied in nursing, it has been found in nearly every facet of healthcare and is strongly associated with clinician burnout, intent to leave position, and behaviors that can in turn compromise patient safety. Intensive care unit (ICU) nurses experience moral distress at higher rates than other subspecialties. Prevention of and recovery from moral distress is complex, but various forms of debriefing have long been suggested to …

Mental Health Interventions For The High-Risk Antepartum Inpatient Population, Mary Halle Bsn, Rn

Nurse Residency

In the high-risk antepartum patient population, do tailored mental health interventions, compared to routine intervention, improve patients’ overall mental well-being during inpatient hospitalization?

A Celebration Of Innovation And Discovery In Healthcare, Cara Gallegos

2024 Swedish Learning and Celebration Day

No abstract provided.