Evaluating Mindfulness On Loneliness In An Older Adult Population, Jessica Tieskoetter

Dissertations

Problem: Loneliness is a widespread public health concern and has negatively impacted mortality and health outcomes among older adults. This quality improvement project’s purpose was to evaluate mindfulness on loneliness and quality of life among adults aged 65 years and older, participating in a weekly befriending socialization program.

Methods: A descriptive cohort design was utilized to assess loneliness pre-and post-implementation of a mindfulness telephone line over three months. A convenience sample of 22 older adults enrolled in a befriending socialization program was used. The Iowa Model of Evidence-Based Practice framework was applied to guide the implementation of a practice change …

When St. Louis School Nature Leaders And Environmental Partners Work Together Nature-Based Learning Inspires Joy And Curiosity In K-2 Students, Julie Frisch, Melissa Politte

Dissertations

This study focused on what values teachers saw in nature-based learning, what outcomes they saw for their students, and what factors have enabled them to do nature-based learning. This explanatory sequential mixed-methods study looked at nature-based learning in St. Louis elementary schools with kindergarten through second-grade students.

We used purposive sampling to choose six schools to examine further through case studies. We then conducted interviews with 8 teachers on qualities of nature-based learning captured in 12 words.

We identified five themes from our interviews and observations: Every School Needs a Nature Champion, Community Bridges in Nature-Based Learning, There is Magic …

Implementing A Standardized Nursing Communication Tool To Improve Inpatient Nursing Communication, Ashley D. Nator

Dissertations

Implementing a Standardized Nursing Communication Tool to Improve Inpatient Nursing Communication

Ashley D. Nator

B.S. Nursing, University of Missouri-St. Louis, 2018

A Dissertation Submitted to The Graduate School at the University of Missouri-St. Louis in partial fulfillment of the requirements for the degree

Doctor of Nursing Practice with an emphasis in Family Nurse Practitioner

August 2022

Advisory Committee

Cathy Koetting, PhD, DNP, APRN, CPNP, PMHS, FNP-C

Chairperson

Sarah Jackson, DNP, APRN, FNP-C

Amy Terbrock, MSN, PCCN, SCRN, RN

Copyright, Ashley D. Nator, 2021

Original: 08/2021 Revised: 09/2021, 10/2021, 04/2022

Abstract

Problem: Patient handovers occur among nurses more than 4,000 times …

Reducing Catheter-Associated Urinary Tract Infections In The Pediatric Intensive Care Unit, Maria Smith

Dissertations

Problem: CAUTIs (catheter-associated urinary tract infections) are a common hospital-acquired condition (HAC) that increase length of hospital stays, hospital costs, and risk for patient mortality. CAUTI rates in a PICU increased in 2021 from the year 2020. A rapid cycle PDSA revealed nurses were not using soap and water for foley catheter care, which is the recommended cleanser by the Centers for Disease Control and Prevention (CDC).

Methods: An observational descriptive design was used to evaluate foley catheter cleaning and CAUTI rates. PICU nurses completed behavior surveys regarding foley catheter cleaning practices. An education intervention occurred when nurses answered anything …

Policy Knowledge Communication In Nursing, Curtiss J. Vavra

Dissertations

Evidence-based practices in nursing improve patient outcomes, decrease healthcare costs, and can be implemented with policies and procedures. However, there is limited literature describing how nurses acquire policy knowledge, the dissemination of which may require a significant investment of resources by a hospital. The purpose of this study was to learn more about how nurses obtain policy knowledge. Rogers's diffusion of innovations theory guided the examination of communication channels and how they relate to the formation of policy knowledge. The research questions were designed to gather information on the relationship of policy communication channels, demographic factors, and the frequency of …

Auditing Workplace Aggression And Violence In The Emergency Department, Michelle Parmentier

Dissertations

Abstract

Problem: Emergency Department (ED) staff are not reporting patient and visitor episodes of aggression and violence. The rate of violence per patient visit is unknown.

Methods: An observational, descriptive quality improvement project about Type I and II workplace aggression and violence (WAAV) reporting by ED staff and security consisted of education, an anonymous survey of the previous six months of WAAV, and a monthlong anonymous WAAV audit in a Midwestern ED.

Results: The survey response rate was 59% with 65% never reporting WAAV, 13% reporting all WAAV occurrences, 9% reporting some occurrences, and 13% usually not experiencing WAAV. The …

Evaluation Of A Process Change Using An Updated Sedation Protocol, Rachel Allen

Dissertations

Problem: Pediatric delirium is continuing to increase intensive care environments and for patients who require mechanical ventilation and continuous sedative medications. Delirium is harmful to the patient creating lasting neurologic and mental health issues along with prolonged hospitalization and increased healthcare cost

Method: For this quality improvement (QI) project, a descriptive observational study was used to evaluate the implementation of a sedation protocol for patients who are mechanically ventilated and on continuous sedative medications. This was completed with the use of retrospective chart reviews three months prior to implementation and three months after the new protocol was implemented. Nurses were …

Quality Improvement Competency Development For Correctional Nursing Leaders, Angela Chandler

Dissertations

Nurse leaders are often promoted with little to no leadership development. Lack of development is a leading cause of turnover. Leadership development is crucial to retaining qualified leaders and the National Academy of Medicine identified that quality improvement (QI) competency development for nursing leaders is critical to improved healthcare. To invest in leader development and improve QI competence, a structured, weekly, coaching intervention was used for four consecutive weeks to reinforce QI concepts and assist in development of a QI project plan for nursing leaders. The Beliefs, Attitudes, Skills, and Confidence in Quality Improvement (BASiC- QI) instrument was used before …

The Effectiveness Of Continuous Video Monitoring In Reducing Inpatient Fall Rates, Yunhee Cruse

Dissertations

Abstract

Problem: Falls are one of the most frequently occurring safety events in hospitalized patients, resulting injuries that can be devastating and burdensome. Patients in neuro-telemetry unit are at greater risks for falls due to their conditions. The continuous video monitoring (CVM) program was implemented to reduce fall rates in the neuro-telemetry unit. This project was to examine the effectiveness of CVM program in reducing fall rates.

Method: A pre- and post-implementation observational evaluation was conducted. By reviewing retrospective data from January 1, 2020 to January 31, 2021 for pre-implementation period and from March 1, 2021 to October 31, …

The Mission System: An Electronic Health Record For Medical Treatment In Guatemala, Tawniece M. Curry

Dissertations

Abstract

Problem: The introduction of an electronic health record (EHR) system has become an essential component in monitoring and tracking patient information in most developed countries but are difficult to implement in underdeveloped countries. Guatemala is a country with poor health care and limited resources for patient tracking and monitoring. An organization in Guatemala, Nursing Heart Inc. (NHI), provides care to over 40 underserved rural communities but lacks the ability to monitor and track patient information. In order for NHI to properly monitor and evaluate their programs and track patients’ continuity of care, the introduction of an EHR system is …

Evaluation Of Neonatal Ankyloglossia, Ellen M. Ray

Dissertations

Problem Ankyloglossia occurs when the tongue cannot extend past the gums or lips due to frenulum restriction. In breast feeding, proper movement of the tongue around the nipple is hindered causing difficulty for the infant to obtain a proper latch. This may result in slow weight gain (SWG), failure to thrive (FTT), and dehydration due to poor milk production. Evaluating for ankyloglossia is difficult, however, the Hazelbaker Ankyloglossia Tool for Lingual Frenulum Function (HATLFF) may be of benefit.

Method Observational descriptive design utilizing a retrospective medical record review. The HATLFF was utilized in full term neonates suspected of ankyloglossia in …

Implementation Of Quantitative Blood Loss Tool To Detect Postpartum Hemorrhage After Vaginal Delivery, Rachael Williams

Dissertations

Problem Maternal deaths and comorbidities related to postpartum hemorrhage (PPH) continue to be high despite being quite preventable. The delay in recognition and treatment of PPH due to the use of imprecise estimated blood loss (EBL) instead of precise measurement using quantitative blood loss (QBL) attributes to this issue.

Methods For this quality improvement (QI) project, a descriptive, observational design was used to gather quantitative data regarding QBL implementation instead of EBL as well as the number of PPH’s identified. A pilot cohort of staff nurses participated by documenting QBL two hours after each delivery. The nurses were given an …

Preventing Falls Using Evidence-Based Interventions In A Long-Term Care Facility, Pibi Bouda

Dissertations

Falls and fall-related injuries are common and significant health issues among older adult patients living in Long-Term Care (LTC) facilities, especially those with memory impairment. The current quality improvement (QI) project aimed to educate staff members and implement a structured 4 Ps hourly rounding (HR) protocol on an LTC facility pilot unit in Missouri. The project was implemented in a memory care unit housing older military veterans patients in a large metropolitan area of Missouri. The project question that guided the intervention was: In older residents living in a memory care unit of an LTC facility, what is the impact …

Standardizing Discharge Practices For Pediatric Urology Outpatient Procedures: A Quality Improvement Project, Megan Bush

Dissertations

Background: Standard discharge instructions of verbal and written methods are only understood by about 45-50% of caregivers. Video discharge instructions (VDIs) in addition to standard methods of verbal and written instructions can be very effective for caregiver comprehension (CC), retaining discharge education information and improving patient outcomes. Problem: In an outpatient surgery department in a Midwestern Children’s hospital, 100% of the discharge instructions for pediatric urology outpatient procedures are different than the instructions given to caregivers by the surgeon. Methods: The study utilizes a descriptive evaluation of change in how discharge instructions were written and provided. Interventions …

Implementation Of A Pre-Anesthesia Questionnaire In The Preoperative Phase Of Care, Katherine Jones

Dissertations

The preoperative assessment is an integral component in the prevention of perioperative complications and costly procedure cancellations. Efforts to improve the quality and efficiency of the preoperative assessment have included the use of surgical safety checklists in the preoperative and postoperative phases of care. Patient information obtained in the preoperative setting provides the foundational structure for the information relayed down the clinical pathway. Strategies to improve the quality and integrity of the preoperative assessment are needed to ensure the patient’s safety and avoid procedure delays.

Purpose: To improve the preoperative assessment by decreasing the occurrence of incomplete or inaccurate information …

Implementation Of Postpartum Oral Glucose Testing Follow-Up In Women With Gestational Diabetes, Amanda Rose Metz

Dissertations

Implementation of Postpartum Oral Glucose Testing Follow-up in Women with Gestational Diabetes

Problem One of the most common medical complications of pregnancy is Gestational Diabetes (GDM). After delivery, guidelines recommend follow-up glucose tolerance testing (OGTT) 4-to 12-weeks postpartum. Despite these recommendations, only 16% to 22% of women complete an OGTT postpartum.

Methods The purpose of this quality improvement (QI) project is to pilot a postpartum outreach follow-up via telephone to reach women diagnosed with GDM; the communication will be sent using the institution’s electronic messaging system. Quantitative data were collected prospectively. Data collected included if the patient was contacted and …

Evaluation Of An Updated Maternal Severe Hypertension Recognition And Response Protocol, Diana Marshall

Dissertations

Problem: Hypertensive disorders of pregnancy are a leading cause of morbidity and mortality. An area of concern is the lack of women and infant departments that have a standardized approach for treatment of severe hypertension congruent with the American College of Obstetricians and Gynecologists (ACOG) recommendations.

Methods: A department with approximately 4,000 deliveries per year was the site for this quality improvement project. A descriptive observational design was used to evaluate the effect of an updated protocol on treating hypertensive events within 30-60 minutes. The protocol was updated by a maternal fetal medicine physician and a certified nurse midwife. Data …

Evaluation Of An Initiative To Increase Rates Of Exclusive Breastfeeding Among Rural Hispanic Immigrant Women, Naomi E. Pitcock

Dissertations

This project was a retrospective evaluation of the prenatal education component of a multi-component breastfeeding promotion intervention. The educational portion of this program, provided in Spanish using intercultural communication techniques, was designed to increase the number of Hispanic women who choose to initiate breastfeeding, using breast milk exclusively to nourish their newborns. The Hispanic women included in this program were all registered with a local prenatal-care coordination program for low-income women, had routine hospital births (both vaginal and C-section) and elected to participate in the prenatal education class. Data regarding intention to breastfeed and breastfeeding during hospitalization were gathered through …

Untold Perspectives: The Impact Of The Closure Of A Health Institution In A Black Community In North St. Louis County, Patricia Zahn, Kiley Bednar, Andrea Jackson-Jennings, Erica L. Henderson

Dissertations

Based on the literature of social determinants of health, health equity, and anchor institutions, it is evident that hospitals have a role to play in ensuring the health of their community. However, our understanding of the impact of hospital closures is limited, especially when it comes to Black communities. The purpose of this study is to examine the relationship of the closure of the Normandy Osteopathic Hospital to the social determinants of health—specifically access to care and economic stability as it relates to income and wealth generation—for a Black community in one near-North suburb of St. Louis. Ten individuals with …

Africa In Transition -- Nexus Between State Building & Regional Integration, Tenley Erickson

Dissertations

Regional integration in Africa is at a nascent stage, despite long-standing interest in continental unification since the Pan-African independence movements. The current surge in continental-wide economic integration builds on previous efforts, yet is markedly different in terms of the ideas, interests, and institutions today. A primary reason for the failure of the first East Africa attempt to integrate was the lack of a strong private sector. Research on African regionalism has focused mostly on limited success, lack of economic growth, and persistent wide-spread poverty. Recent developments present an opportunity to objectively study the gradual evolution in African perspectives and state …

Self-Compassion And Perceived Readiness For Practice Among Baccalaureate Nursing Students: A Mixed-Methods Study, Laurie A. Walter

Dissertations

There is increasing concern about how nursing students’ psychological health will impact their future nursing practice. The COVID-19 pandemic has enhanced these concerns. Nurse educators are being challenged with preparing nursing students to provide compassionate, patient-centered care despite the stress and psychological challenges of today’s healthcare environment. Self-compassion is a practice of mindfulness, self-kindness, and common humanity which positively influences and predicts psychological health. The purpose of this study was to explore the relationship between self-compassion and perceived readiness for professional practice among undergraduate nursing students.

A convergent mixed-method design utilizing correlational and directed content analyses explored this relationship. The …

Predictors Of Engagement In Nursing Professional Practice: Transforming Organizational Culture In The Post-Covid Healthcare Environment, Jennifer Garnand

Dissertations

Cultivating the shared belief that individuals matter within an organization enhances the empowerment of staff and supports enthusiastic engagement in organizational efforts aimed toward a common mission, vision, and goals (McShane & Von Glinow, 2019). The nursing profession has been plagued by an unprecedented decrease in engagement and diminished job satisfaction, particularly following the prolonged tenure of the COVID-19 pandemic, leading to subsequent attrition amidst a staffing crisis. This quantitative predictive correlational study seeks to determine whether proactive and persevering characteristics, professional identity, and passion of nurses are predictors of engagement in a post-COVID healthcare environment. The research was based …

An Investigation Of Anti-Intellectualism Among Nurses, Jamie Davis-Tubbs

Dissertations

Anti-intellectualism is often offered as an explanation for irrational actions, especially in the grips of uncertainty. The effects of the COVID-19 pandemic have uncovered the consequences of anti-intellectualism within the healthcare system. Nurses, the most identifiability trusted healthcare professionals, have been used to illustrate a healthcare paradox regarding COVID-19. The healthcare paradox presents nurses as highly trained healthcare professionals who do not believe in their own science and reject scientific expertise. Furthermore, nursing anti-intellectualism has been used to spread misinformation during a major health crisis. Yet, we do not know the depth in which anti-intellectualism exists within the nursing profession. …

From The Shadows Of Incarceration To Higher Education: Associated Invisible Identity Development Of College Students With Incarcerated Parents, Andrea Blake

Dissertations

The purpose of this study was to understand the experiences of college students who have experienced parental incarceration and explore how they make meaning of their associated invisible identity in the campus environment at four-year institutions in the U.S. Traditionally socio-historical events and messages about system-impacted individuals, their families, and children have contributed to the invisibility of this population in educational settings. This study employed a narrative inquiry approach. Also, it applied Bronfenbrenner’s (1977, 1979, 1993) ecological model to explore the college experiences of ACIPs while not excluding wider societal and environmental factors that could shape their associated invisible identity …

Secondary School Administrators, Teachers, And Students' Perspectives On Reducing Recidivism In Disciplinary Alternative Education Programs, Chrissell Rhone

Dissertations

This mixed-methods study sought to explore student and staff perspectives on what led students to return to or remain in DAEPs for longer than they were assigned. The researcher reviewed literature related to the history of alternative education programs, placement policies, and alternative school practices. This researcher obtained permission from two schools in a rural county in a southern state. Qualtrics was used to collect all quantitative data. Data was collected using questionnaires and focus groups. The quantitative component of this study was employed so that students could maintain anonymity and honestly respond without feeling pressured or intimidated. Student data …

Evaluating The Effects Of Mindstrong™ In Graduate Nursing Students, Syeda Shah

Dissertations

Abstract

Problem

A high rate of burnout and lack of resiliency is a major problem in nursing graduate students resulting in dropout and mental health issues. MINDSTRONG™ is an evidence-based cognitive behavioral skills-building program with the goal of building resiliency and decreasing burnout through coping skills to improve overall adult health and well-being.

Methods

A descriptive design using quantitative data analysis through pre, and post surveys was used. The surveys evaluated graduate nursing students’ burnout and resiliency after participating in MINDSTRONG™, a cognitive behavioral theory program, implemented by trained facilitators for seven sessions. The sample consisted of all six self-enrolled …

A Study Of Hybrid Cte Programming Vs. Traditional Cte Programming For Students With Ieps At Two Technical High Schools, Esthere K. Scott

Dissertations

The purpose of this paper is to research the postsecondary readiness of students with IEPs at North and South Technical High schools within Special School District of St. Louis County (SSD). The attention is on the description of the readiness outcome of the students in a traditional career in the education program and technical education programs to the students with IEPs in hybrid technical programs. The paper also exploits the concept of inclusivity and diversity in learning and highlights the role of the CTEs in the preparation of the students for the future. However, success is described as either the …

A Thematic Exploration Of The Liberation Of Identity Through Indigenous Self-Determination: Themes Of Native American And Alaska Native Identity, Martha Fiskeaux

Dissertations

Strong ethnic identity is associated with overall well-being, resilience to change, and higher self-esteem (Kiang et al., 2006; Martinez & Dukes, 1997; Umaña-Taylor, 2003; Yip & Fuligni, 2002) and serves as a protective factor against the stress associated with discrimination (Alvarez & Kimura, 2001; Phinney et al., 1998). Given the historical and systemic barriers faced by the Native American and Alaska Native population, including the history of genocide, colonization, and intergenerational trauma, the development of a strong Indigenous ethnic identity is a necessary area of research focus. Specifically, Native American and Alaska native individuals are 3.5 times more likely to …

The Developmental Pathways And Treatment Approaches For Maladaptive Perfectionism In Undergraduate Student Athletes, Kara Hoff

Dissertations

Developmental and contextual factors may largely contribute to how an undergraduate student athlete develops maladaptive perfectionism (MP) within his or her athletic performance. Being able to understand different possible etiologies of MP will provide enriching clinical information to tailor more in-depth treatment approaches for the student-athlete(s) being impacted by the serious and life-threatening side effects of MP. This literature review provides a comprehensive summary on MP and how it may manifest in the athlete, in addition to how it can mature and intensify throughout one’s athletic career. Treatment approaches for MP in undergraduate student athletes will be discussed in how …

Perceptions Of Out-Of-School Reading Motivation For Female Middle School Students, Danielle Porch

Dissertations

Literacy engagement and motivation to read is lacking in middle school reading classrooms. Educators struggle with the challenge of motivating students to read and actively engage with text both inside and outside of school. Research indicates that female and male middle school students have unique characteristics and habits as readers. The purpose of this qualitative study was to examine the perspectives of female middle school students regarding their out-of-school recreational reading time, their attitudes towards reading, and their reading habits. The themes derived from this study indicated the students’ desires to have their reading instruction personalized and have their reading …