Digital Commons Network^™

Bringing Hospital And Community Together: Interventions To Bridge The Transitional Care Gap, Jeremy Yates

Dissertations

Abstract

Problem

As healthcare spending continues to increase and overall quality lags in comparison to other developed countries, hospital readmission has been targeted to increase quality while decreasing cost. Components of the Affordable Care Act (ACA) have placed an emphasis on preventative and transitional care which has created programs aimed at reducing readmission, including the Community Health Access Programs (CHAP). One program in St. Louis, Missouri consisted of advanced practice paramedics and an occupational therapy assistant that performed discharge follow-up through in-home, in-office, and telephone visits. An in-depth program evaluation can create a foundation to build other programs in communities …

The Role Of Counseling Trainee Adversity, Attachment Style, And Trauma-Informed Principles In Clinical Supervision, Nicole Hurless

Dissertations

Current supervision literature suggests that supervisees with insecure attachment styles may perceive a poorer relationship with their supervisor and feel less satisfied with supervision. Studies across disciplines indicate a relationship between traumatic and/or adverse experiences and insecure attachment; however, this association has not been studied within the context of supervision. This dissertation explores a structural equation model assessing the associations between student’s adverse experiences, insecure attachment, and quality of the supervision relationship. It was hypothesized that greater prevalence of adverse experiences would negatively relate to supervision relationship quality, and this relationship would be mediated by insecure attachment. The results of …

Discovering Hidden Signs And Symptoms Of Heart Failure In The Electronic Health Record Using The Omaha System, Anita Reger

Dissertations

Purpose/Background/Significance: For the past 30 years, heart failure has been in the top 3 readmission diagnoses with patients discharged to community care. This is costly to the healthcare system and negatively impacts the patient’s quality of life. The purpose of this study is to evaluate a community care database to determine if previously under-considered latent variables exist that could provide early detection of heart failure signs and symptoms. Theoretical/Conceptual Framework: The theoretical and conceptual frameworks surrounding this work are the Omaha System and Donabedian’s structure, process, and outcomes theory for healthcare quality improvement supported by Neuman’s Systems Model. The Omaha …

Improving Post-Operative Infection Rates Using My Five Moments For Hand Hygiene, Reginald Mark R. Dimailig

Dissertations

Adequate hand hygiene is known to diminish surgical site infections (SSIs) and prevent healthcare-associated infections (HAIs) in the post-operative settings. An increase in SSIs due to poor hand hygiene compliance was observed at the chosen project site. The purpose of this quantitative quasi-experimental quality improvement project was to determine if the implementation of the World Health Organization's (WHO) Five Moments of Hand Hygiene, would improve hand hygiene compliance and reduce post-operative infection rates among orthopedic patients in a same-day surgery unit. The project took place in a medical center located in the Northeast United States. The health belief model (HBM) …

Academic Intensive Care Units: What Is The Impact On Student Achievement?, Brandi Compass

Dissertations

The purpose of this study was to determine if academic intensive care units along with no-zero grading policies at the high school level result in students having higher achievement levels on state EOC assessments. A mixed-methods approach was taken in order to obtain both qualitative and quantitative data from surveys and interviews. Additional quantitative data were analyzed from archival data. Two separate schools were chosen for the populations. High School A implemented academic intensive care units and no-zero grading polices while High School B did not. Participants in the study consisted of both teachers and students at High School A …

Lived Experiences Of Or Nurses Working Off Peak Hours, Tashma E. Watson

Dissertations

Nursing plays a vital role in the care and safety of patients. Compared to other health care disciplines, nursing spends the greatest amount of time at the bedside. As health care continues to evolve, nursing will be an active participant in effecting the delivery of patient care. However, there is a paucity of research focused specifically on experiences of nurses caring for patients in the OR. Recent research explores the phenomenon of the "weekend effect." This phenomenon suggests variations in patient outcomes on weekends and nights (off-peak hours) compared to weekdays. The purpose of this hermeneutic phenomenological study was to …

Fluctuating Cohesion: A Grounded Theory Study Of Nursing Students Engaged In A Hybrid Debriefing Format, Carol L. Senette

Dissertations

Debriefing is a key component of simulation that promotes development of students' reflective processes. Instructor-led debriefing (ILD) is considered the gold standard; however, research conducted over the past decade demonstrates the negative effects of anxiety on student reflection during ILD. Nursing students' experiences with ILDs have been substantially investigated; yet scant research explores students' perceptions and experiences of more learner-centered debriefing formats that deemphasize the instructor role.

Impact Of Comfort Management On Narcotic Use In The Cardiopulmonary Surgical Icu, Caroline Janga Doe

Dissertations

Patients may experience acute pain after cardiopulmonary surgery. Narcotic pain relievers may reduce pain, yet many patients still complained of discomfort at the project site despite the medications provided to reduce it. The purpose of this quantitative quasi-experimental quality improvement project was to determine if the implementation of Kolcaba's comfort verbal and comfort daisies scale assessments combined with the use of non-pharmacologic comfort measures would reduce the narcotic dose and increase the patients' comfort levels among post-cardiopulmonary surgical intensive care patients in an acute care hospital in urban New York over four weeks. Kolcaba's comfort theory guided the project. Narcotic …

Documenting The Journey Towards Becoming An Anti-Racist White Educator, Heather Mccord

Dissertations

As a White teacher in public education, I have had the great pleasure of educating students from all over the globe. My career began in a district that served predominantly White students from middle class families. The only Black students I interacted with were those bused in from the city while participating in the desegregation program. There were noticeable biases and beliefs teachers held toward those students. However, since I was early on in my career with little experience, I was unaware of damage being done to these students. Once I began working for an extremely diverse district, in a …

Budget Gaming: Politics, Ethics, And Compensation, Gretchen Decker

Dissertations

Practitioners are frustrated with the budgeting process, frequently complaining that budgets cause undesirable and political behaviors in the organization (Jensen, 2001). One of the most frequent problems is budget gaming, which critics consider non-value added and frustrating. In a 2010 survey, over 95% of respondents acknowledged that budget gaming exists at least “occasionally” (Libby & Lindsay, 2010). Previous studies indicate budget gaming is frustrating, prevalent, and wasteful (Hansen et al., 2003; Libby & Lindsay, 2007; Neely et al., 2003).

I conducted an experiment to investigate organizational influences (organizational politics, compensation condition, ethics attestation) and their impact on budget gaming. The …

An Empirical Analysis Of Factors Affecting Autonomous Truck Adoption, Christopher Mondy

Dissertations

Autonomous vehicles have the potential to revolutionize the transportation industry. The segment of truck transportation is no exception. Autonomous vehicles have the potential to improve trucking safety, to increase shipping velocity, and to decrease costs. Additionally, autonomous trucks could be an important tool to help alleviate the ongoing driver shortage that the trucking industry is contending with.

Autonomous truck adoption is not guaranteed. Transportation equipment decisions are market-based, and autonomous trucks must present a compelling business case to transportation professionals. As such, it is imperative to understand the decision-making factors that drive transportation solution adoption, and how autonomous trucks could …

Thriving In Student Affairs Professionals: An Exploration Of Supporting Constructs, Shawn Brodie, Phillip Campbell, Gretchen Day Fricke, Kawanna Leggett, Norris Manning

Dissertations

Student affairs professionals provide vital services to college students while also facing various challenges that impact their ability to thrive at work. This study examined overall thriving, its constructs and a set of predictors that impact thriving in student affairs professionals. Seligman’s (PERMA) theory of thriving provided the conceptual foundation for this study. Understanding the constructs that support thriving for student affairs professionals will help institutional leaders and professional organizations develop work environments and strategies that promote thriving. A global pandemic occurred during the time of this research, allowing exploration of how COVID-19 impacted thriving. This study also included variables …

The Culturally Intelligent School Leader: Leadership Strategies Of Exemplary Elementary School Principals In Creating A Culture Of Inclusiveness, Leila Dodge

Dissertations

Purpose: It is the purpose of this explanatory mixed-method study to identify and describe the leadership strategies that exemplary elementary school principals use to create an organizational culture of inclusiveness using Kennedy's five leadership qualities of cultural differences.

Methodology: For this study, an explanatory mixed-method design was used to conduct research to identify and describe the leadership strategies that exemplary elementary school principals use to create an organizational culture of inclusiveness using Kennedy's five leadership qualities of cultural differences. The study's quantitative part was conducted using a SurveyMonkey delivered to each participant. In the survey, participants were asked if they …

A Correctional Study Of Nursing Instructor Use Of Best Practice With Multiple Choice Questions, Diane Droutman

Dissertations

Multiple choice questions are used as evaluations in nursing schools. Nursing instructors and nursing book publishers develop exam questions. The specific problem addressed by the study was how best practice in multiple choice test items, item analysis, and revision of choice test items used by nursing instructors. Using a survey method, this correlational design research looked at the relationship of faculty use of best practice in test item construction, analysis, and revision of multiple choice test item in nursing programs in the United States. Even though a relationship was noted, the statistical effect level was minimal. There was no correlation …

Religious Leadership: Agents Of Social Change, Jacqueline Carter

Dissertations

Historically, churches in the United States acquired respect as institutions that cultivated spiritual maturity and advocated for social equality in Black communities. Religious leaders represent the voice of reason for communities facing complex social problems, then and today. How educational attainment influences religious leaders’ social action strategies and decisions to engage or disengage in social activism is under explored. Additionally, it is unclear what strategies religious leaders use for social advocacy in their communities. Using andragogy and social cognitive theory as theoretical frameworks, the purpose of this phenomenological study was to explore the educational experiences of religious leaders to understand …

The Impact Of Spiritual Leadership On The Leadership Practices Of Public School Superintendents, Mark D. Hedger

Dissertations

The role of the superintendent is crucial in providing the form of leadership necessary to meet the needs of all stakeholders within a school district, it takes clarity and consistency for a leader to deliver on this promise of public education (Fullan & Quinn, 2016). By demonstrating the qualities of a spiritual leader, the superintendent can play a critical role in accomplishing the goals of a school district through relationships with employees that exemplify the transformational process (Northouse, 2016). Björk et al. (2018) pointed out that superintendents must research and act on information from reliable sources to make the best …

Use Of An Affective Teaching Intervention To Impact Connections Between Academic And Professional Integrity, Deborah Morrill

Dissertations

Dishonesty and misconduct of nursing students during their education is a continuing concern, especially as it relates to expected professional behaviors. This quasi experimental pre-and post-interventional study explored the impact of an affective learning module on developing beliefs and perceptions of ethicality of academic and professional misconduct of students in a BSN program. A modified version of McCrink's (2008) tool, entitled "Nursing Student Experiences and Perceptions of Academic and Professional Conduct Survey" measured these constructs. The affective learning module, based on Rest's theory of moral development, and Krathwohl's affective taxonomy, actively engaged students in ethical decision-making with connections to professional …

Registered Nurses' Perceptions Of Obesity, Elizabeth Pettifor

Dissertations

Obesity has become an epidemic in the United States (U.S.) population. Obesity is a risk factor for many health problems that ultimately lead to death or disability. Nurses in the U.S have a higher-than-average rate of overweight and obesity. The purpose of this exploratory, qualitative case study was to identify and recommend areas for change in the hospital environment to assist bedside nurses in the U.S to have a healthier lifestyle. Social media was used to conduct a purposeful sampling technique and recruit 10 registered nurses working full time at the bedside in the U.S who struggle with obesity. Semi …

Vocational Education: Cna Students’ Perspectives Of Soft Skills In Training And The Workplace, Kimberly S. Mcclendon-Payton

Dissertations

Purpose: The purpose of this quantitative study was to identify CNAs’ perceptions about the most important soft skills used by CNAs in training and the workplace.

Methodology: This quantitative research study identified CNAs’ perceptions of the most important soft skills they used based on the composite model for soft skills. CNAs were selected based on purposeful sampling. Likert scores were collected from the survey responses.

Findings: Examination of the quantitative data from the 35 CNAs revealed that brainstorming is the most important collaboration soft skill in CNA training and the workplace.

Conclusions: Results based on the findings of this study …

Educating Nurses To Engage In Health Policy And Advocacy, Donna J. Barry

Dissertations

Few nurses engage in developing health policy from the local to global level. For a scholarly practice project, American Association of Colleges of Nursing (AACN) accredited nursing schools in New England were surveyed to measure what recommended AACN Essentials content on health policy is taught in their baccalaureate and master's programs. The online, quantitative-descriptive survey captured whether content is taught in stand-alone courses and if those courses are required. Barriers to teaching health policy at both levels and barriers to nurses engaging in health policy and advocacy were also solicited. A majority of responding programs include most AACN content in …

The Mother's Lived Experience Of Breastfeeding In The First 4 Weeks Postpartum: A Heideggerian Hermeneutic Phenomenological Analysis, Stacy Rosales

Dissertations

The purpose of this study was to more fully understand, in their own words, the experiences of mothers who began breastfeeding their infant after birth and may or may not have been breasting at four weeks postpartum. A single research question guided this study: What are the lived experiences of breastfeeding mothers during the first four weeks postpartum? Eight mothers who delivered in the past four to six weeks were interviewed. Data were analyzed using a Heideggerian hermeneutic phenomenological approach. This method was chosen because it allowed the researcher to conduct interviews and explore the lived experience of breastfeeding mothers …

How Elementary Principals Use The Six Sources Of Influence To Achieve Extraordinary Results, Monette Perez

Dissertations

Purpose: The purpose of this phenomenological study was to identify and explore how elementary principals of organizations who have achieved extraordinary results influence employees through personal motivation, personal ability, social motivation, social ability, structural motivation, and structural ability.

Methodology: This phenomenological study identified and explored 12 Southern California public elementary school principals and how they used the 6 sources of influence with their stakeholders to achieve extraordinary results. An interview protocol aligned with the study’s theoretical framework was developed with a thematic team. The respondents were purposefully chosen from principals who have led their schools to attain National …

Post-Cesarean Section Pain Management Using Pre-Built Computerized Order Entry Sets, Ashleigh Hunkins

Dissertations

Abstract

Problem

Electronic medical records (EMR) have helped decrease common medication errors. However, prescribing errors are still elevated. Creating pre-built order sets can decrease medication errors for post-cesarean section women.

Methods

This project used an evidence-based practice approach to create new order sets. Women undergoing a cesarean section between January 15, 2021 and April 14, 2021 received the new order sets. A retrospective data review was conducted pre and post-implementation between the dates of October 15, 2021 and April 14, 2021 to view medication errors.

Results

Before implementation of the order sets, there were 239 cesarean deliveries and eight errors …

Enhancing Communication Between Nurses And Physicians On Patients With Sepsis, Jayne Ehirim

Dissertations

Abstract

Problem: The condition of sepsis is life-threatening, and its severity increases when there are delays in interventions. Communication challenges exist on medical-surgical units and are major contributors to poor management of patients with sepsis. Ineffective communication among health care team members continues to threaten patients` health outcomes. The purpose of this project was to implement a standardized form of communication between nurses and physicians of patients with sepsis.

Methods: An observational descriptive design with a retrospective chart review. A quality improvement PDSA cycle was used to implement an SBAR communication instrument.

Results: A total of 16 …

County Youth Athletics Response To Covid-19 Pandemic, Elise Schaller

Dissertations

Problem: To ensure safe participation in youth athletics and prevent COVID-19 transmission during the COVID-19 pandemic, St. Louis County Department of Public Health (DPH) implemented Youth Sports Guidelines on October 14, 2020. This project aimed to identify level of adherence to precautions listed in the guidelines at six county public high school athletic events.

Methods: An observational descriptive study design was used to monitor guideline adherence at high school athletic events. Two observers tallied violations by participants and spectators to Youth Sports Guidelines at St. Louis County public high school athletic events. Six high-frequency contact (basketball and wrestling) events …

Impact Of Social Isolation In Hiv-Positive Individuals During A Pandemic, Corina Jane Bakoylis

Dissertations

Problem: The global pandemic of COVID-19 caused concern for immunocompromised individuals. The purpose of this quality improvement initiative was to assess the impact of social isolation on feelings of loneliness, depression, and social isolation experiences in HIV-positive individuals residing in a long-term care facility.

Methods: A mixed-method convergent design with a purposeful sample of HIV-positive adult residents residing in a long-term care facility was utilized. An evaluation of loneliness using the University of California Los Angeles (UCLA) Loneliness Scale (Version 3) and depression using the Patient Health Questionnaire-8 (PHQ-8) were completed. Personal experiences were also assessed with five predetermined open-ended …

Pre-Anesthesia Assessment In Children With Down Syndrome: A Head To Toe Guide, Laurel Kinsey

Dissertations

The purpose of this project was to provide and assess an educational intervention for a multidisciplinary interprofessional collaborative sedation team at a children's hospital in Anchorage, Alaska.

Bladder Management Post Epidural Anesthesia: Impact On The Second Stage Of Labor, Megan Hedgcorth

Dissertations

Abstract

Problem

Currently, no national practice guidelines or organizations suggest the use of continuous bladder catheterization during labor for women receiving epidural anesthesia (DeSevo & Semeraro, 2010). Despite there being no national practice guidelines supporting the use of continuous bladder catheterization, many labor and delivery units still utilize this method for bladder drainage following epidural anesthesia in labor. The purpose of this project is to evaluate if the type of bladder management post-epidural anesthesia affects the length of the second stage of labor and the mode of delivery after implementation of new intermittent catheterization pilot.

Methods

This quality improvement project …

Intimate Partner Violence Education For High School Students, Morgan Foster

Dissertations

Problem Adolescents are at risk for experiencing intimate partner violence (IPV). As early as seventh grade, over half of adolescents have reported being in a romantic relationship. Adolescent screening for and education of IPV is minimal, and only the Healthy Relationships Quiz developed by the U.S. Department of Health and Human Services [HHS] screens young adolescents across all aspects of IPV, including psychological and sexual violence. The purpose of this project was to develop an IPV education plan for high school students in a health course.

Methods An educational lesson plan for IPV was created for high school teachers.

Results …

Effect Of Purposeful Nurse Rounding On Patient Satisfaction, Jayne Mangi

Dissertations

Problem Delayed nurse response times in an inpatient setting can have a negative impact on patient experience, and is reflected in patient satisfaction surveys such as The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The purpose of this project is to improve HCAHPS scores related to “responsiveness” in an antepartum unit.

Methods A prospective observational study designed to improve HCAHPS scores regarding nurse response time conducted as a retrospective and prospective review of data. Results of HCAHPS scores related to “responsiveness”, and actual nurse response times were examined before and after a nurse education tool was implemented. …