Digital Commons Network^™

Establishing And Validating Foundational Competencies In The Application Of Behavioral Gerontology Through Expert Consensus, Alexandra Doran

Dissertations

Behavioral gerontology continues to evolve and grow as an application of behavior analysis, but there remains a critical need to define competencies necessary for behavior analysts to provide ethical, effective care within their scope of competence. This study sought to establish and validate foundational competencies for Board Certified Behavior Analyst s® (BCBA s® ) working in this area. A mixed-methods design using three experiments was used. In Experiment 1, a review of discipline-specific competency frameworks and a job mapping process yielded a preliminary set of behavior-analytic competencies for behavioral gerontology. This produced a preliminary framework consisting of 142 competencies. Experiment …

Enhancing Well-Being: Implementing Weekly Social Interventions For Older Adults In Independent Living, Rosa Huang

Dissertations

Loneliness and social isolation significantly impact the physical and mental well-being of older adults. This quality improvement project implemented an eight-week social intervention designed to reduce loneliness and enhance well-being through weekly sessions incorporating mindfulness exercises, gratitude journaling, and structured socialization activities. The intervention was delivered by nursing students to a sample of residents in a Midwestern independent living community. While most standardized measures of loneliness and mood did not show statistically significant changes, the project resulted in a statistically significant increase in social network engagement as measured by the Lubben Social Network Scale-6 (LSNS-6). The findings suggest that group-based …

A Qualitative Study Of Gratitude Practice Among Won Buddhist Older Adults And Implications For Gerontological Social Work, Sungsim Lee

Dissertations

Although gratitude has been widely studied in social science, existing scholarship has largely relied on Western worldviews and quantitative research frameworks, limiting understanding of lived gratitude experiences within diverse spiritual and cultural contexts, including Eastern spiritual traditions. In Won Buddhism, originating in South Korea, gratitude holds a central place in spiritual life and is understood as an essential practice. This qualitative study explores the views of Won Buddhist older adult practitioners regarding their experiences, benefits, and challenges of engaging in spiritually grounded gratitude practice. Semi-structured interviews were conducted with 23 practitioners aged 65 and older from English-speaking Won Buddhist communities. …

Implementation Of Mindfulness-Based Interventions And Weekly Visits To Reduce Loneliness In Older Adults, Victoria E. Cobb

Dissertations

Implementation of Mindfulness-Based Interventions and Weekly Visits to Reduce Loneliness in Older Adults

Abstract:

Problem: Social isolation and loneliness have emerged as a significant public health issue for the older adult population. Loneliness has been linked to both physical and mental health effects. According to current literature, there is no standard intervention to treat loneliness in the older adult population.

Methods: This quality improvement (QI) project utilized a descriptive cohort design and the Visit-A-Bit screening assessment instrument. Undergraduate nursing students implemented mindfulness interventions during weekly visits over an eight-week period at an independent living facility located in the Midwest. Descriptive …

Race-Neutral Pft: Implementing Patient Activation Measure Following Race- Neutral Pulmonary Function Testing, Ann M. Way

Dissertations

Abstract

Background

The introduction of a race-neutral equation to predict normal values on pulmonary function testing (PFT) has led to changes in the diagnosis of pulmonary diseases previously diagnosed using a race specific equation. Minority patients appear to be most likely impacted by this change, potentially impacting how they self-manage their pulmonary health. Patient self-management can be measured and assessed by using the Patient Activation Measure (PAM) tool.

Purpose

The purpose of this project is to assess patient activation levels amongst minority patients with a new or changed pulmonary diagnosis to identify a possible need for interventions to improve patient …

Assessing Psychologists’ Clinical Knowledge Of Geriatric Depression: A Validation Study Of The Later Life Depression Knowledge Questionnaire, Abigail J. Laine

Dissertations

Because the US population is rapidly aging, generalist clinicians will increasingly be called upon to provide mental health services to older adults. Unfortunately, most generalist clinicians do not possess the specialized knowledge to provide clinical services to this population and will require training. Professional training efforts are currently hindered by the lack of psychometrically supported scales of clinical disorders specific to aging. Without such scales, it is difficult to evaluate the impact of continuing education programs. The purpose of the present study was to investigate the psychometric properties and scale dimensionality of the Later Life Depression Knowledge Questionnaire (LLD-KQ), a …

Prostate Cancer Screening Survey Among African-American And Their Partners, Angela James

Dissertations

The purpose of this translational research project was to survey adult African-Americans and their partners to explore inhibitors and facilitators to PC screening.

A Randomized Controlled Trial Comparing A Companion Dog Walking Intervention To An Attention Control Education Intervention On The Psychological Health Of Adult Intensive Care Unit Survivors: The Pooch Study, Lindsey Nelson

Dissertations

Intensive care unit (ICU) survivors are at risk for persistent anxiety and depression after hospital discharge that contribute to the psychological component of post intensive care syndrome (PICS). Quality evidence supporting innovative home and community-based interventions that improve psychological health in ICU survivors is needed. The use of companion dogs to improve the health and wellbeing of ICU survivors is a novel strategy not previously explored in the ICU survivor population. The purpose of this randomized controlled trial (RCT) was to evaluate the feasibility and acceptability of a companion dog walking intervention compared to an attention control education intervention for …

Effect Of Activities, Social Environment, And Psychotropic Medication Use On Behavioral Symptoms Of Persons With Dementia In Nursing Homes, Ben R. Inventor

Dissertations

A secondary data analysis was conducted using existing clinical and observational data of a 3-year longitudinal study to describe associations of time-varying background factors (cognitive function, physical function, psychotropic medication use), and proximal factors (activities, social environment) with positive and negative behaviors of persons with dementia at 24 months. Participants included residents with Alzheimer's disease living in two nursing homes in Chicago. A Total 25,560 observation sessions, collected for all participants at baseline, 12-months and 24-months were used in analyses. Results showing that: 1) higher cognitive and physical functions, and being located in own bedroom and shower/tub/bathroom had the most …

Influences Of Perceived Environment, Partner Support, And Attitudinal Familism On Physical Activity Among Mexican American Women, Neomie C. Congello

Dissertations

Healthy lifestyle behaviors such as engaging in physical activity (PA) may reduce the risk for cardiovascular disease (CVD), the number one cause of mortality among Mexican American women (MAW). Research findings show that MAW have low levels of leisure time PA and vary in the amount of overall PA. The influence of partner support has received little attention in studies examining predictors of PA. This cross sectional study investigated factors influencing PA among MAW aged 19 to 64 years old (mean = 39.4, SD = 11.1) who may be at increased risk for CVD based on hypertension, diabetes and obesity …

Using The Home Health Oasis To Promote Advance Care Planning Among Community-Dwelling, Frail Older Adults, Suzanne S. Sullivan

Dissertations

Despite an aging population with increasing proportions of frailty and decline, the rates of documented Advance care plans (ACP), meant to align goals for care with the level of treatment at end-of-life (EOL), are low (~30-40%). Patients expect clinicians to raise the question about serious illness goals for care when the time is right, however, there are a number of barriers to the initiation of these difficult conversations including provider bias and uncertainty. A review of the literature indicates that there are few prognostic indices available for use to identify the right time to initiate EOL conversations based on risk …

A Comparison Of Training Approaches On Skill Acquisition Among Direct Care Staff At An Adult Day Program, Sandra Wagner

Dissertations

Adults with intellectual and developmental disabilities (IDD) are often dependent on direct care staff to engage in daily activities, such as personal care, eating, and engaging in leisure activities. One way direct care staff can support adults with IDD to become more independent is by using prompting strategies. Often times, however, direct care staff have not been trained on how to use prompts to encourage independence. Current studies have demonstrated success in teaching direct care staff prompting strategies in personal care tasks (e.g., Engelman et al., 2002; Parsons et al., 1993) through behavioral skills training. Although the trainings produced an …

Perceptions Of Graduate Nurse Practitioner Faculty On The Use Of Simulation In Lieu Of Traditional Clinical Hours, Virginia Strong

Dissertations

Simulation in undergraduate nursing curriculum has been identified as an effective and safe substitution for the traditional clinical experience; however, graduate nurse education programs could not substitute clinical hours with simulation-based education. These clinical hours required NP students to provide direct face-to-face patient care. Simulation had wide variability in the number of hours utilized within each specialty. NONPF discussed the use of simulation, as it pertains to the curriculum of the NP student on more than one occasion and concluded its impact on NP education was a potential alternative to traditional clinical experiences. Studies indicated that graduate nursing students enjoy …

Gerontological Continuing Education Needs Of Nurses Employed In Nursing Facilities In North Carolina, Sandra J. Todd-Atkinson

Dissertations

The major purpose of this investigation was to determine the self perceived learning needs of nurses employed in nursing facilities. Questionnaires were utilized to gather these data from nurses employed in fourteen nursing facilities thus representing 10% of all nursing facilities in North Carolina. Nonparametric tests were utilized to analyze the differences in perceived needs and selected independent variables. The selected independent variables were respondents' ages, educational preparation, years of experience, years of experience in a nursing facility, size of the facility, and position held. Two research questions guided the study: (1) what are the specific areas of felt needs …

Caring Behaviors Of Nursing Students And Their Attitudes Toward Older Adults, Jacquelyn D. Lambert-Davis

Dissertations

Caring is an emotion. It is a feeling of compassion and an understanding of the difficulties of others. Research indicates that caring behaviors and attitudes are an important part of the knowledge base for nursing students. Caring behaviors and attitudes are an important part of the knowledge base for nursing students in order to provide competent care for older adults. This descriptive cross-sectional study reports findings of caring attitudes and behaviors of nursing students using the Caring Dimensions Inventory (CDI). The purpose of this study was to examine the self reported attitudes and caring behaviors of nursing students toward older …

Integrating Geriatric Content Into Traditional Undergraduate Baccalaureate Nursing Curriculum, Gina B. Diaz

Dissertations

Geriatric content in baccalaureate nursing curriculum is essential. Nursing students need the knowledge, skills, and attitude in providing quality care to older adults. The goal of this project was to integrate geriatric content into the traditional undergraduate (TUG) baccalaureate nursing curriculum. This was completed by providing a 16-week didactic learning experience in the classroom and clinical experiences in the community setting and long-term care facility. Fourteen TUG baccalaureate nursing students from a private college participated in the project. Results indicate that the integration of geriatric content into baccalaureate nursing curriculum increases students' knowledge and skills and enhanced attitude towards older …

Transitional Care Medical House Call: A Pilot Project, Ron Billano Ordona

Dissertations

Vulnerable, homebound older adults are highly susceptible to unplanned 30-day hospital readmissions, which is costly for the healthcare system. As a result, health care expenditures for this population continue to rise. Studies have shown that transition of care programs, when complemented with home-based primary care delivery, may improve health care outcomes for this population.

The purpose of this quality improvement pilot project was to implement medical house calls as a component of transitional care management (TCM) and measure patient outcomes such as unplanned 30-day readmission rates and correlate predictors of readmission. As a secondary outcome, the project explored, tracked, and …

Nursing Student Attitudes Toward Mental Illness: A Quantitative Quasi-Experimental Study, Todd B. Hastings

Dissertations

Nursing students often harbor negative stereotypes and feel unknowledgeable and unprepared to work with mentally ill people. In addition, nursing students rarely choose the psychiatric specialty as a career option. A quantitative quasi-experimental study was conducted to examine nursing student feelings about engaging those with behavioral health problems. Over 300 nursing students in eight Bachelor of Science in Nursing professional nursing programs were surveyed on the first and last day of their program's psychiatric mental health nursing course (the independent variable). A valid and reliable survey instrument was used to collect nursing student responses characterizing attitudes, impressions of knowledge and …

Licensed Nurse/Certified Nurse Aide Collaboration In The Nursing Home, Cynthia Beynon

Dissertations

The purpose of this dissertation was to explore how collaboration is perceived and experienced by the licensed nurse (LN) and the certified nurse aide (CNA) in the nursing home (NH) setting. Understanding perspectives and patterns in the process of LN/CNA collaboration is critical in the quest to secure safe, quality care delivery for NH residents.

Targeting Loneliness In Older Adults With Weekly Socialization, Tanja Johnson

Dissertations

Problem: Loneliness related to social isolation among the older adult population has become an increasing health concern with few interventions available for the general population. Loneliness has been directly associated with depression, poorer physical health outcomes, and overall quality of life.

Methods: The purpose of this study is to evaluate loneliness in the older adult population residing in a senior living community in an urban area in Missouri. Weekly one-on-one socialization, ranging from 45-60 minutes, will be implemented over 6 weeks, with pre and post-intervention screening for loneliness with the 28-item Visit-A-Bit (VAB) screening tool. Approval was received by both …

Beyond Prognosis Communication: Exploring The Existential Dimensions Of Palliative Care Conversations With Adults With Advanced Cancer, Elise C. Tarbi

Dissertations

Communication about prognosis is integral to effective palliative care. However, prognosis communication often entails considering mortality, which can trigger existential questions. We understand very little about how existential experience is communicated in palliative care conversations. To fill this gap, this dissertation addresses the following aims: (1) Clarify the concept of the existential experience within the context of adults with advanced cancer (Chapter 2); (2) Describe how patients, families, and clinicians communicate about existential experience in palliative care conversations (Chapter 3); and (3) Explore the intersection between prognosis communication and existential dimensions of conversation (Chapter 4).

The Effects Of Mindfulness On Depression In Dialysis Patients, Nakeia Saddler

Dissertations

Abstract

Problem: Depression is a prevailing global health issue and a typical complication of dialysis patients. This quality improvement project's purpose was to evaluate mindfulness on depression in dialysis patients, aged 18-93, who are on dialysis and participated in a mindfulness program over three months.

Methods: A descriptive, prospective, and retrospective design was used to assess depression pre- and post-implementation of a mindfulness telephone line over three months. A convenience sample of twenty adults aged 18-83 who use this hemodialysis center on Monday, Wednesday, and Friday was utilized. The Iowa Model is the framework selected to guide the implementation of …

The Nursing Process And Allegations Of Malpractice Against Perinatal Registered Nurses In Florida, Genifer Jones Johnson

Dissertations

The nursing process as a foundation of professional nursing practice organizes care around the components of assessment, diagnosis, planning, implementation, and evaluation as required for professional registered nurses by the Florida Nurse Practice Act. Nurses who fail to comply with the Nurse Practice Act risk poor outcomes for their clients, disciplinary action from the State regulatory body, and legal action from the clients. This study was an examination of litigation claims against professional registered nurses in Florida who practice perinatal nursing seeking to identify and categorize allegations of negligence within the components of the nursing process. The expectation of this …

The Perceived Level Of Self-Efficacy Of Direct Care Staff Who Complete Person-Centered Care Dementia Training In Long-Term Care Setting, Tammy B. Retalic

Dissertations

Education that enables direct care workers to provide person-centered care approaches to older adults with dementia is necessary to optimize quality of life and reduce unnecessary antipsychotic medication use in long-term care settings. A quasi-experimental repeated measure project design evaluated the effectiveness of a dementia training program (one of several interventions implemented to reduce antipsychotic medication rates) by measuring the perceived level of self-efficacy before the training, immediately after the training and four to six weeks after completing the training.

The Impact Of Social Determinants Of Health And Acculturation On Quality Of Life In Older Chinese American Adults With Chronic Pain: A Quantitative Study, Chi Lam

Dissertations

Despite a rapid increase in the older Chinese American adult population, there are very few research studies examining the impact of social determinants of health and acculturation on the quality of life in older Chinese American adults. The purpose of the study was to determine the impact of social determinants of health and acculturation on quality of life in older Chinese American adults with chronic pain. This quantitative, descriptive correlational study utilized Madeleine Leininger’s Transcultural Theory as its theoretical framework. Two research questions guided this study: (1) Was there a difference in the quality of life in older Chinese American …

Cancer-Related Cognitive Impairment: Examining The Perspectives Of Survivors And Speech-Language Pathologists, Patricia Lynn Geels

Dissertations

Scientific advancements have led to significant improvements in cancer treatment and increased survival rates. However, cancer survivors often experience long-term effects, including cognitive impairments known as cancer-related cognitive impairment (CRCI). CRCI is a common and distressing side effect that affects affected individuals’ quality of life. The discipline of speech-language pathology (SLP) is well-positioned to assess and treat CRCI. Still, there is a gap in determining the most effective support for cancer survivors with CRCI. This mixed methods, three-paper dissertation implements exploratory, cross-sectional survey design to examine how speech-language pathologists and survivors view CRCI symptoms, its impact on daily functioning, and …

Standardized Reporting For Hospice Admissions, Courtney Davenport

Dissertations

­­Background: Effective communication should include the use of a standardized handoff reporting tool. Without the use of a standardized reporting tool in the hospice setting, there is the risk for a lack of communication between team members, which can lead to increased symptoms at end of life and less-than-optimal quality care.

Purpose: The purpose of this project is to implement a standardized handoff reporting tool, known as HAND-IT, to be used with hospice admissions. The primary outcome measure is to record the percentage use of the HAND-IT tool with admissions.

Methods: A quality improvement prospective design was used for this …

Orthostatic Vital Signs In Bone Marrow Transplant Patients, Julianne Tomac

Dissertations

Abstract

Background: Orthostatic hypotension is a potentially serious risk factor that can cause falls in adults, especially those receiving a bone marrow transplant. The odds of falling increase if diagnosed with a hematological form of cancer while receiving treatment due to side effects of chemotherapy and medications.

Methods: This retrospective record review investigated the completion rate of orthostatic vital signs in bone marrow transplant patient’s days 10 to 17. The aim was to discover 2% of positive orthostatic cases in a 6-month period. The primary outcome measures included the number of orthostatic vital signs obtained and secondary outcome measures included …

The Experiences Of Black American Older Adults Managing Pain: A Nursing Ethnography, Sheria G. Robinson-Lane

Dissertations

Pain can negatively affect quality of life for Black elders. They are less likely to report pain concerns and have voiced pain needs adequately met. To better understand the pain management experiences and concerns of Black elders, an ethnographic study was completed within an urban, low-income, elder housing facility.

Impact Of A Standardized Handoff Tool Between Gastroenterology And Pacu Nurses’ Communication And Satisfaction, Matthew Kahmann

Dissertations

Impact of a Standardized Handoff Tool between Gastroenterology and PACU Nurses’ Communication and Satisfaction

Abstract

Problem: Patient handoff between nurses is a critical moment where it is imperative that complete and accurate information is exchanged. Handoff of patient information can be complex, and the use of unstructured, non-standardized handoffs could result in poor communication leading to the omission of pertinent information and a decrease in patient safety and staff satisfaction. Several studies have found the use of standardized handoff tools improve communication, decrease omission of critical information, and improve staff satisfaction. While the use of standardized handoff tools is best …