Digital Commons Network^™

Professional Development For Classified Managers Within The Business Services Departments At California Public School Districts, Juliet Castorena Orozco

Dissertations

Purpose. The purpose of this Delphi study was to identify and describe professional development topics required to prepare classified managers in California public school district business services departments as effective leaders as perceived by a panel of experts. This study also sought to identify the degree of importance of each professional development topic and the best strategies to address those topics as perceived by a panel of experts.

Methodology. A Delphi research design was used to identify and describe professional development strategies necessary to prepare classified managers in the business services division of California public school districts. The Delphi panel …

Nursing Students' Intention To Work With The Elderly After Graduation: A Qualitative Study, Terri Murabito

Dissertations

America's population is aging. More than one in five Americans will be over 65 by 2030. These numbers are expected to challenge existing healthcare systems. The recruitment and retention of qualified, competent registered nurses (RNs) to care for this vulnerable population have become urgent. However, undergraduate baccalaureate nurses consistently report geriatric nursing as the least preferred clinical area to in work after graduation. To understand how graduating nurses discern their career intentions, a basic qualitative study was undertaken using Ajzen's theory of planned behavior as an underlying theoretical framework. The purpose of the study was to understand and interpret nursing …

The Experience Of "Doing Well" In Older Nursing Home Residents: Bringing The Past To The Present, Ronald J. Walent

Dissertations

Though discussions of well-being and quality of life for older adults in American nursing homes have flourished over the past decade, relatively few studies have explored these notions from the perspective of older residents themselves. The purpose of this research is to understand experiences and perceptions of "doing well" in older nursing home residents.

Cognitive Dysfunction In Older Breast Cancer Survivors, Adele Crouch

Dissertations

Up to 75% of the more than 3.5 million breast cancer survivors (BCS) living in the United States report cognitive dysfunction. However, little is known about cognitive dysfunction among older BCS, who may be at greater risk. Therefore, the purpose of this dissertation was to characterize cognitive dysfunction in older BCS. Specific aims included:

(1) synthesize the literature regarding cognitive dysfunction in older BCS

(2) examine the relationships between a) objective cognitive function (immediate memory, delayed memory, attention, executive function-working memory, verbal fluency) and subjective cognitive function (attention); b) demographic factors, medical factors, treatment factors, and cancer-related symptoms (depressive symptoms, …

Improving Outcomes Through Patient Empowerment At Transition Of Care: A Fall Prevention Program For Stroke Survivors, Tiffany M. Hoke

Dissertations

Stroke survivors fall 7 times more annually than same-aged healthy adults; and most fall within the first 2 to 6 months post stroke after transition of care home from the acute setting. These falls cause hip fractures and other bodily injury, further compounding post-stroke mobility, fear of falling, social isolation, and social dependence while collectively yielding poorer outcomes at greater financial burden.

To date, no fall prevention program has targeted stroke survivors as they prepare for transition of care home from the acute setting.

The purpose of this practice inquiry is to develop an evidence-based fall prevention program aimed at …

An Exploratory Study To Shape A Disaster Nurse Practitioner Scope Of Practice, Frances Dunniway

Dissertations

The impact and devastation from national disasters pose imminent risk to large populations. If trained in disaster response and following evidence-based practice standards, the Nurse Practitioner (NP) could be prepared to adapt to any setting or surrounding, utilizing their full educational and health care training. Currently there are no written guidelines during disasters to manage the various clinical conditions. Using a Delphi technique, this exploratory study investigated the multidisciplinary understanding about the disaster NP role. Key findings included: 1. Across four groups of disaster responders, there was confusion about the disaster NP role, indicating a need for role clarity. 2. …

A Quality Improvement Project On Evaluating The Effectiveness Of Implementing A Fall Intervention Checklist During End Of Shift Report On A Post-Operative Unit, Victoria Hogans

Dissertations

Introduction: Falls are a current issue affecting our senior citizens within the hospital setting. A fall may result in patient injuries, increased length of stay, and hospital costs. To prevent patient falls and fall-related injuries, hospitals have implemented fall bundles. The bundles consist of assessment tools to identify those at risk for a fall and the interventions that should be implemented to prevent them from falling.

Methods: A quality improvement project was implemented based on the DMAIC Six Sigma concept model to assess if implementing a fall intervention checklist at shift change combined with a fall bundle already in place …

Implementation Of The Family Help Protocol: A Feasibility Project For A West Texas Icu, Rebecca Mcclay

Dissertations

The purpose of this project was to determine if there is sufficient bedside ICU nurse buy-in to the Family HELP protocol to make implementation feasible at one county hospital in West Texas.

Cross-Cultural Adaptation And Validation Of Lung Cancer Screening Health Belief Scale, Fang Lei

Dissertations

Lung cancer is the leading cause of cancer death and the third prevalent disease among Chinese Americans. Lung cancer screening with low dose computed tomography is an effective method to detect lung cancer. Compared to chest X-ray, low dose computed tomography can reduce the mortality rate of lung cancer by 20% in the high-risk smokers. Since 2013, lung cancer screening has been recommended by most health organizations and covered both by private and public insurances. However, the uptake rate of lung cancer screening is still low in the US, and there are few studies on lung cancer screening among Chinese …

The Impact Of Structured Orientation On Role Transition And Turnover Intentions Of Advanced Practice Registered Nurses, Nadege Jules

Dissertations

The first year of transitioning from being an expert nurse to embracing the role as an Advanced Practice Registered Nurse (APRN) is challenging. The literature identifies a gap in APRNs transition to practice support in the new role. The impact of structured orientation on role transition and job turnover intentions of novice Advanced Practice Registered Nurses in their first APRN position is warranted and have not been addressed.

The purpose of this nonexperimental, correlational study was to investigate the impact of structured orientation on role transition and job turnover intentions of novice Advanced Practice Registered Nurses in the United States …

A Beginning Look At The Effect Of Age On Dyspnea, Physical Functioning And Self-Efficacy For Home Walking And Managing Shortness Of Breath In Adults With Chronic Obstructive Pulmonary Disease (Copd), Lynda A. Mackin

Dissertations

Chronic illness is common in older adults and is associated with functional impairments. Older adults with chronic obstructive pulmonary disease (COPD) face both age-related and disease-related decline in pulmonary function. Dyspnea, also referred to as shortness of breath, is a major symptom in COPD and progressive dyspnea is associated with decline in physical function. Aging, chronic illness and a decline in physical function can compromise the individual's confidence, also known as self-efficacy, for performing physical activities. Chronic disease self-management programs for COPD that include an exercise program have been reported to improve functional status, decrease dyspnea and improve self-efficacy for …

Nursing Students' Self-Efficacy To Care For Older Adults In Acute Care Settings In Ghana: A Mixed Method Study, Diana Abudu-Birresborn

Dissertations

Self-efficacy has been reported to serve as a motivator for goal achievement and to impact care quality and career development choices. Understanding nursing students' self-efficacy to care for older adults can provide an opportunity to identify gaps and develop strategies to shape nursing students' interest in caring for older adults. This study sought to identify the relationship between nursing students' knowledge about, attitudes towards, and self-efficacy to care for older adults and explored nursing students' understanding of their self-efficacy to care for older adults. The study also examined stakeholders' perceptions about nursing students' self-efficacy to care for older adults and …

Caregiver Burden And Its Relationship To Health-Related Quality Of Life Of Spouses Of Coronary Artery Bypass Patients, Margo A. Halm

Dissertations

With today's aging population and short hospitalizations, patients recovering after coronary artery bypass (CAB) surgery rely on family assistance, usually from their spouse. While caregiving may be meaningful, this experience may be stressful. Very little is known about caregiver burden after CAB surgery. The purpose of this cross-sectional study was to investigate the correlates of caregiver burden in the first year after CAB surgery and its relationship to spousal health-related quality of life (HRQL) outcomes.

A Qualitative Case Study Of Health-Related Baccalaureate And Graduate Web-Based Simulated Clinical Learning Platforms, Kathrine Choura Branch

Dissertations

Simulation has been recognized as a teaching, learning, evaluation, and research strategy based on learning theories, that has come to play a significant role in healthcare education (Beal et al., 2017; La Cerra et al., 2019). Health-related academic programs in higher education have traditionally used simulation to fill gaps in learning and strengthen students’ clinical and critical thinking skills in conjunction with didactic classroom content, laboratory practice, and clinical education in the community setting (Hayden et al., 2014). With the onset and unpredictability of COVID-19, there was almost an immediate need for health-related academic programs across the world to transition …

“I Just Want To Play”: Methodological Considerations For Including Older Adults In Co-Creation Of Research With A Focus On The Meaning Of Activity For Residents Of A 55+ Active Adult Master Planned Community, Becky Alice De Oliveira

Dissertations

Co-creation of research with older adults is examined methodologically and the meaning of activity for older adults living in a 55+ active adult master planned community is examined contextually. Older adults are often the subjects of research but rarely involved as co-creators. Literature on co-creation of research indicates that it allows stakeholders greater participation (Halvorsrud et al., 2021), and older adults should be seen as stakeholders (Weil, 2015). This perspective challenges bias toward older people (van den Berg et al., 2019), and acknowledges the wealth of knowledge they possess as “experts” (Partridge, 2022). While potential exist for co-creation of research …

Choices Related To Maximizing Quality Of Life At End Of Life, Theresa Lynn

Dissertations

Humans, including those residing in the United States, can live in denial of their own mortality. Because of this, futile care is sometimes provided, often at great monetary expense and for little or no return in terms of quality or length of life. At least two opportunities exist for making choices regarding care at the end of life in the U.S.: completing advance directives and choosing hospice care.

Adverse Childhood Experiences (Aces) Education Implementation For Graduate Nursing Students, Courtney Kovachevich

Dissertations

Chronic conditions are a leading cause of death and disability in the United States (U.S.). Adverse Childhood Experiences (ACEs) are risk factors for chronic conditions and death; however, screening and assessment of ACEs do not occur in primary care settings. A barrier to screening is a lack of knowledge and education during providers’ didactic courses. To address this barrier, a standardized education tool was implemented into a midwestern public graduate nursing Doctor of Nursing Practice (DNP) curriculum. The design was a Quality Improvement (QI) project with a descriptive cohort design and purposive sample. The inclusion criteria were students in the …

Fall Risk Screening In Community Dwelling Elders Through Self-Assessment, Natasha Dickinson

Dissertations

Problem: Falls and fall-related injuries are considered preventable. Fall risk screening is crucial in the prevention of falls and fall-related injuries in community dwelling elders. The purpose of this quality improvement project was to initiate the use of the CDC’s self-rated Fall Risk Questionnaire (Self-rated FRQ) screening tool and CDC-guided education in a cohort of community dwelling seniors at a geriatric agency.

Method: A pre-post assessment was conducted on community dwelling seniors 65-years and older. A convenience sample of eligible participants (N=16) was taken from a geriatric agency in a Midwest, metropolitan city. Fall incidence and fall-related injuries …

Evaluating The Effectiveness Of Implementing Depression Screenings With Uninsured African American Adults, Pamela Talley

Dissertations

Problem: Uninsured African Americans are underdiagnosed and often untreated for depression. Individuals usually do not present to their primary care provider with a complaint of depressed mood, however, may report symptoms such as decreased energy, general body aches, digestive concerns, somatic complaints, or older adults' memory or cognitive problems. The purpose of this quality improvement pilot project was to examine the results of the implementation of a depression screening (PHQ-9) in a primary care setting for uninsured adults for detection, diagnosis, and treatment of depression in African American clients.

Results: The PHQ-9 screening questionnaire was given to 100% (N …

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 …

Implementation Of A Protocol Nurse In The Emergency Department, Marissa Kramer

Dissertations

Abstract

Problem: Increased wait times and extended length of stay (LOS) of patients in the Emergency Department (ED) are contributing to overcrowding, burdening EDs worldwide. A nurse can initiate patient care using protocol order sets while a patient is in the waiting room; however, triage nurses are often too busy to complete these orders. Scheduling a nurse to complete these protocol order sets could reduce ED overcrowding and patient LOS.

Method: A convenience sample was used to retrospectively chart review and collect data utilizing an excel spreadsheet with patients 40 years of age and older with a chief complaint of …

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 …

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 …

The Hustler Award Program, Julia N. Biayi

Dissertations

Problem: Hospitalized adults are at increased risk of falling due to multiple aspects, including but not limited to changes in health status, the environment, pain, weakness, confusion, and prolonged immobility. This project focused on the question: How will the utilization of the Hustler Award Program decrease fall rates in an adult inpatient medical-surgical unit?

Method: A prospective quality improvement pilot study focused on a 24-bed medical-surgical unit in a Midwest, 487-bed metropolitan-based facility.

Results: The results captured are for the evaluation period occurring from September through November 2021. The staff responded to 52-bed exit alarms, which yielded a response rate …

Transitioning Eating Practices Of Older Adults, Michelle Lajoy Jackson

Dissertations

Purpose: The purpose of this descriptive qualitative study was to explore what factors may have influenced the transition of an individual older adult’s eating practices over a lifespan and the impact participants perceived those factors currently had upon their nutritional health in older adulthood.

Background: The older adult population is recognized as one of the fastest growing populations in the United States. One of many growing concerns for this population is the impact of dietary practices on the morbidity and mortality of this aging population. There is limited research to date that has explored the transitioning of appetite …

Advanced Nursing Education: Critical Factors That Influence Diploma And Associate Degree Nurses To Advance, Rose L. Mcghie-Anderson

Dissertations

Advanced nursing education needs to be pursued along the continuum of the nursing career path. This education process is indispensable to the role of the nurse as educator, manager, nurse leader, and researcher who will effect policy changes and assume leadership roles as revolutionary thinkers in addition to implementing paradigmatic shifts.

This grounded theory study sought to unearth the critical factors that motivate nurses to advance academically. The study aimed to gain an understanding of the social processes associated with the decision of diploma and associate degree nurses to advance their nursing education.

The Effect Of Using The Adaptive Crawler™ On The Development Of Infants With Spina Bifida, Age 6-12 Months, Margaret E. Williams

Dissertations

During the timeframe of crawling, age 6--12 months, infants typically interact independently with their environment and their parents in order to perform certain developmental tasks. However, many infants with spina bifida are unable to crawl, as would typically developing infants. The inability to crawl may place these infants at a distinct disadvantage during this developmental timeframe. As a result of the developmental disadvantage, the parent-infant relationship may be negatively affected. For this study, the Adaptive Crawler™ assistive technology infant mobility device was designed, and a prototype created, to promote independent mobility and exploration of their environment by infants with spina …

Exploring Mentoring Relationships Among Novice Nurse Faculty: A Grounded Theory, Katie Ruth Busby

Dissertations

The growing and aging population has created an increased demand for health care, resulting in a need for hundreds of thousands more nurses across the United States. As a result, additional nurse faculty are needed to teach the next generation of nurses. However, nurses who enter the faculty role in academia often come from various professional backgrounds with different educational preparation that may not equate to success with the tripartite faculty role of teaching, scholarship, and service. As a way to retain and develop novice faculty, mentoring relationships and programs are promoted as an intervention for career and psychosocial development …

The Changing Of Ambulatory Care: Provision And Utilizations As Influenced By The Patient Protection And Affordable Care Act, Heather Marie Brom

Dissertations

Nurse practitioners (NPs) represent a growing healthcare provider workforce, which is poised to assist with the shortages of physicians and growing demand for healthcare services driven by the Affordable Care Act (ACA). Restrictions to NP scope of practice may present a barrier to meeting this need. This research sought to determine if NP scope of practice laws were altered in response to passage of the ACA and to examine changes in the number of NPs, to test for differences in the delivery of ambulatory care in the United States, and to characterize ambulatory practice by state-level NP scope of practice …

The Lived Experience Of Aging: Listening To The Oldest-Old, Julia A. Pusztai

Dissertations

Although embraced as desirable by most, living into very old age is largely unexplored as a distinct season of life, with increased, varied, and cumulative changes during a unique time of vulnerability and frailty. The purpose of this study was to listen to the oldest-old, and to explore their lived experience of growing old. This hermeneutic phenomenology study examines the experience of finding meaning and living with losses and gains in advanced old age.

This study design included three separate interviews one month apart with participants over 85 years of age. Purposive sampling resulted in 13 participants, 5 being male …