Pinch Span And Force: Normative Data, Requirements For Functional Tasks And Life Roles, And The Influence Of Carpometacarpal Joint Osteoarthritis, Nancy Hock

Dissertations

The three studies that form this dissertation build knowledge related to functional pinch. Study 1 provides normative data for the Baseline® 5-Position Hydraulic Pinch Meter, which may be used in clinical practice. The data collected in this study demonstrate the relationship between lateral pinch strength and age and reveal that strength decreases with age in both males and females. Through examination of the lateral pinch force produced at the 5 different pinch spans, it was found that the strongest lateral pinch strength was produced at 4-5 cm of pinch span. This information can be used by clinicians as they modify …

Exploring Functional Health Literacy In Older Adults With Age-Related Macular Degeneration, Jennifer K. Fortuna

Dissertations

This three-paper dissertation explores functional health literacy (i.e., the ability to access, process and understand health information) in older adults with vision loss caused by age-related macular degeneration (AMD). This research builds scholarship that explores the unique patient education needs of older adults with AMD. The specific aims of this research are to: (1) explore associations between functional health literacy and severity of visual impairment; (2) determine the general readability, suitability and comprehensibility of online patient education materials (PEMs) designed for older adults with AMD; and, (3) assess the overall quality of one PEM that has been simplified based on …

Older Adult Caregiving In An Amish Community, Helen Mavis Farrar

Dissertations

The focus of this study is Amish experiences of older adult caregiving. As an ethnic and religious minority group, the population of Amish in North America is doubling every 18 to 20 years, increasing from an estimated 235,000 in 2008, to 282,000 in 2013 (Young Center for Anabaptist and Pietist Studies, 2013). Cultural values of the Amish include separation from mainstream society, avoidance of modern technology and an adherence to a rural, agrarian lifestyle according to scripture (Hurst & McConnell, 2010). In spite of sequestration from mainstream society, there is growing evidence that the Amish communities are increasingly seeking healthcare …

Adapting To Obstacles: Inhibition And Creative Potential In A Sample Of Successfully Aging Older Adults, Cassandra Dinius

Dissertations

Studying older adults who are aging ‘successfully’ (i.e., avoiding disease/disability; maintaining high cognitive and physical functioning; engaging in meaningful interpersonal/social engagement) may offer insight into variables that contribute to cognitive change throughout the lifespan. Successful aging is related to levels of engagement, which may be promoted by the problem solving and reevaluation encouraged by the creative process (Fisher & Specht, 1999). Creative thinking requires the consideration of diverse concepts and strategies (e.g., generating many solutions), as well as the regulated filtering of these possibilities (e.g., neither too permissive nor too narrow when eliminating ideas; Baas, De Dreu, & Nijstad, 2011). …

Factors Influencing End-Of-Life Decisions Regarding The Living Will And Durable Power Of Attorney: An Application Of Roy's Adaptation Model, Weihua Zhang

Dissertations

Modern technology offers extraordinary life-saving opportunities that were not imaginable in old times. However, it also takes us to a new frontier where the challenge of life-saving becomes death-prolonging. More than a decade after the Patient Self-Determination Act which guarantees the individual's legal right to decide the end-of-life care, the utilization of this right has seen no significant increase. The purpose of this quantitative study was to identify the variables that influence the decision-making responses related to Advance Directives (ADs). A path model applying Roy's Adaptation Model was developed for the study. Publicly accessible data collected for the Longitudinal Study …

Variables That May Affect Physical Activity Levels In African American Females With Type 2 Diabetes, Melanie K. Samardzija

Dissertations

Type 2 diabetes continues to pose a significant health challenge for the United States. The incidence and prevalence rates for type 2 diabetes are higher for certain at risk populations such as African American females. Personal behaviors including high-fat, high-caloric diets and physical inactivity result in obesity and insulin resistance that are associated with type 2 diabetes. Physical inactivity is particularly common in African American females, and this places them at an increased risk for the development of type 2 diabetes. Certain variables have been shown to influence physical activity. The purpose of this study was to examine how selected …

Functional Status Of Older Adults After Hip Fracture, Christina L. Garcia

Dissertations

This dissertation is composed of three manuscripts addressing functional status of adults age 65 years and older after hip fracture. The first manuscript is a review of the literature on the impact of gender, age, comorbidities, pain, depression, self-efficacy, cognitive status, and social support on functional status of older adults after hip fracture. Further research on the relationships among these factors will assist healthcare providers in early identification of adults age 65 years and older after hip fracture at risk of decline in functional status. Results of this literature review led to a concept analysis aimed to provide clarity of …

The Effectiveness And Perceived Effectiveness Of Simple Reminiscence Therapy Involving Photographic Prompts For Determining Life Satisfaction In Noninstitutionalized Elderly Persons, Tommie L. Norris

Dissertations

The purpose of this study was to determine the effectiveness and perceived effectiveness of simple reminiscence therapy using photographic prompts on the life satisfaction of noninstitutionalized elderly persons. The Self-Anchoring-Life Satisfaction Scale (SALSS) was used to measure life satisfaction. Erikson's Developmental Theory and the concept reminiscence formed the theoretical framework for this study.

The Impact Of A Multisensory Stimulation Environment Within A Memory Care Assisted Living Facility, Dana M. Prince

Dissertations

The use of Multisensory Stimulation Environments (MSSE) has grown increasingly more common in the United States (U.S.) as a nonpharmacological intervention for Behavioral and Psychological Symptoms of Dementia (BPSD). However, typical MSSE designs require a secluded room isolated from outside stimulation and demand direct supervision from the care provider during treatment. Due to projected shortages in the clinical workforce and the population of older adults on the rise, a study was designed to reveal the effectiveness of an open-floorplan MSSE to reduce the demand of care providers during the use of the MSSE while allowing subjects diagnosed with dementia to …

A Quality Improvement Study On Missed Appointment Management In Primary Care, Aunye' Dina Amos

Dissertations

Abstract

Problem: Patients who miss appointments have poorer health outcomes and increase costs for medical care. The purpose of this quality improvement study was to evaluate the effects of missed appointments on patients’ outcomes for diabetes mellitus, and resulting financial losses to a private primary care practice.

Method: A quality improvement initiative with a retrospective review of patients over a six-month period in 2018 (before) and 2019 (after a missed appointment fee was implemented). All adult patients, aged 18-92 years, were included. For those with diabetes, a HbA1c for each patient who kept or missed their appointment was recorded.

Results: …

Impact Of A Web-Based Instructional Module Of Alzheimer’S Disease Within Seven Content Knowledge Domains, Joyce Haynie

Dissertations

Abstract

Alzheimer’s Disease (AD) has been classified as the most common form of dementia. Primary health care providers are usually the first clinicians to whom individuals present with symptoms of dementia. By 2050, it is expected that as many as 13.8 million Americans will be living with AD, and millions more will be placed in the challenging role of providing care for these individuals. However, studies continue to show that dementia is often underdiagnosed and under detected. The purpose of the study was to systematically inquire about the impact of AD education on level of knowledge about AD among primary …

Managing Personal Integrity: A Grounded Theory Of Elderly People Surviving Hospitalization, Cynthia S. Jacelon

Dissertations

The goal of this grounded theory research was to develop a substantive theory of the social processes engaged in by elderly people while in the hospital. The derived theory is entitled Managing Personal Integrity. Within the theory, Personal Integrity is defined as a dynamic, intrinsic quality of the self which has properties composed of physical and psychological attributes.

A Silent Epidemic With No Voice: Alzheimer's Education In An African American Midwest Community, Sandra D. Fields

Dissertations

Alzheimer’s disease is a growing crisis in this country, particularly in the African American community. Despite this awareness by the health care community and educational programs offered about the disease, a deficit in research assessing the impact of these programs exists. Consequently, the purpose of this study is to analyze the key criterion relative to the educational programs about Alzheimer’s offered by local organizations and the impact they have on a Midwest African American community.

According to research regarding Alzheimer’s disease, African Americans continue to go undiagnosed and untreated. The literature review in this study explores the synergy of three …

Down Home: An Ethnography About Community Process And Health Of Older Persons In A Rural Setting, Carol A. Craig

Dissertations

The purpose of this study was to understand how rural-dwelling elderly people describe their health and to gain an understanding of rural community processes as they relate to the health of older residents. Although community health nursing practice supports community-level interventions, the influence of communities upon the health of older community members is not well known. Ethnographic design and methods were employed to study the health of older residents in a Western Plains farming community of about 500 people.

Specialty Certification In Nursing: The Influence Of Nursing Faculty On Pre-Licensure Students, Christina N. George

Dissertations

The seminal publication To Err is Human focused on designing healthcare processes to ensure safe patient outcomes (IOM, 2000). That report identified board certification of health professionals as one way to improve patient care quality and safety (IOM, 2000). Current discussions within the nursing profession regarding professional development have recognized value in specialty certification post-licensure, but the research on the perceived value of specialty certification has been limited among nurse educators. This study utilized the Perceived Value of Certification Tool (PVCT) to examine whether nursing faculty perceive value in certification and whether that perception is shared in the educational setting. …

Race-Based Trauma Care Training For Veteran’S Health Administration Nurse Practitioners, Vanessa Loyd

Dissertations

Abstract

Problem: Trauma informed care has become a priority for persons exposed to psychological, physiological, emotional consequences as a result of traumatic experiences. Veterans are from different cultures, including gender, race, religion, sexual orientation and other social groups. The Veterans Health Administration (VHA) is responsible for the health of this culturally diverse patient population. Healthcare providers without any prior military experience may experience difficulty obtaining an accurate history and physical exam due to the military’s cross-cultural environment. The project aim was to increase confidence and competence in race-based trauma care by incorporating training into a new acute care fellowship …

Adult-Geriatric Acute Care Nurse Practitioner Fellowship For The Veterans Health Administration, Karen Scaglione

Dissertations

Problem: Nurse practitioner (NP) fellowship programs assist the novice NP in transitioning from a traditional nursing role to advanced practice. The Veteran’s Health Administration (VHA) utilizes a NP primary care fellowship program. An acute care fellowship may assist with role transition, confidence and competence for acute care NPs. The purpose of this evidence-based pilot project was to develop a transition to practice acute care fellowship program at a Midwestern VHA hospital.

Methods: A prospective, descriptive design utilizing a convenience sample of senior adult-geriatric nurse practitioner (AGNP) students during a pilot study of an acute care fellowship program. Outcome measures …

Education-Based Interventions Effects On 30-Day Readmission Rates For Patients With Copd, Gina Hand-Eoloff

Dissertations

Purpose: This Quality Improvement (QI) project evaluated the impact of an existing education-based program for Chronic Obstructive Pulmonary Disease (COPD) and its effect on 30-day readmission rates in one hospital in rural Missouri.

Method: A retrospective chart review was completed on 493 patients with an inclusive diagnosis of COPD from June 1, 2018, to March 31, 2019, using a cohort study design and a two-sample t-test analysis. Additional variables were analyzed to determine if there were predictive factors of an elevated risk of readmission.

Results: The two-sample t-test reveals there is no statistically significant difference between the rates of readmission …

Outcome Evaluation Of An Interdisciplinary Care Model For Children With Cystic Fibrosis, Roberta P. Pawlak

Dissertations

Cystic Fibrosis (CF) is a life-limiting, autosomal recessive inherited disease that affects approximately 30,000 individuals in the United States. Health problems of children with CF tend to be complex, requiring specialty health services. Often children with CF are cared for in CF Care Centers, where an interdisciplinary care team addresses these needs. The Cystic Fibrosis Foundation (CFF) recommends specific Clinical Practice Guidelines be applied to all patients with CF. A major gap in the CF literature is evidence of guideline application results on health outcomes. The purpose of this study was to examine the influence of an interdisciplinary care model …

Widowhood: The First Anniversary Spousal Bereavement-Related Stress, Coping, And Well-Being In Older Women, Mary Elizabeth Minton

Dissertations

By 2020 approximately one million individuals will experience spousal bereavement annually, primarily older women. However, little is known about the survivor's well-being around the first year death anniversary. This study examined spousal bereavement-related stress, coping, and well-being in widows 65 years and older at months 11, 12, and 13 following the death of the spouse based on Lazarus and Folkman's transactional approach and Schaefer and Moos' model of life crises and transitions. Using a prospective, longitudinal, correlational design, data were collected from 47 widows.

Exploring The Homeless Persons Perception Of Living In A Long-Term Care Facility, Janice Woods

Dissertations

Objective:The purpose of this study was to explore the lived experiences of homeless persons admitted to a nursing home facility. Originally, the study was to explore their understanding of and their experience with advance health care planning; coincidently, the participants were more open to their experience of living in a long-term care facility.

Method:A convenience sample of 13 participants (12 male, 1 female) at four long-term care facilities in Southern California were interviewed about their perception of advanced health care planning, including the physician’s orders for life sustaining treatment (POLST); a consent form required in all nursing homes. …

Explication Of The Meaning Of Reminiscence For The Elderly Living In The Community, Roberta Claire Cavendish

Dissertations

Human beings have the distinct capacity to reminisce. Reminiscence is a function of memory and memories are autobiographical. Studying memory expanded an understanding of the phenomenon. Although reminiscence occurs in all age groups, special significance has been attributed to its meaning in this population. This area has yet to be studied. Using a semi-structured interview technique, eight participants, six females and two males were asked to describe reminiscing. The data were analyzed using a qualitative methodology.

A Collaborative Case Management Model In An End Stage Renal Disease Patient Population, Linda Q. Everett

Dissertations

The purpose of this pilot study was to examine the effectiveness of a collaborative case management (CCM) model on an end stage renal disease (ESRD) patient population. The study attempted to confront some of the conceptual and methodological issues surrounding the study of case management. Those issues included: absence of a theoretical framework; the omission of operational definitions of case management; lack of clear specification and measurement of sample selection criteria; the frequent use of weak pre-post designs; and the use of unstandardized instruments. The following strategies to address these issues were presented: a theoretical framework was developed in which …

Exploring Older Adults' Perceptions Of The Utility And Ease Of The Use Of Personal Emergency Response Systems, Patrica Ann Mclean

Dissertations

The aim of this study was to explore and describe perceptions of the utility and ease of use of a personal emergency response system (PERS) among older adults who are aging in place. Research Question: "What is the meaning of a PERS use for functionally impaired older adults?"

Lived Experience After Surgery Among Hispanic Adults, Kimberly Sanchez

Dissertations

Background: In 2010, more than 51.4 million procedures were performed in hospitals in the United States. Almost half of all patients had a surgical procedure prior to their hospital discharge and over 80% of patients experienced acute pain after surgery. When acute pain persists for two or more months after surgery, chronic pain develops, costing the United States up to $635 billion annually. Hispanics, in particular, disproportionately experience disparities in pain treatment as they are less likely to receive analgesics. Routine pain assessments conducted using instruments may be inaccurately capturing the pain experience of Hispanic adults. No research has …

The Meaning Of A Family History Of Colorectal Cancer In Black Families In The United States, Cassandra Loggins

Dissertations

The purpose of this study is to understand the meaning of a family history of colorectal cancer (CRC) for first-degree relatives of Blacks diagnosed with CRC. Even though CRC is more preventable than other cancers because of effective screening tests for prevention and early detection, Blacks experience a disproportionate burden of CRC compared to other groups. Interventions to increase CRC screening among Blacks have not produced a significant reduction in CRC disparity. Underutilization of CRC screening and low perceived risk of CRC are major factors contributing to CRC disparity. The informing methodological approach employed in this study was hermeneutic phenomenology, …

Experiences Of African American Women And Their Ascension To Senior Academic Leadership Positions In Higher Education Institutions, Jennifer Simms

Dissertations

Previous research has noted that African American women are absent in senior administrative positions in institutions of higher education. Few studies have provided detailed insight into the experiences of African American women during their transition to senior-level leadership roles in the academy. The purpose of this qualitative research study was to document the experiences of African American women during their ascension to senior academic leadership positions in higher education institutions. This research employed purposeful sampling and snowball sampling to recruit five African American women in Midwestern U.S. who ascended to a leadership role within the Office of Academic Affairs. This …

The Lived Experience Of Nurse Practitioner Role Transition: A Phenomenology Study, Anthony Michael Angelow

Dissertations

This qualitative, descriptive phenomenology study sought to answer the following question: What experiences do nurse practitioners identify as being associated with their transition to the nurse practitioner (NP) role? Using purposive sampling and snowball techniques, eight nurse practitioners participated in this study. The study included participants from across the United States. Data from this study were developed from unstructured interviews with participants using audio-recorded open-ended questions, which were then transcribed by the principal investigator. The data were analyzed using Colaizzi’s (cited in Creswell, 2013) method for qualitative data analysis to identify common themes. Four central themes were generated from these …

Family Care Partners Of Chronically Ill Older Adults: The Role Of Uncertainty In Illness, Jillian Pine

Dissertations

Abstract This study integrated research on family care partners of older adults and

research on uncertainty in chronic illness. Previous findings were extended by examining care partners of older adults with multiple chronic conditions and highlighting early-stage undiagnosed cognitive impairment as a uniquely unclear condition. Participants were 45 women assisting community-dwelling, earlier generation older adults with multiple chronic health conditions and a prognosis of more than six months. Online survey data were used to test the hypotheses that increased illness uncertainty would be associated with increased care partner-recipient relationship strain and increased care partner perceived stress. This study also hypothesized …

Implementing A Caps Simulation To Increase Nursing Education Practice Students’ Self-Awareness Of Attitudes And Beliefs About Poverty, Melissa Ehmke

Dissertations

Problem. The purpose of this project is to determine if college students who are currently in nursing school, will benefit from the addition of a poverty simulation to positively influence their self-awareness and individual-level beliefs and attitudes towards poverty, therefore being able to serve those in poverty fully and guide them to appropriate resources.

Methods. Bachelor of Science in Nursing (BSN) and Doctoral Nursing Practice (DNP) students participated in a three-hour Community Action Poverty Simulation (CAPS). A twenty-one item Attitude Toward Poverty Scale short form (ATPS) survey was completed pre and post-simulation participation.

Results. Significant improvements resulted in three of …