Digital Commons Network^™

Evaluation Of Pre-Procedural Phone Call Effectiveness Before A Colonoscopy, Rachel Schoelch

Dissertations

Abstract

Problem: Colorectal cancer is the third most diagnosed cancer in the United States (Gu et al., 2019). A colonoscopy procedure is the best diagnostic tool to evaluate the colon for pre-cancerous and cancerous polyps (Dang et al., 2020). Inadequate bowel preparation decreases colon visualization where adenomatous colon lesions may be missed.

Methods: Using an observational, pre/post design, a chart review was conducted for this QI project. Quantitative data comparing Boston Bowel Preparation Scale (BBPS) scores was collected on patients who received nurse-led phone calls one month prior to a colonoscopy, and patients who received phone calls one week prior …

Eye Care Protocol In Critically Ill Pediatric Patients On Neuromuscular Blockage, Jinnie Tkach

Dissertations

Abstract

Problem: Patients admitted to the pediatric intensive care unit (PICU) are at increased risk for the development of ocular surface disease (OSD) due to impaired ocular mechanisms while intubated, sedated, and on continuous neuromuscular blockade. The purpose of this project is to prevent OSD and vision impairments by increasing the frequency of eye care in accordance with a PICU eye care protocol.

Methods: An observational descriptive study was conducted utilizing retrospective and prospective chart review. Comparisons were drawn between the 2021 pre intervention group and the 2022 post intervention group regarding the impact of linking lubricating eye ointment orders …

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

Dissertations

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

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

Nursing Anxiety Self-Evaluation And Resiliency Methods, Dianne Deck

Dissertations

Abstract

Introduction: Nurses are stressed due to the demands of their job. This study aims to determine whether MICU nurses at a large Midwestern hospital would have reduced stress and anxiety after a 30-day meditation and exercise intervention.

Design and Methods: A quasi-experimental pre-post pilot study design was adopted. The convenience sample consisted of eight Medicine Intensive Care Unit (MICU) nurses in a large Midwestern urban tertiary medical center. Data collected included demographics, pre- post-Beck Anxiety Inventory Scale (BAIS), pre- and post-Single Item Stress Scale (SISS), and weekly diaries on exercise and meditation.

Results: The pre- post-SISS showed statistical significance …

Improving Saint Louis University Mental Status (Slums) Exam Adherence, Kelsie Patek

Dissertations

Problem: Mild Neurocognitive Disorder (MNCD) and dementia remain one of the most common debilitating problems facing the elderly. The Saint Louis University Mental Status (SLUMS) Exam is a screening questionnaire to assess for MNCD or dementia. With the utilization of the SLUMS, clinicians can detect cognitive impairment and provide early intervention resulting in improved function and delayed progression of illness. The aim of this project was to increase the rate of SLUMS completion by at least 75% at a long-term care facility in a rural Midwestern state and to assess changes in diagnoses and treatment plans resulting from use of …

The Effects Of Early Lactation Support On Breastfeeding Exclusivity Rates, Alexa Fleming

Dissertations

Abstract

Problem Breastfeeding exclusively for the first 6 months of a child’s life is the recommendation across medical professionals. Unfortunately, exclusive breastfeeding rates are on the decline due to insufficient support, lack of self-efficacy and inadequate hospital interventions.

Methods For this quality improvement (QI) project, a descriptive observational study design was used to identify appropriate participants who were planning to have a full-term, healthy, exclusively breastfed newborn. Within one hour after delivery, a lactation specialist provided the mother with breastfeeding education and assistance with the initial latching process. At the time of discharge, data was collected to examine if the …

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

Dissertations

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

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

Dissertations

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

Evaluating Patient Health Questionnaire-9 (Phq-9) Use In Burn Survivors, Chelsey Friend

Dissertations

Problem: A burn injury affects both psychological and physical health, resulting in a greater than 50% major depressive disorder morbidity. The purpose of this quality improvement (QI) project is to evaluate the use of the Patient Health Questionnaire-9 (PHQ-9) in adult burn survivors, with an aim to increase the use of the screening tool.

Methods: A mixed-methods pre/post-survey design with an educational component was utilized to assess nurse knowledge, confidence, willingness, and barriers to completion of the PHQ-9. Aggregate data were collected to determine PHQ-9 completion rates for patients admitted to and discharged from the unit during the two months …

Implementing A Child Friendly Menu Guide In A Pediatric Unit: Promoting Healthful Choices, Lauren Hull

Dissertations

Problem: Over 1/3 of children in the United States are overweight or obese and children’s nutritional status while hospitalized worsens rather than improves. Hospital meals have too many calories, too much sugar, and too few nutrients compared to recommended guidelines for children. The primary purpose of this quality improvement project is to increase the amount of healthy foods ordered by children in a southeastern pediatric hospital unit through implementation of a menu guide.

Methods: A quality improvement pre-post interventional pilot study was done through implementation of a child friendly menu guide promoting healthful eating. Data was collected by retrospective and …

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

Dissertations

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

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

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

Dissertations

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

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

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

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

Dissertations

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

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

Left Ventricular Assist Device (Lvad) Driveline Infection Rates Between Two Different Dressing Methods, Gretchen Compton

Dissertations

Problem: Heart failure has a growing impact on Americans, and this contributes to an increased number of patients requiring treatment for advanced heart failure. Typical treatment options may include cardiac transplant or the implantation of a left ventricular assist device (LVAD). The use of an LVAD requires sterile management of an external driveline site. Driveline infections are a common complication in this patient population and can lead to chronic complications. There are no published guidelines on the management of the driveline site. This project aimed to provide evidence that can be used in the establishment of standardized guidelines for driveline …

Dental Screening And Caries Prevention In Pediatric Primary Care, Amy Hoch

Dissertations

Problem: Early childhood caries (ECC) is the most common chronic condition worldwide. Although the American Academy of Pediatrics (AAP) recommends all children through age five receive a fluoride treatment during well-child visits, this often does not happen. This project aimed to implement caries risk assessment (CRA) in the pediatric primary care setting and increase the rate of fluoride varnish applications and pediatric dental referrals.

Methods: An observational, descriptive study design was used to review retrospective data and collect prospective data on fluoride varnish applications in a pediatric primary care office located in a Midwestern suburban community. A validated CRA was …

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

Dissertations

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

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

Dissertations

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

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

Dissertations

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

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

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

Dissertations

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

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

Dissertations

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

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

Dissertations

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

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

Dissertations

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

Relationships Between Monomer Chemical Structure, Network Architecture And Thermal Stability In Glassy Polycyanurates, Rebecca Haber

Dissertations

We study monomer melt properties and polymer properties using two approaches. The first approach takes advantage of molecular dynamics to calculate monomer melt properties. The second approach involved an experimental investigation of polycyanurate networks with varying monomer functionality and rigidity.

For our computational study we applied an existing voids method by Solca et al. to calculate melting temperature for four different cyanate esters: (a) 2’-(4-cyanatophenyl) propane (BADCy), (b) 4,4'-(ethane-1,1-diyl) bis(cyanatobenzene) (LECy), (c) tris(4-cyantophenyl) methylsilane (SiCy-3), and (d) bis(4-cyanatophenyl) dimethylsilane (SiMCy). For systems with 1 to 10% voids, the predicted melting temperature decreased due to a decrease in the free energy …

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

Dissertations

Abstract

Problem

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

Methods

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

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

Dissertations

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

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

Dissertations

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

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

Dissertations

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

Evaluating Outcome Factors Of Childhood Emotional Neglect: An Exploratory Factor Analysis, Taylor Levitt

Dissertations

Experiencing childhood maltreatment has been shown to have major implications on adult outcomes. Less is known about the outcomes of childhood emotional neglect (CEN). The purpose of this study was to identify factors related to psychological outcomes of CEN within the domains of depression, anxiety, and alexithymia as a precursor to the development of an inventory. One hundred and fifty participant responses on the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Toronto Alexithymia Scale-20 (TAS-20) were collected. Exploratory factor analysis was conducted where nine factors yielded significant results and were titled, “Depressive Symptoms,” “Difficulty Identifying Feelings,” “Usefulness of …

The Role Of Traumatic Experiences In Developing Nocturnal Panic Attacks, Nicole S. Smith

Dissertations

Nocturnal panic attacks refer to panic attacks that occur out of a sleeping state with no obvious cause, resulting in awakening at the peak of a panic attack. Nocturnal panic affects roughly half of patients with panic disorder as well as individuals with other psychological disorders such as PTSD. Prior research has suggested that experiencing a traumatic event may lead to the development of nocturnal panic attacks. The current study sought to expand upon the extant literature related to the role of trauma in nocturnal panic by collecting a comprehensive trauma and panic history in order to establish a timeline …

Using Contingent Praise To Increase Visual Engagement In An Asynchronous Online Learning Environment: An Eye Tracking Study, Andrew Rozsa

Dissertations

As more students move to online learning, this results in not only new barriers but new opportunities in academia. The purpose of this study was to examine how behavior-contingent praise affects visual engagement with an online video lecture when using WebGazer, a publicly available eye tracking software, with a user’s integrated webcam. A second aim of this study was to examine if using WebGazer with an integrated webcam was a valid alternative to hand scoring when collecting visual engagement data. Results of WebGazer measurement indicated a moderate effect size for three participants in the presence of contingent praise, and …