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Development And Evaluation Of A Nurse Practitioner-Directed Medication Adherence Program For Adults With Hypertension In An Academic Medical Center, Adrienne E. Thorne

Dissertations

Hypertension affects one in three American adults and is the leading modifiable risk factor of atherosclerotic cardiovascular disease deaths (Arnett et al., 2019). Medication adherence to antihypertensive medications plays an important role in controlling hypertension. Adherence is affected by multiple factors such as medication side effects, multiple medication regimens, and being asymptomatic, as well as social and economic factors, patient-related factors, therapy-related factors, comorbid conditions, and health care system factors (Egan, 2019). Frequent interactions between patients and providers and medication refill reminders have shown to improve medication adherence in cardiac patients (Lambert-Kerzner et al., 2015), thus this project focused on …

Experiences, Attitudes, And Perceptions Of Female Adjunct Clinical Instructors Teaching Male Pre-Licensure Nursing Students, Amanda E. Shilo

Dissertations

The global shortage of nurses is a problem that has serious consequences. Recruitment of men into nursing has been seen as one possible solution to both diversify the profession, and fill the shortfall, but there are multiple barriers for males in nursing. These barriers are reported as they first contemplate a career in nursing, during nursing education, and as they transition into the profession. This results in decreased retention and success, with males leaving nursing in higher numbers than their female peers. Clinical instructors are described as an essential source of encouragement and support for nursing students, yet are also …

Promoting Prep Uptake In Primary Care Practice For The Prevention Of Hiv Transmissions, Sokonie S. Reed

Dissertations

The nation is charged with the great task of eradicating human immunodeficiency virus (HIV) by year 2030. PrEP is an acronym for pre-exposure prophylaxis. Multiple clinical trials have recognized it as a safe and highly effective regimen that includes taking a daily dose of an antiretroviral medication to prevent HIV transmissions. The regimen is backed by prominent healthcare organizations like the Centers for Disease Control and Prevention (CDC) that have developed guidelines for PrEP implementation. Yet, there is a nationwide problem of low provider uptake of PrEP. Investigators in the literature on PrEP implementation concur that PrEP, as a preventative …

An Evaluation Of The Healthfulness Of The Hospital Food Environment, Cynthia E. Horton Dias

Dissertations

Though nurses may have knowledge about the health promoting benefits of a healthy diet, many do not consume enough fruits or vegetables. For hospital shift nurses to achieve healthy eating while at work, environmental barriers were reportedly the most challenging to overcome. To better understand the hospital food environment from the nurses' perspective, two mechanisms for workplace food acquisition were studied: 1.) hospital consumer food environment, which includes cafeterias, vending machines, and gift shops; and 2.) free food at work.

Improving Patient Satisfaction At An Inpatient Rehabilitation Facility, Ahmed Hariri

Dissertations

Patients hospitalized in Inpatient Rehabilitation facilities (IFRs) have complex needs that impact their satisfaction with care. The project site sought to improve patient satisfaction at discharge. The purpose of this quantitative quasi-experimental quality project was to determine if the implementation of the Studer Group's Hourly Rounding® tool would impact patient satisfaction at discharge among adult patients in an IRF in rural California over four weeks. The theoretical foundations of the project utilized Roy's model of adaptation and Lewin's planned change theory. The total sample size was N=50, n=25 in the comparative and n=25 in the implementation group. Discharge scores were …

Empowering Nurses Of Minority In The Face Of Incivility And Bullying: Through The Lens Of Phenomenology, Corrine M. Floyd

Dissertations

Up to 85% of nurses have reported exposure to incivility in the workplace (Hunt and Marini, 2012). The often-subtle nature of incivility toward nurses in a minority population may partially explain why it remains a problem. Healthcare organizations realize the need for civility to counter the high turnover rate, staff shortages, and low job satisfaction reported by nurses, but lack understanding of how nurses of a minority population perceive incivility and bullying. This study aimed to answer the research question how do nurses with minority representation experience incivility and bullying versus empowerment in the workplace? A descriptive phenomenological design used …

Improving Tobacco Cessation Processes For Behavioral Health Professionals In Primary Care, Iesha R. Floyd

Dissertations

The purpose of this quality improvement project was to develop evidence-based tobacco cessation recommendations through a pre-program evaluation of current tobacco cessation processes at a Federally Qualified Health Center in Casa Grande, Arizona. The primary investigator explored tobacco screening and counseling practices within the behavioral health department. The project took place alongside two similar projects focused on the pharmacy and primary care departments. Together the three projects functioned together to develop evidence-based recommendations, for implementation by future Doctor of Nursing Practice student cohorts.

Provider-Focused Lgbtqia+ Education: A Quality Improvement Effort, Amir W. Raad

Dissertations

The purpose of this quality improvement doctoral project was to implement an educational session at Southwest Behavioral & Health Services (SB&H) in rural Kingman, Arizona. The provider education focused on promoting transformational change in mental health provider awareness through education on health disparities, health related risk factors, interpersonal communication, and cultural sensitivity specific to the lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual/allies population (LGBTQIA+).

An Examination Of The Impact Of Student Loan Debt On Alumni Giving, Ashley N. Nickell, Molly B. Hurley

Dissertations

This study examined the effect of student loan debt on alumni’s willingness and ability to donate to their alma mater, including other identity-based motivating factors associated with an alumnus’ decision whether or not to donate. Participants of this study were recent (2015-2020) graduates of a doctoral program in the healthcare field in the Midwest, and were purposefully selected to answer questions regarding their income, loan debt, decision to give in monetary or non-monetary ways, and financial literacy education/financial preparedness. Data were gathered from virtual interviews that were transcribed and coded for emergent themes. The findings revealed that the majority of …

The Impact Of The Absent African American Father: Findings And Implications, Tambra Cross

Dissertations

This study focused on the difficulties and challenges experienced by sons who had absent fathers. The purpose of this qualitative study was to explore the lived experiences of sons who grew up with absent fathers and the effects on them as adults at home, in school, in their neighborhoods, and their decision-making processes. The sample consisted of eight men who grew up with absent fathers. Data were collected using face-to-face, structured and semi-structured interviews. Results indicated that participants' lived experiences of home life were characterized by financial and emotional hardships resulting from not having a father's earnings and care. The …

Comparison Of Pre-Licensure Bsn Student Outcomes Between Team-Based And Traditional Learning Methods, Tressa J. Pedroff

Dissertations

The increased complexity of healthcare systems requires nurses to have a different skillset, largely not provided in today's nursing curricula. Team-based learning is one possible teaching strategy believed to increase nurses' critical thinking and teamwork self-efficacy. Currently, there is insufficient objective data available that demonstrates improved academic performance and perceptions of teamwork skills in pre-licensure Bachelor of Science in Nursing students.

The purpose of this study is to compare the effects of team-based learning and traditional lecture-format teaching strategies among pre-licensure Bachelor of Science in Nursing students in a Foundations of Nursing Practice course.

Emotional Intelligence Education And Civility In Nursing Education: A Basic Qualitative Study, Vicki A. Ireland

Dissertations

Incivility in nursing is a multidimensional problem that requires a new, innovative approach to managing complicated interpersonal behaviors. Emotional intelligence has emerged as an essential skill for the nursing profession, as these competencies have been associated with enhanced interpersonal interactions and may be effective in cultivating a civil academic and clinical environment. As little was known about how nursing faculty integrated such essential concepts in their curriculum and teaching, the purpose of this study was to gain an understanding of how undergraduate nursing faculty incorporated formal and informal emotional intelligence strategies to foster civility in baccalaureate nursing education. Additionally, faculty …

Identifying Factors Influencing Pediatric Professionals' Self-Reported Collaborative Practice Behaviors, Susan Kilroy

Dissertations

The aim of this study was to: (1) determine the impact of interprofessional American Heart Association (AHA) resuscitation courses on health care professionals' self- reported collaborative practice behaviors (CPBs); (2) identify differences between the three professions of nursing, medicine, and respiratory therapy on self-reported CPBs; and, (3) describe which specific CPBs were most strongly associated with health care professionals' perceptions of interprofessional teams and enhanced patient care in clinical practice.

Profitably Risky: A Study Of Medicare Capitation Contracts For Primary Care Medical Practices, Michael Wieck

Dissertations

The Centers for Medicare and Medicaid Services is seeking to move medical providers from a fee-for-service reimbursement model to a value-based reimbursement model. In this dissertation, we studied the financial rewards and risks that accompany capitation contracts. We employed Poisson regression to estimate health-care utilization of beneficiaries under the care of primary care providers with varying levels of capitation. Then, we calculated capitation contract results for primary care practices using Monte Carlo simulations. We used three methods to predict medical payments for beneficiaries: (1) empirical probability distributions of annual medical payments, (2) theoretical probability distributions of annual medical payments, and …

Exploring How Tourism Majors’ Perceived Professional Competence Influences Their Choice Of Tourism Careers In China, Zhixin Sun, Lihong Wang, Miao Zhao

Dissertations

With the rapid development of tourism in China, various economic sectors such as agriculture, sports, food and beverages, cultural heritage, and outdoor adventure have become integrated into the tourism industry. China's tourism industry has changed and these changes now require tourism practitioners to adapt. Chinese universities must also adapt their tourism curriculum and educational practices to reflect changes in the tourism sector. Research suggests that university training programs should increase their emphasis on developing students’ professional competency and expand the range of competencies they address in their curriculum. At the same time, tourism enterprises in China are unable to recruit …

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

Dissertations

Abstract

Problem

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

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

Dissertations

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

Complexation Of Glycoalkaloid Α- Tomatine With Sterols And Its Potential Application As An Anti-Cancer Drug, Bishal Nepal

Dissertations

Glycoalkaloids (GAs) are secondary metabolites found mostly in higher plant species and some marine invertebrates. They are known to form complexes with 3β-hydroxy sterols such as cholesterol causing membrane disruption. So far the visual evidence showcasing the complexes formed between glycoalkaloids and sterols has been mainly restricted to some earlier studies using Brewster angle microscopy. This study aimed to develop a method for topographic and morphological analysis of sterol-glycoalkaloid complexes. Langmuir-Blodgett (LB) transfer of monolayers comprising of glycoalkaloid tomatine, sterols, and lipids in varying molar ratios onto mica followed by AFM examination was performed. The AFM method used required minimal …

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

Dissertations

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

Fostering The Non-Academic Trait Of Grit To Increase Nursing Student Success, Marianne Biangone

Dissertations

In nursing education, there are few challenges as elusive as determining why attrition occurs. Attrition has been attributed to factors such as academic underperformance, adverse life events, and financial issues. It is imperative to identify additional tools for students to increase the opportunity for program success despite his or her challenges. Grit is passion and perseverance for long-term goals. Grit has had a positive impact on academic achievement, and the need is present for research on the ability to foster the development of the characteristics that make up grit in undergraduate nursing students. The purpose of this study is to …

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

Dissertations

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

Mentorship Program To Improve Nursing Knowledge On Prevention Of Hospital-Acquired Pressure Injuries, Terri Lo

Dissertations

In the United States, hospital acquired pressure injuries (HAPIs) is one persistent patient safety problems with an increasing incidence rate resulting in patient harm and patient deaths. Pressure injuries can lead to problems for the patient and family related to wound care and quality of life. Prevention of HAPIs is an essential aspect of nursing practice. Education and mentorship about HAPI prevention can help facilitate translation of evidence-based research findings to clinical nursing practice to improve patient care outcomes.

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

Dissertations

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

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

Dissertations

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

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

Dissertations

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

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

Dissertations

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

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

Dissertations

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

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

Dissertations

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

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

Evaluation Of A Hypertension Bundle To Improve Maternal Outcomes, Jamie Jetton

Dissertations

Abstract

Problem: Hypertensive disorders of pregnancy continue to be on the rise in the United States, contributing to an increase in both maternal morbidity and mortality rates. These disorders not only have an effect on the pregnant women, but also the neonate. Early recognition and treatment of increased blood pressure findings can improve maternal and fetal outcomes.

Methods: This Quality Improvement (QI) project used a descriptive design and was comprised of a retrospective chart review, focused on the effectiveness of evaluating a hypertension bundle to improve maternal outcomes. The data collected for this project encompassed six months pre and post …

Safe Opioid Prescribing Through Proper Screening, Joelle M. Carson

Dissertations

It is known in today's healthcare that opioid abuse is on the rise in the United States. The project site noted aberrant behaviors and the seeking of narcotics from certain clients in the occupational health clinic. The purpose of this quantitative quasi-experimental quality improvement project was to determine if the implementation of Webster's Opioid Risk Tool (ORT) would impact the number of opioid prescriptions written for acute pain among patients seen an occupational health clinic in central Indiana over four-weeks. The theoretical frameworks utilized in the project included Skinner's behaviorist theory, Bandura's social cognitive theory, and Orem's self-care deficit theory. …