Digital Commons Network^™

The Relationship Between Painful/Provocative Training Experiences And Capability For Suicide Among Medical Students, Brittney L. Assavedo

Dissertations

The primary aim of this study was to examine the relationship between capability for suicide and painful and provocative experiences related to practicing within the medical profession (mPPEs) among students enrolled in a College of Osteopathic Medicine (n = 114). It was posited that frequency of engagement in mPPEs would predict scores on measures of capability for suicide above and beyond the effects of gender and painful and provocative experiences unrelated to practicing within the medical profession (PPEs). It was also posited that frequency of both witnessing and performing an mPPE would moderate the impact of curriculum component on capability …

Dependability Of Two Group Observation Methods Across Rater And Time, Kayla E. Bates-Brantley

Dissertations

Collecting efficient and reliable behavior assessment data is often a goal for school districts and school psychologists. Unfortunately, the most accurate methods of behavior observations, systematic direct observations (SDO), can be time-intensive and often requires specific training. This often minimizes the number of trained professional available for observation procedures. Planned activity check (PAC), a variation of momentary time sampling, has the potential to combine the accuracy of SDO with efficiency. However, few studies have evaluated the psychometric principals of PAC. The current study sought to evaluate the reliability and dependability of PAC by comparing PAC to an individual-fixed (I-F) SDO. …

The Impact Of Traumatic Brain Injury On Neuropsychological Functioning And Tau Accumulation Later In Life In Military Veterans, Lindsay Eatman

Dissertations

Abstract The following study examines aging veterans that experience a TBI while in service and

compares to older veteran without a history of TBI. The objective is to look at cognitive profile later in life for military veterans with moderate to severe TBI different and compared to older veterans with no history of TBI. Is there a difference in tau accumulations on neuroimaging in military veterans with moderate to severe TBI compared to older veterans without a history of TBI? What is the relationship between the cognitive profile and tau imaging correlates for military veterans with moderate to severe TBI …

The Utility Of Music-Based Interventions In Dementia Care, Adriana C. Doerr

Dissertations

While research has investigated the impact of music-based interventions on management of behavioral and psychological symptoms of dementia (BPSD), there is limited discussion of which music-based interventions are most effective for various levels of dementia severity, or of how to determine which music-based interventions are both accessible and feasible for caregivers and nursing staff. This review sought to identify the benefits of music-based interventions in dementia care within various domains of functioning and determine whether music-based interventions are effective for various levels of dementia severity. Peer-reviewed articles and studies that evaluated the effectiveness of various music interventions or demonstrated music's …

Use Of Mindfulness To Treat Mental Health Symptoms Of Individuals Subjected To Human Sex Trafficking And Prostitution, Amanda Mccaw

Dissertations

Human sex trafficking and prostitution is a global phenomenon that has been occurring for centuries. Millions of people are subjected to the cruelties that occur within sex trafficking and prostitution. The distinction between sex trafficking and prostitution is minute. Large economic profits serve as an incentive to sustain the sex work industry, despite the harm it causes to the people that are employed as sex workers. Numerous mental health problems can arise for individuals subjected to sex trafficking and prostitution including posttraumatic stress disorder, depression, dissociation, terror, anxiety, guilt, anger, and substance abuse (Dalla, 2002; Farley, Baral, Kiremire, & Sezgin, …

The Relationship Between Frequency Of Yoga And Meditation On Ptsd Symptoms In Individuals Who Have Experienced Intimate Partner Violence, Kimberly Polignani

Dissertations

Intimate partner violence (IPV) has become a growing phenomenon in the United States,

affecting nearly 13% of the population. The adverse mental health outcomes from people who experience IPV are prevalent and more than half have a diagnosis of posttraumatic stress disorder (PTSD). Therefore, therapeutic techniques for PTSD appear to be feasible for IPV survivors and their mental health issues. Complementary and alternative medicine has become a widely accepted approach for PTSD. Being two complementary and alternative medicine techniques, yoga and meditation are effective forms of therapy in many diagnoses, including PTSD. This study utilized a not-for-profit organization called the …

Identifying Barriers In Black Communities That Hinder The Engagement In Lgbt Affirming Behaviors. Clinical Implications For Understanding Barriers To Attaining Adequate Social Support When Working With Lgbt People Of Color., Raven Howard

Dissertations

Institutional oppression and social inequality have been a topic of importance for decades within the literature. These adverse events may lead to many mental health problems, segregation between identity groups, and a hostile environment. This study aims to analyze the barriers in Black communities that may prevent Black communities from providing adequate social support or advocating for LGBT people of color. The primary question is: Does religious beliefs and levels of engagement in intergroup dialogue and intergroup contact impact the likelihood of engagement in LGBT affirming behaviors. Participants (n = 276) completed an anonymous online survey, and linear regression results …

Examining The Gender- And Sexuality-Related Cognitive “Stuck Points” Of Men And Women With Experiences Of Adult Sexual Assault: Implications For Cognitive Processing Therapy, Marin Beagley

Dissertations

Cognitive Processing Therapy (CPT) is considered a gold-standard psychotherapy protocol for the treatment of posttraumatic stress symptoms secondary to a variety of traumatic events. Despite its demonstrated efficacy, there is research to suggest CPT may not be as effective in reducing PTSD symptoms for men with an adult sexual assault trauma as it is for their female counterparts. The purpose of the present study was to determine whether CPT treatment outcome discrepancies may be attributable to gender differences in posttraumatic cognitions, or “stuck points.” As the act of sexual victimization is incongruent with socially prescribed masculine gender norms, it was …

Exploring The Characteristic Triad Of Resilience: Personal Disposition, Family Support And The Environment Within The Cultural Context Of Quality Mariachi Academies In The Impoverished Central Valley Of California, Lucia Vazquez

Dissertations

Purpose: The purpose of this qualitative multiple case study, was to explore through the lens of the Characteristic Triad of Resilience: personal disposition, family support and environment, how participation in community-based Quality Mariachi Academies (QMA) in impoverished counties contribute to educational resilience.

Methodology: This qualitative multi-case study explored the lived experience of ten resilient students in the impoverished San Joaquin Valley of Central California, utilizing the Characteristic Triad of Resilience as the framework in the context of Quality Mariachi Academies. Data collected from resilient students was triangulated with data from parents, grandparents and site staff.

Findings: Community-based Quality Mariachi Academies …

The Intersection Of Andragogy And Courtroom Practice, Grant Shostak

Dissertations

Learning takes place not only in a traditional classroom setting, but in a plethora of avenues outside of the lecture hall. Learning paradigms like life-long learning and Andragogy, the teaching of adults, have been used by adult educators for fields such as education, finance, accounting, law enforcement, nursing, technology, and many others. A review of the existing literature has revealed an absence of the application of andragogy to the courtroom setting. This paper investigates and discusses the andragogical orientation of successful trial lawyers in Missouri. This study has shown that successful trial lawyers have adapted and share particular principles of …

The Perceptions Of Online Community College Instructors Regarding The Most Effective Collaborative Instructional, Content Specific, And Social Interaction Learning Strategies To Help Online Students Succeed, Maureen Curry

Dissertations

Purpose. The purpose of this phenomenological study was to discover what collaborative instructional, content specific, and social interaction learning strategies online community college instructors perceive to be most effective in helping students succeed.

Methodology. Data were collected through interviews and review of artifacts. The target population consisted of online community college instructors in southern California. Twelve participants from three community colleges were chosen using both criterion and convenience sampling procedures.

Findings. Most online community college instructors apply a variety of collaborative instructional strategies through shared discussions, relevant group projects for content specific learning, and community building interaction …

The Influence Of Social Capital On Community Sustainability In Meacham Park, Missouri During 1996 -1999, Sheila Green-Samuels

Dissertations

Abstract

The purpose of this study was to examine the influence of social capital on the phenomenon of community sustainability in Meacham Park Missouri, a Black neighborhood located in south St. Louis county. It is believed that social capital influences the collective action needed to create structures which lead to economic growth essential to community sustainability (Farrell, 2007, Ginwright, 2015; Putnam, 1993). The core idea of Robert Putnam’s social capital theory is there is value in social networks (Putnam, 2000, 1993). Examined were experiences of current and past residents of Meacham Park using social capital constructs to analyze the significance …

Same-Sex Sexual Coercion Among Women: The Impact Of Minority Stress On Perpetration And Victimization Experiences Of Women Of Diverse Sexual Identities, Allison Kirschbaum

Dissertations

The purpose of the current study was to investigate women’s experiences with same-sex sexual coercion perpetration and victimization. Specifically, I sought to explore the role that the stress of living as a sexual minority plays in these experiences as well as to determine whether the psychological variables of perceived powerlessness, psychological distress, social support, and alcohol use mediate the relationship between minority stress and perpetration and victimization experiences. Data were collected online from self-identified women and individuals assigned female at birth who reported experiencing genital sexual contact with another woman (N=339). Of the cisgender women in the sample, 31.6% reported …

A Survey Of Healthcare Workers On Safe Patient Handling And Mobility Resource Availability, Utilization, And Adherence, Kimberly Waltrip

Dissertations

The purpose of this study was to examine the current status of safe patient handling and mobility—specifically resource availability, utilization, and adherence to established safe patient handling and mobility standards—and measure any relationships among these factors. This study builds on the reliability and validity of the adapted American Nurses Association’s (2016) Safe Patient Handling and Mobility Self-Assessment Resource. Responses came from a one-shot survey of healthcare workers in direct patient care across several private and Veterans Health Administration healthcare organizations in the Midwestern United States. The risk of injury is higher in patient handling than in many other professions; …

Barriers To Mental Health Treatment In Patients Referred By Primary Care, Rebecca Palmer

Dissertations

Problem: Limited access to mental health treatment is one of many potential barriers to treating mental illness in the United States. Where resources are readily available, reportedly high no-show rates for established mental health appointments suggests further investigation is necessary to identify frequent barriers within that population. This was a quality improvement project to identify common themes in patient-reported barriers to care.

Methods: A 4-question phone survey was offered to individuals that did not appear at their mental health appointment. Data was analyzed to identify the most commonly reported barriers to mental health treatment. Additional data collected includes reported history …

A Quality Initiative To Reduce Pneumonia Readmissions And Mortality In Older Adults, Terri Morris

Dissertations

The United States (U.S.) healthcare system journey for making improvements in the quality and value of healthcare continues. Hospital organizations are required to compose and make publically available their health quality outcome data. The publication transparency and increased availability of local, regional and national health quality metrics, including readmission and mortality rates, to governmental agencies, health plans, investors, other hospitals, providers and potential patient and families’ knowledge, creates a competitive pressure for a hospital to assure their quality outcomes data are the best. Despite breakthrough improvements using innovative care models that target vulnerable and potentially high cost of care areas …

Referrals To An Opioid Overdose Program With Ems Involvement: Comparing Treatment Outcomes, Courtney Haas

Dissertations

Problem. The rising rates of opioid overdose deaths continue to be a significant public health concern. Innovative programs utilizing a Recovery Coach in the Emergency Department (ED) have demonstrated initial success. However, there is limited evidence to support their effectiveness for improving treatment or recovery outcomes for people living with opioid use disorder. The purpose of this study was to evaluate whether the method of arrival to the ED for an opioid overdose affects engagement and retention in an opioid overdose project in a midwestern metropolitan area, which utilizes a Recovery Coach in the ED. Methods: Utilizing the Plan-Do-Study-Act framework, …

Nitrous Oxide Use For Minor But Painful Pediatric Procedures, Samantha Kremer

Dissertations

Problem: Nitrous oxide (N₂O) is used for mild to moderate pain control and anxiolysis. Registered nurses (RN) as providers of N₂O administration may decrease the number of missed opportunities for pain control or anxiolysis. The purpose of this quality improvement initiative was to evaluate the type of procedures and rate of N₂O administration by providers, and cost difference between them.

Method: A descriptive, cohort-design for pediatric patients in the Imaging and Sedation Department between October through November of 2017 and 2018. Data was compared between physicians in 2017 and either a physician or RN …

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 …

Management And Support Of Uninsured Patients With Diabetes Type Ii Within A Nurse Managed Clinic, Emma Spencer

Dissertations

The purpose of the project was to improve the quality of care for the uninsured, Type II Diabetics residing in a Midwestern urban underserved community. Community Health in Partnership Services (CHIPS) was a nurse-managed clinic, located in that area, that sought to lessen the burden of being uninsured. An annual fee of $35.00 allowed an uninsured community member access to a variety of different health care providers including specialists. In order to utilize this health care team efficiently, it was necessary to implement nurse-led care coordination for patients diagnosed with Type II Diabetes. This quality improvement project followed the Plan …

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 …

A Vaccine Administration Training Program To Increase Adolescent Vaccination Rates, Claire Jensen

Dissertations

Abstract

Immunizations have been proven to control life-threatening diseases. Often Registered Nurses (RNs) administer vaccines but are unsure how to discuss vaccines with vaccine hesitant patients. Missouri’s adolescent vaccination rates are below its neighboring states. This initiative’s purpose was to increase adolescent vaccine administrations at a Missouri County Health Department (MCHD).

This quality improvement initiative had an observational, cross-sectional, descriptive design. RNs employed at three MCHD clinics attended an adolescent vaccine administration training program (VAT) and completed pre-/post-tests regarding the Advisory Council on Immunization Practices recommendations. Medical record reviews from March 1-April 30, 2018 and March 1-April 30, 2019 compared …

Increasing Nursing Competence And Confidence During Obstetric Emergencies Through Simulation: A Quality Improvement Project, Tram Wallen

Dissertations

Problem: This quality improvement project aimed to improve the knowledge and confidence of the mother/baby nursing staff during postpartum hemorrhages through in situ simulation. PPH is a leading cause of maternal death. Hospitals across the U.S. lack a standard approach to managing obstetric emergencies; the complications of childbirth are often identified too late. Multidisciplinary simulation-based team training has been associated with improved outcomes in obstetrics.

Methods: A convenience sample of 26 registered nurses (RNs) that care for postpartum patients attended a one-hour instructor-led presentation followed by in situ simulations of postpartum hemorrhage. A knowledge assessment and confidence survey were administered …

Evaluating The Delivery Of Diabetes-Related Care Among The Asian Population, Lyly Bui

Dissertations

Purpose: This project evaluated current practices for Type 2 diabetes mellitus (T2DM) screening and management among Asian Americans (AAs) presenting to a primary care clinic and determined whether these practices adhered to the American Diabetes Association (ADA)’s 2018 guidelines.

Methods: A retrospective chart review was performed to extract data from clinical case records of AAs who visited the Vietnamese Health Center (VHC) between November 1, 2017 and November 1, 2018. Descriptive statistics were utilized to analyze the data.

Results: Of 173 charts reviewed, 76.3% of AAs had no previous T2DM diagnosis and 23.7% had a previous diagnosis. Among those without …

A Rural Telehealth Objective Structured Clinical Examination, Devon Schlottach

Dissertations

Problem Rural healthcare consumers experience increased health disparities, especially when accessing health care. The use of telehealth to improve access has become an essential competency for nurse practitioner (NP) students. This study evaluated NP students’ confidence and competence of rural social determinants of health (rSDOH) before and after a telehealth simulation.

Methods A descriptive, cohort design was used to review NP students’ pre- and post-surveys, written case studies, and a video-recorded telehealth OSCE for a patient living in a rural area.

Results Student self-rated knowledge of rural health care did not improve despite didactic learning and simulation (z = …

Decreasing Opioid Overprescription Following Outpatient Gynecology Surgery, Monica Kistler

Dissertations

Problem: Opioid abuse may be a result of overprescribing opioids. There are no opioid prescribing recommendations for minor gynecologic surgery. As a result, there is a wide variation in prescribing practices at a privately-owned surgery center where excessive opioid prescription occurs.

Methods: A quality improvement initiative with a descriptive, cohort design. A retrospective review of medical records and telephone surveys over three months resulted in the development of a series of posters describing prescription data for three procedures: hysteroscopy dilation and curettage (HDC), uterine ablation (UA), and laparoscopy (LAP). The trends and changes in opioid prescription practices were displayed throughout …

Depression Screening In Antepartum Females, Michelle Burk

Dissertations

Problem: Perinatal mood disorders, including depression, affects one in five pregnant or postpartum females. The American College of Obstetricians and Gynecologists (ACOG) and the US Preventative Task Force (USPTF) recommended screening for depression at least once during the antepartum and postpartum periods. The purpose of this quality improvement initiative was to introduce depression screening using the patient health questionnaire (PHQ) in antepartum women in a Midwestern private OB-GYN practice.

Methods: An observational, descriptive, cohort design utilizing a retrospective record review was used to evaluate for PHQ depression screening. A convenience sample of antepartum patients at/or around 36-weeks gestation was studied. …

Examining Opioid Ordering Rates Of Advanced Practice Providers In An Emergency Department, Bridgette Thompson

Dissertations

Problem Opioid abuse has become a major public health issue in America. Many Americans die daily from an opioid overdose. The Centers for Disease Control and Prevention (CDC) has identified prescription drug abuse and overdose as a major health threat.

Methods Descriptive cohort design with a retrospective record review of the number of opioids ordered by the advanced practice provider six weeks before and six weeks after a didactic and simulation educational experience.

Results The total sample was four (N=4). Using the paired samples t test there was no difference (t = 0.65, p = 0.56) between the number …

Primary Care Delays In Underserved Areas: A Strategic Plan To Improve Access To Care, Debra Connell-Dent

Dissertations

Hypertension (HTN) and Diabetes Mellitus Type 2 (DM2) are two chronic conditions contributing to morbidity and mortality. 23.1 million people have DM2 and 7.2 million people have it an are undiagnosed in the U.S. During 2015-2016, the prevalence of HTN was 29.0% and increases with age (CDC, 2018). This purpose of this article was to discuss the benefits of developing a Transition Clinic (TC) in a highly traveled metro transit area and the development of a strategic plan on implementing this project, as well as the barriers that may be encountered when implementing such a clinic similar to this. A …