Digital Commons Network^™

The Influence Of Behavioral Cues On Immunization Practices Of Elders, Lynn A. Chilton

Dissertations

A quasi-experimental intervention study was designed to compare the influence of behavioral cues on immunization practices of elders. Elders also were surveyed to determine immunization practices related to influenza and pneumonia and to ascertain reasons for under-immunization among this age group. The Neuman Systems Model and the Health Belief Model were used as conceptual frameworks to guide the study. Data were collected utilizing a Demographic Survey (DS) and an Immunization Survey (IS).

Information Retrieval Of Self-Care And Dependent-Care Agents Using Netwellness, A Consumer Health Information Network, Linda C. Rieg

Dissertations

Since the earliest times a major focus of nursing has been to provide health care information to those in their care. The purpose of this exploratory study was to investigate information retrieval of consumers using NetWellness ®, a community health information network. Using Orem's Self-Care Deficit Nursing Theory, six research questions were developed. These questions were designed to determine if there were any differences in information retrieval based on whether the participants were self-care agents or dependent-care agents, or whether differences were based on basic conditioning factors identified as age, gender, race, household income and educational levels. In addition questions …

Transitioning From Hospital To Home: An Evidence-Based Approach In Heart Failure Patients, Donna G. Flynn

Dissertations

Heart Failure (HF) is a complex syndrome affecting millions of Americans and is considered to be a major public health threat. It is responsible for $33.2 billion dollars in healthcare spending annually. The Center for Medicare and Medicaid Services (CMS) will no longer reimburse hospitals for readmissions within 30 days of hospital discharge for a primary diagnosis of HF. Patients diagnosed with HF often receive care from multiple practitioners across multiple settings. Crucial information is frequently lost when patients transition from one care site to another. This evidence-based practice project examined the effect of an evidence-based bundle to provide a …

Quality Of Life, Self-Transcendence, Illness Distress, And Fatigue In Live Transplant Recipients, Kathy A. Baker

Dissertations

This cross sectional study described the relationship between quality of life (QOL) and self-transcendence (ST) in liver transplant recipients. Self-transcendence is a dynamic process reflecting spiritual growth and maturity and a broadening of personal perspective during challenging life experiences. Illness distress, fatigue, age, gender, marital status, education, and time-since-transplant were also investigated relative to QOL.

The Moral Certainty Or Uncertainty Of Nurses Regarding End-Of-Life Treatment Decisions, Mary Ellen Wurzbach

Dissertations

Much has been written about the importance of decision-making in nursing ethics, but few research studies have been completed which examine nurses' ethical decision-making. In order to address this absence of research, two concepts that are integral to nurses' ethical decision-making were analyzed: moral certainty and moral uncertainty. These concepts were studied in the context of the issue of withholding or withdrawing artificial nutrition and hydration. This issue was chosen as an exemplar of issues about which nurses feel morally certain or uncertain. The research questions addressed by this research were: (a) Are nurses morally certain or uncertain about whether …

Kids These Days: Increasing Youth Engagement In Community Heritage And Social Justice Through The Implementation Of A Youth Participatory Empowerment Model, Melanie Canaday-Talley, Lindsay Clemens, Amanda J. Dworak Rowland, Mary Gillis, Curlinda Mitchell Blacksheep, Jancarlos Jose Romero

Dissertations

The purpose of this co-authored, qualitative, action research study was to examine how to empower youth to become active participants in their communities. Citizen engagement in community and public life is vital to a healthy democracy and young people have a unique place in community citizenry, but are often dismissed or excluded from decision-making. The research team developed a model, the Youth Participatory Empowerment Model (YPEM), to guide youth through a process of identifying and engaging a community heritage or social justice need in their community. The team assembled a guidebook of activities to engage groups in difficult self, group, …

The Use Of The Re-Engineered Discharge (Red) Toolkit On Patients Undergoing A Hip Or Knee Joint Replacement Or Revision, Kathleen Mitchell

Dissertations

Discharge planning plays a crucial role in the transition of care. Despite the expenditures dedicated towards discharge planning, organizations struggle with reducing 30-day readmission rates, improving patient satisfaction scores, and length of stay. Poorly coordinated care transitions account for nearly one-fifth of Medicare readmissions within 30 days' post discharge. It is estimated that more than 75% of these are preventable at an estimated cost savings of $12 billion per year. The evidence-based practice improvement project instituted a discharge planning process using the Re-Engineered Discharge (RED) Toolkit on patients undergoing a hip or knee joint replacement or revision. The RED Toolkit …

Patient’S Utilization Of Health Information Technologies For Disease Self-Management, Mahmoud Hamzeh Altawalbih

Dissertations

Background: The rapid growth of Health Information Technologies (HITs) provides

patients with greater opportunity to take control over their health. HITs utilization has

been proven to be a critical component of disease self-management and can result in

positive outcomes. Its widespread adoption and utilization is still relatively low among

patients with chronic disease. It is important to understand the factors that may impact

HITs utilization, such as the perceived Task-Technology Fit (TTF). A very limited

number of studies have examined the relationship between HITs utilization and the

perceived fit between task and technology in the context of TTF theory.

Aims/ …

Nurse Family Member Perceptions Of Patient Death And Nursing Care After Withdrawal Of Life-Sustaining Treatment, Deena Drake

Dissertations

Purpose/Aims: This pilot study explored nurse family member perceptions of nursing care and patient quality of death and dying during and after withdrawal of life-sustaining treatment within Intensive Care Units (ICU).

Rationale: Past research that examined physician, nurse, and family member experiences of End-of-Life (EOL) care within the ICU found significant differences between the three groups.

Background: Approximately 500,000 people die within an ICU each year in the United States. End-of-Life and Palliative Care programs focused primarily on physician interventions to improve quality of EOL care have had little impact on family member perceptions of quality of care or patient …

Perinatal Mood And Anxiety Disorders, Stigma, And Social Support Among Postpartum Women, Ellen K. Fleischman

Dissertations

Purpose/Aims: The purpose of this descriptive, correlational, cross-sectional study was to examine the relationships among perinatal mood and anxiety disorder (PMAD) symptomatology, select demographics, stigma of mental illness, and social support, among inpatient postpartum women. Rationale: PMADs affect as many as 21% of childbearing women, yet these disorders are identified and treated less than half the time. There is a gap in the literature regarding the relationships among stigma, social support, and PMADs in postpartum women.

Conceptual Basis/Background: Despite recommendations from professional organizations, screening for PMADs is not consistently completed using a valid, reliable instrument. Stigma contributes to the low …

The Lived Experience Of Discharged And Readmitted African Americans With Chronic Obstructive Pulmonary Disease To A Safety-Net Hospital, Kiiyonna Jones

Dissertations

Background:Chronic Obstructive Pulmonary Disease (COPD) is a debilitating respiratory disease that negatively affects the quality of life of those affected and has been a major contributor to the continuous rise in healthcare cost in the Unites States (Guarascio, Ray, Finch, & Self, 2013; National Heart Lung and Blood Institute, 2009; Shavelle, Paculdo, Kush, Mannino, & Straus, 2009; Scott, Smith, Sullivan, & Mahajan, 2001). In 2014, Centers for Medicare & Medicaid Services (CMS) identified COPD as an applicable condition to the Hospital Readmissions Reduction Program, which penalizes healthcare organizations having readmissions higher than the national average. COPD is the second …

Delirium In Long Term Care Rehabilitation Residents: A Correlational Retrospective Study, Rebecca Lerma-Kjonegaard

Dissertations

Abstract Background: Delirium is associated with devastating outcomes, cognitive loss,

decreased function and an increase risk of mortality which affects patients and places a heavy burden on family and the healthcare system. The purpose of this study was to describe the relationship between select demographics, clinical characteristics, CHART- DEL-derived delirium diagnosis and ICD-10 coded discharge delirium diagnoses among Long Term Care (LTC) rehabilitation residents.

Method: A retrospective correlational design from174 LTC rehabilitation residents age 65 years or older using EMR and hard copy charts. The setting was a Southern California community hospital-based 100-bed LTC. Abstracted data included demographic characteristics (age, …

Patient Perception Of Fall Risk And High Fall Risk Screening Scores, Nicole D. Pena

Dissertations

Purpose: The purpose of the study was to describe the relationship between patient

perception of fall risk and high fall risk screening scores.

Background: Despite mandated government regulations and multiple hospital

interventions, falls are the most prevalent adverse event among hospitalized patients and

are the leading driver of health care costs, amounting to over $30 billion each year with

projections to double by 2030. Recently, perception was identified as a major component

in preventing falls. A dearth of research examines the relationship between a patient’s

perceived risk for falls and standardized fall screening scores.

Methods: A descriptive correlational design with …

Adult Postoperative Open-Heart Patients: Anemia And 30-Day Hospital Readmission, Lindsey Ryan

Dissertations

Background. In 2013 alone, more than 4% (3.9 million) of patients discharged from a hospital were readmitted. Anemia following a surgical procedure is associated with early hospital readmission.

Purpose/Aims. The following were specific aims of this dissertation:

• Aim 1. To develop an operational definition of the term condition-based maintenance as applied to health care and discuss the applicability and effectiveness of condition-based maintenance within health care.
• Aim 2. To identify the number of adult patients undergoing elective open-heart surgery with preoperative anemia.
• Aim 3. To examine the relationship between preoperative anemia, sociodemographics, and 30-day hospital readmission rates among postoperative open-heart …

Prenatal Care Education For Women Experiencing Unplanned Pregnancy, Sharon T. Heskitt

Dissertations

This project suggested that the Prenatal Care Education Module (PCEM), a series of three brief videos lasting a total of ten minutes, may be an effective way to educate women experiencing an unplanned pregnancy about the importance of prenatal care for themselves and their babies. To assess the effect of the PCEM, the Brief Pregnancy Perception Questionnaire (B-PPQ), a tool adapted from the Brief Illness Perception Questionnaire (B-IPQ) (Broadbent, Petrie, Main & Weinman, 2006) was employed. The B-PPQ assessed participants' health care needs, their understanding of pregnancy, their emotional response to pregnancy, and current contact with a prenatal health care …

Variables Affecting Quality Of Life And Adherence In Adults With Type 2 Diabetes, Michele L. Poradzisz

Dissertations

The purpose of this two-phase mixed methods study was to examine the influence of selected variables on quality of life (QOL) and adherence to diabetes regimen in a convenience sample of adults with Type 2 diabetes. Participants were all clients of the same American Diabetes Association-recognized diabetes center and had previously received comprehensive diabetes education.

Impact Of Managed Care On Health Care Delivery Practices As Perceived By Health Care Administrators And Practitioners, Mari F. Tietze

Dissertations

Managed care has had a significant impact on many components of the U.S. health care delivery system such as cost effectiveness, access to care, and quality of care. These changes have affected how administrators and practitioners perceive the impact of managed care on health care delivery practices. The problem of this study was to explore whether health care administrators and practitioners perceive the impact of managed care on health care delivery practices differently and to explore which organizational variables explain the difference. A descriptive, cross-sectional survey design was used for the target population of administrator and practitioner health care professionals …

Elements Of A Decision Support System For Chief Nurse Executives, Amy J. Barton

Dissertations

The objective of this nursing informatics research was to identify data elements for a decision support system (DSS). The specific purposes were to (a) prioritize issues for strategic planning decisions that are expected to involve chief nurse executives during the next 10 years; (b) determine the information required to reduce uncertainty in making strategic decisions; and (c) translate the information required for strategic decisions into specific data elements to be included in a DSS. The methodology employed was a modification of the Policy Delphi using two rounds with a national sample of 240 nurse executives. The questionnaire consisted of 20 …

Predictors Of Nurse Adoption Of A Computerized Information System As An Innovation, Carol A. Romano

Dissertations

Computerized information systems are viewed as innovations in the health care delivery system and are used by nurses to support the management of clinical and administrative information. The development, implementation and use of computerized information systems are viewed as predictable activities in the future health care environment. Adoption of these innovations is critical to the achievement of improved information management. Nurses are challenged to direct these activities to achieve efficiency, effectiveness and productivity in the delivery of health care services. The adoption of information systems is envisioned as a vehicle to enhance and improve the quality of information and ultimately …

Toward A Theory Of Home Health Care Nursing Practice, Leslie J. Neal-Boylan

Dissertations

Current theories of home health nursing practice in the United States are not based on research. The purpose of this study was to build a substantive theory of home health nursing practice using a qualitative methodology. A grounded theory study of 26 home health nurses practicing in the tri-state area of Virginia, Washington, D.C., and Maryland was conducted to explore how home health nurses define their practice. The nurse participants varied in nursing background, level of education, home health nursing experience, age, race, position within the organization, and the type of organization that employed them. Unstructured interviews that were audiotaped …

The Relationship Of Leadership Patterns To Usage Patterns And Suitability Of Information Technology For Decision-Making Of Nursing And Non-Nursing Academic Administrators In Higher Education, Martha J. Morrow

Dissertations

This dissertation describes the relationship of leadership patterns to computer usage patterns and the suitability of information technology for decision making among academic administrators in higher education in the Nursing departments and Arts and Science Departments of universities in the United States and its provinces.

Increasing Parental Competency By Demonstration Of Newborn Behavioral Characteristics, Mary Jane Hamilton

Dissertations

The purpose of this study was to investigate the question: Does an explanation, demonstration, and return demonstration of the Infant Behavioral Assessment Record by a nurse and new parents increase maternal and paternal observed and perceived parental competence?

Relationships Between Pressure Ulcer Risk Potential, Nursing Interventions, And Pressure Ulcer Presence, Suzanne S. Prevost

Dissertations

The development of pressure ulcers is a common and expensive problem within acute care hospitals. Nurses are expected to identify patients at risk for pressure ulcers and provide preventative interventions accordingly. The purpose of this descriptive correlational study was to identify what preventative nursing interventions were being used, and to examine relationships between pressure ulcer risk, nursing interventions, and pressure ulcer presence in two acute care facilities. Bloch's (1975) Framework for the Evaluation of Nursing Care and Braden's (1987) Conceptual Schema for the Development of Pressure Sores provided the conceptual framework for the study.

Physical Activity As An Intervention For Pain Based On Gate Control Theory, Martha E. Mcdonald

Dissertations

The purpose of this study was to investigate the effect of physical activity on pain tolerance and pain perception. The expectation that physical activity would reduce the perception of pain was deduced from clinical observation and propositions of the Gate Control Theory. The specific proposition tested was that large primary afferent fiber stimulation would inhibit pain perception. Following this proposition, stimulation of innocuous fibers by muscle movement should mediate pain perception. The hypothesis tested was that there would be no difference in time to tolerance or descriptors of pain perception among subjects when they experienced noxious stimulation with no intervention …

How Navy And Marine Corps Veterans Make Meaning Of The College Choice Process In The Post-9/11 Gi Bill Era, Derek Abbey

Dissertations

The Post-9/11 GI Bill was implemented in 2009. Since then more than 1,900,000 people have used the benefit and more than $90 billion have been paid to institutions of higher learning and to Post-9/11 GI Bill users. During this period there has been a shift in the types of college and universities veterans attend, as well as the educational models they select. These shifts are different than the general population of students. This period also included a spike in questionable recruiting practices by some colleges. In response to many institutions taking advantage of veterans, the President of the United States …

The Development Of Local Government Leaders: The Use Of Competencies And Methods In A City Context, Dominika Bukalova

Dissertations

How do local government leaders perceive the development of their leadership competencies and the methods they have used to acquire competencies to meet on-the-job challenges in a city context? There have been few attempts to document leaders’ perceptions of the competencies they need or how they get developed; however, the critical and ubiquitous role of city government demands that we increase understanding of these crucial issues. Not only does a majority of the world’s population already live in urban areas (i.e., areas in which competent local governmental activity is required), but this percentage is forecasted to increase from 55% to …

A Tale Of Two Influences: An Exploration Of Downward Accountability In World Vision International, Elena Mccollim

Dissertations

International nongovernmental organizations (INGOs) face increasing accountability challenges stemming from past scandals and their claims to advance the public good. Since the 1990s, INGOs have responded with numerous reforms. The creation of the Humanitarian Accountability Partnership in 2003 and the INGO Accountability Charter in 2009 reflect sector-wide efforts to enhance accountability to mission, intended beneficiaries, and peer organizations.

Many INGOs have adopted a broad range of accountability reforms. This dissertation focuses on how World Vision, the world’s largest INGO, has done so. Downward accountability remains elusive due to such factors as INGOs’ lack of transparency toward beneficiaries; the power imbalance …

Truth Or Myth? Millennial Stereotypes, Self-Image, And Engagement In The Workplace, Stephanie Van Dellen

Dissertations

There are approximately 58 million Millennials working for corporations in the United States. Millennials generally born between the years 1980 to 1995 are said to have been shaped by events such as the invention of the Internet and cell phones. Given that Millennials make up a large percentage of the active workforce, it is important to understand the perceived stereotypes of Millennials and how these generalizations may impact their engagement and effectiveness at work.

This research aims to better understand how managers perceive Millennial employees, how Millennials self-identify with their generational stereotypes, and how they differ from other generations. The …

Employee Engagement And Burnout: A Quantitative Study Of Their Correlations With Job/Organizational Satisfaction, Sarah Burnett

Dissertations

Since Kahn introduced the concept of employee engagement in 1990, the focus on motivating employees has been en vogue in practitioner literature. The federal government as well now measures its agencies annually on how well they implement conditions conducive to engagement. Federal agencies are also ranked annually as “Best Places to Work” based on their aggregated score on three survey items deemed to represent job/organizational satisfaction. The concept of burnout, or the so-called “erosion of engagement”, however, has received significantly less attention. To begin to fill this void in the literature, secondary survey data from the 2017 Organizational Assessment Survey …

Exploring, Examining, And Explaining How Participatory Governance Adds Value To Saudi Foundations’ Philanthropic Strategy, Afnan E. Koshak

Dissertations

Foundations’ flexibility, given their independence from fundraising imperatives, competition forces, and accountability pressures, enables them to invest in long-term, high-risk, multi-level experiments to deal with the increasingly complex societal problems. This flexibility, coupled with the growing role philanthropy plays in promoting social welfare across the world, is arguably what makes studies that focus on foundations’ philanthropic approaches of utmost importance.

There is a mounting interest among scholars in the governance of foundations, the systems and processes concerned with ensuring the overall strategic direction of organizations. Influenced by agency and stewardship theories, an increasing number of studies address such topics as …