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

Dissertations

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

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

Impact Of Child And Family Teaming In A Child Welfare Agency, Madeline Roachell

Dissertations

Purpose. The purpose of this mixed-methods study was twofold, (1) to describe the family experiences of those who had a CFT and those who did not, and (2) to identify and describe the impact of child and family teams (CFTs) on reentry into foster care.

Methodology. The study used a mixed-methods approach collecting both quantitative and qualitative data. Quantitative data included archival data and an electronic survey. Qualitative data included in-depth interviews and narrative comments from the survey.

Findings. A careful analysis of the data resulted in nine major findings and three dominant themes. The dominant themes of the study …

Bariatric Surgery Regain And Long-Term Weight Loss Among Women: Self-Efficacy, Social Support And Health Promotion Lifestyle Behaviors, Raelene Z. Brooks

Dissertations

Although bariatric surgery appears to produce success in a short period of time immediately after surgery, weight regain over time in this population cannot be ignored. Understanding the relationship between potential psychosocial predicting post-surgical variables influencing bariatric surgery may prevent long-term weight regain. The purpose of this research is to examine self-efficacy, social support, and lifestyle habits and their relationship to long term weight loss and regain in women post bariatric surgery. Weight regain is observed as early as 18 months to 2 years after bariatric surgery. Patients face challenges sustaining the dramatic lifestyle changes required to ensure positive long-term …

Exploring The Quality Of The Leader-Follower Relationship And Its Effect On Followers’ Organizational Citizenship Behaviors In A Public-Service Organization, Kristina Zaragoza

Dissertations

Purpose: The purpose of this sequential, explanatory mixed-methods study was to identify and describe to what extent the quality of the leader-follower relationship, as perceived by followers, affects followers’ organizational citizenship behaviors in a public-service organization.

Methodology: A sequential mixed-methods study was the chosen design for this study. The first phase consisted of quantitative research in the form of a survey questionnaire that measured followers’ organizational citizenship behaviors. The researcher then conducted semistructured, face-to-face interviews that measured the quality of the leader-follower relationship.

Findings: Followers engage in organizational citizenship behaviors at a moderate to high level. Followers willingly assist co-workers …

Optimizing The Involvement Of Women With Opioid Use Disorder In The Care Of Their Infants Experiencing Neonatal Abstinence Syndrome, Rebecca Boedeker

Dissertations

The incidence of opioid use disorder (OUD) has grown to epidemic proportions. Infants exposed to opioids inutero are likely to experience withdrawal symptoms during the hours and days immediately following birth, known as Neonatal Abstinence Syndrome (NAS). Research indicates maximizing non-pharmacologic, supportive management decreases Neonatal Intensive Care Unit (NICU) admissions, the length of stay, and the severity of NAS. The purpose of this project is to evaluate the effects of an antepartum consult designed to prepare mothers with OUD to participate in this nonpharmacologic care. The Women and Infants Substance Help (WISH) Center delivers prenatal care for women with OUD. …

Traumatic Brain Injuries: A Telehealth Alternative For Veterans, Jessica Dickman

Dissertations

Problem: Traumatic Brain Injuries (TBI) are known as the signature wound of veterans serving in Operation Enduring Freedom (OEF) and the Operation Iraqi Freedom (OIF). After the initial TBI diagnosis, outpatient TBI follow-up rates are reported to be approximately 9% less in the Veteran Healthcare Administration (VA) system when compared to the private sector. The purpose of this quality initiative was to decrease the rate of missed appointments among OEF/OIF veterans using a telehealth alternative.

Methods: The Plan-Do-Study-Act (PDSA) method was used to implement a consistent process for the telehealth visit option. A retrospective medical record review over the same …

Permanent Housing And On-Site Nursing Care: Effects On Homeless Individuals With Hiv And Other Cormorbidities, Lynelle Hinden

Dissertations

Abstract

Problem. Providing housing to otherwise homeless individuals who are HIV/AIDS-positive has been demonstrated to improve control of the disease. This was a healthcare quality initiative to review the viral load and Cluster of Differentiation Protein Four positive (CD4+) counts over time of residents in an urban housing facility for HIV/AIDS-positive individuals. Also, a nurse-run clinic was introduced for residents, especially those with comorbidities such as hypertension and diabetes.

Methods. A repeated measures design was utilized. Viral loads and CD4+ counts were retrospectively reviewed from facility records at entrance into and five-years later at the facility. Additionally, measurements of blood …

Assessment Of Nursing Knowledge Before And After Implementation Of Educational Intervention On Heart Failure, Sarah Scott

Dissertations

Purpose: The purpose of this study was to assess the knowledge of nursing staff on a cardiology unit before and after the implementation of heart failure specific education. Methods: Forty staff nurses on a cardiology unit at a single institution were given The Nurses Knowledge of Heart Failure Education Principles Survey (NKHFEP), a validated tool to assess nursing knowledge of heart failure. A series of four educational sessions were given to the same forty nurses. They were then given the NKHFEP survey a second time to assess change in knowledge post educational intervention. Results: The mean of Pre-education (M = …

Implementing The Cdcs Core Elements Of Outpatient Antibiotic Stewardship Program Into The Urgent Care, Deanna Powelson

Dissertations

Purpose: The inappropriate use of antibiotics has led to the development of antimicrobial

resistance which is a severe threat to the public and an increasing global problem. The

Centers for Disease Control and Prevention (CDC) estimates at least two million illnesses

and 23,000 deaths are caused by antibiotic-resistant bacteria in the United States (CDC,

2014). The purpose of this quality improvement (QI) project was to evaluate the

effectiveness of an antibiotic stewardship program (ASP) on urgent care providers'

prescribing on viral respiratory tract infections (RTIs) including the common cold,

pharyngitis, and bronchitis.

Methods: This QI project implemented the CDCs Core …

An Exploration Of Nicu Nursing Staff Perspective On The Change From Pod To Private Room Patient Care, Julie Nickles

Dissertations

Neonatal Intensive Care Units (NICU) are designed to care for critically ill newborns who require constant care. The design of the NICU may have an impact on not only the patient and their family but also the nursing staff. Historically neonatal intensive care have employed a cohort model of care. In this model multiple infants are in the same room or pod. With success of single room maternity care, the increased need for changes in neonatal care became apparent. Today, new parents desire extended contact with their extremely preterm and often very sick infant. This trend has led a standard …

Aligning With Patient-Centered Medical Home Standards: Depression Screening In Primary Care, Elizabeth Segura

Dissertations

Abstract

Problem: The Patient Centered Medical Home (PCMH) is a model of care that improves the quality and experience of care and decreases cost. Use of a validated depression screening tool for adult patients is a PCMH certification requirement. The purpose of this quality initiative was to obtain baseline data when a depression screening tool was utilized among adult patients in an internal medicine clinic within a Midwestern public health department.

Methods: This was a quality improvement project utilizing a descriptive and observational design. A retrospective medical record review was used to assess the rate of depression screening utilizing the …

Evaluation Of A Youth Emergency Room Enhancement Program For Behavioral Health, Anne Thatcher

Dissertations

Problem. Pediatric mental health complaints and subsequent hospitalizations have been steadily increasing. The Behavioral Health Network (BHN) developed an intensive outreach case management program aimed at reducing youth mental health emergency department (ED) visits and inpatient psychiatric admissions. The Youth Emergency Room Enhancement (YERE) program was a process improvement initiative to provide immediate case management to youth and caregivers for mental health care.

Methods. A Plan-Do-Study-Act (PDSA) method utilizing a retrospective case record review occurred over a six-month period. A convenience sample of youth aged 6-20 years presenting to one of eight healthcare facilities for either ED or inpatient hospitalization …

Assessing The Impact Of Practice Transition On Advance Practice Registered Nurse’S Job Stress And Job Satisfaction, Patricia E. Hendrickson

Dissertations

Problem

The impact of the transition to full practice authority (FPA) on job satisfaction and job stress has not been previously described in the literature.

Method

Job satisfaction, job stress, and practice transition stress data was collected from a sample of 33 Advance Practice Registered Nurses (APRN) working at the VA St Louis Health Care System using Misener Nurse Practitioner Job Satisfaction Survey (MNPJSS), National Institute of Occupational Safety and Health Generic Job Stress Questionnaire (NIOSH-GJSQ), and student-developed practice transition stress questionnaire during the initial phase of FPA transition.

Results

APRNs were minimally satisfied to satisfied. Job stress from work …

Nurse-Led Triage Clinic In An Hiv Supportive Housing Apartment Community, Sally Breen

Dissertations

Problem: HIV-positive persons living in supportive housing who were otherwise homeless are reported to have better health outcomes than those who remain homeless. This was a quality improvement project to obtain baseline information regarding the implementation of onsite nursing services for individuals and their families residing in an HIV-positive supportive housing apartment community in an urban Midwestern city. Methods: A nurse triage clinic was implemented in partnership with the Doorways organization. Two registered nurses staffed the clinic two days per week. Data was collected on demographics and clinic utilization over a nine-week period. Results: Of the apartment residents, N=95, the …

Aligning With Patient-Centered Medical Home Standards: Depression Screening In Women's Health, Charity Galgani

Dissertations

Problem: The Patient Centered Medical Home (PCMH) model of care improves health care quality and patient experience of care, and decreases costs. Depression screening is a requirement for becoming a PCMH. The purpose of this quality initiative was to obtain baseline data to describe depression screening rates among female adult patients receiving women’s health care within a Midwestern public health department seeking PCMH recognition.

Methods: The study utilized a descriptive, observational design and was guided by the Plan-Do-Study-Act framework. A retrospective medical record review was used to assess the rate of depression screening utilizing the PHQ-2 and PHQ-9 tools, and …

Alternatives In Magnesium Sulfate Treatment Courses: An Investigation Of Physician Prescribing Behaviors, Erin Williams

Dissertations

Problem: The gold standard for managing preeclampsia in the postpartum patient is 24- hours of magnesium sulfate as this is the time the patient is most susceptible to experiencing a seizure (American College of Obstetricians & Gynecologists, 2013). However, these patients are at an increased risk for experiencing adverse health outcomes, as well as interruptions in maternal-infant bonding due to the mother requiring a higher level of care. Methods: A one group pretest-posttest design was conducted to gain a better understanding of the current practice while also assessing the willingness of physicians to change prescribing behavior after receiving the research-based …

Prophylactic Antibiotic Use In Female Patients With Pelvic Floor Reconstructive Surgery: A Retrospective Comparative Effectiveness Study, Courtney E. Turnbough

Dissertations

Problem: The purpose of this project was to determine the most effective prophylactic antibiotic to decrease the number of patients who have urinary tract infections (UTIs) after pelvic floor reconstructive surgery in a gynecological reconstructive surgery practice.

Methods: This was a retrospective chart review from 2015-2017 that included 732 subjects from a single practice. All patients underwent pelvic floor reconstructive surgery, with or without a midurethral sling placed. Patients also had a catheter and vaginal packing postoperatively. Patients who had a culture-proven UTI within the six-week postoperative period were noted.

Results: There were less UTIs (χ2 = 12.119, df = …

Measurements That Matter: Assessment & Management Of The Symptoms Of Chronic Illness Using The Integrated Palliative Outcome Scale (Ipos), Deborah Jeffery

Dissertations

ABSTRACT

Measurements that Matter: Assessment and Management of the Symptoms of Chronic Illness Using the Integrated Palliative Outcome Scale (IPOS)

Background: The mission of the Advanced Illness Management (AIM) program at the Visiting Nurse Association of Greater St. Louis (VNA) is to relieve the burden of serious illness by providing exceptional care to patients and families through symptom management. A validated symptom tool was needed for holistic assessment.

Purpose: This is a quality-improvement project aimed at enhancing symptom management in patients experiencing advanced illness in a community-based palliative care program. Provider use of the Integrated Palliative Outcome Scale (IPOS) as …

Implementation Of National Pediatric Guidelines To Prevent Chemotherapy Induced Nausea And Vomiting In Children With Cancer, Taryn Sandheinrich

Dissertations

Purpose: The purpose of this study was to assess the use of supplemental, as needed (prn) pharmacologic interventions for uncontrolled acute chemotherapy induced nausea and vomiting (CINV) in children with cancer after implementation of new pediatric CINV prophylaxis guidelines. Description of Project: A retrospective chart review was completed on forty-three children admitted to the hospital for chemotherapy during a 3 month period in 2017 to document the use of medications given for acute breakthrough CINV. The pre-implementation group received anti-emetics based on the institutional standard of care. A second retrospective chart review was completed on thirty-three children admitted to …

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

Dissertations

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

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

Results. Significant improvements resulted in three of …

Evaluation Of Educating Registered Nurses Prior To Implementing New Evidence-Based Protocol: Enhanced Recovery After Surgery (Eras), Lisa Brooks

Dissertations

Evidence-based protocols promote standardization of care and patient safety. The inclusion of major stakeholders is imperative to the success of implementation of a new protocol. The “Enhanced Recovery After Surgery” (ERAS) protocol was implemented at the Veterans Administration Medical Center – St. Louis prior to formal education of direct-care registered nurses (RNs), a major stakeholder group. Due to the lack of knowledge, the RNs who were expected to implement and adhere to the ERAS protocol were not prepared and displayed a lack of confidence. Subsequently, an educational training intervention was designed and executed with thirty-five RN participants. Prior to this …

Indicators And Precipitators Of Special Educator Satisfaction: The Role Of Certification And Advanced Coursework, Jessica Spencer

Dissertations

Special education teachers are leaving the education field at a higher rate than other education professionals. The annual attrition rate for special education teachers is estimated to be between 8-10% of special educators across the United States. These attrition rates are concerning, as they contribute to the shortage of quality special educators. Considering that an estimated 50% of special educators leave their positions within their first five years, researchers have conducted studies examining criteria centered on teacher retention and attrition. This study examined the findings of such studies, and explored the role of how teachers' certifications and obtaining advanced degrees …

Teacher Talk: How Many White, Middle-Class, Female Educators Perpetuate White Privilege In School, Theresa Nomensen

Dissertations

This paper examines the ways middle-class, white, women, who comprise more than eighty percent of the teaching force in public schools perpetuate white supremacy in public schools, explicitly at looking at how and what middle-class, white teachers say to and about their students of color. I interrogate and analyze my own beliefs and experiences, using autoethnography, revealing my journey from learning about my white privilege to understanding how I perpetuate white privilege in schools. Using the theoretical framework of Critical Whiteness Studies, I will interrogate my own whiteness as I confront and wrestle with whiteness in myself and in five …

Management Of Facilitators And Obstacles Experienced By Hispanics In Their First Semester Of A Baccalaureate Nursing Program, Diana Couling Martinez Dolan

Dissertations

Although an ethnically diverse workforce is believed to enhance patient care quality, Hispanics are under-represented in nursing. Recruiting and retaining Hispanic students in nursing programs is essential for greater workforce participation. This grounded theory study explored practices used by Hispanic nursing students to promote their academic success during the first semester of a baccalaureate of science in nursing (BSN) program. Fifteen Hispanic nursing students participated in focus groups and individual interviews. As students moved through their first semester, a trajectory of adaption was identified consisting of arrival, managing, and responding to evaluations. Finances, family dynamics, dealing with potential failure, and …

Get The Beep Out: A Qi Project To Decrease Nuisance Physiological Alarms In A Medical Icu, Jeanine Maine

Dissertations

Background: Upwards of 99% of physiological alarms may not require intervention and make monitoring devices unreliable. Over time, the unreliability of monitoring devices creates desensitization and can lead to patient deaths. Alarm management is now a Joint Commission National Patient Safety Goal and ECRI Institute has named alarm hazards as the number one of the top 10 health technology hazards.

Objectives: To reduce the number of nuisance physiological alarms in adult patients on the medical intensive care unit.

Methods: A quality improvement process was used that included eliminating inactionable alarms from the default settings, customizing alarms, changing electrocardiography electrodes daily, …

Applications Of Big Knowledge Summarization, Ling Zheng

Dissertations

Advanced technologies have resulted in the generation of large amounts of data ("Big Data"). The Big Knowledge derived from Big Data could be beyond humans' ability of comprehension, which will limit the effective and innovative use of Big Knowledge repository. Biomedical ontologies, which play important roles in biomedical information systems, constitute one kind of Big Knowledge repository. Biomedical ontologies typically consist of domain knowledge assertions expressed by the semantic connections between tens of thousands of concepts. Without some high-level visual representation of Big Knowledge in biomedical ontologies, humans cannot grasp the "big picture" of those ontologies. Such Big Knowledge orientation …

Factors That Influence Students’ Decisions To Either Drop Out Or Graduate From High Schools In A Western Kentucky School District, Donna Kay Crouch

Dissertations

The purpose of this research was to identify and examine trends in the themes and patterns revealed in the qualitative analysis of the focus group interviews. Data were derived from responses from 21 graduates and six dropouts who answered questions from interview guides. Findings from the analysis indicate both graduates and dropouts experienced similar barriers throughout their academic career. The barriers identified were institutional, situational, and dispositional. Six themes were identified from the three barriers. They included employment, educational/remediation services, attendance, discipline and/or legal issues; educational values, and student-educator relationships. According to the data, these themes were not mutually exclusive …

Client Perceptions Of The Utilization Of Mindfulness Activities In Therapy, Anissa S. Pugh

Dissertations

The aim of the current study was to examine client perceptions of the use of mindfulness activities in the therapeutic process. For this current study, 21 participants completed a seven-item demographic questionnaire, a 39-item Five-Facet Mindfulness Questionnaire (FFMQ), and a 10-item Mindfulness Experience Questionnaire. The present study investigated three research questions. Research Question 1 looked at how clients perceived the effectiveness of the use of mindfulness activities in therapy. The next research question examined how clients viewed the addition of mindfulness activities to be an acceptable treatment approach based on personal values and beliefs. The third research question for this …

The Role Of Self-Care As It Pertains To Compassion Satisfaction, Burnout, And Secondary Traumatic Stress Among Suicide Prevention Crisis Hotline Staff, Crystal T. Henson

Dissertations

The present study was designed to explore the role of an agency/supervisor to increase self-care participation among suicide prevention crisis hotline staff. The impact self-care participation was found to increase compassion satisfaction while decreasing both burnout and secondary traumatic stress in this population of helpers. Self-care is meant to be a preventative measure to help increase an individual’s overall well-being and can also impact job satisfaction. As helpers, self-care is often recommended to those individuals with whom they are working; however, helpers have historically not followed their own recommendations. Research has shown that those helpers with higher levels of compassion …

The Effect Of Cobra Training On First Responder Self-Confidence To Work In A Toxic Chemical Or Biological Agent Environment, Robert A. Mann

Dissertations

First responders are our nation’s front line defense against intentional or accidental releases of toxic chemical or biological agents. Self-confidence which is a building block of self-efficacy is hypothesized to be malleable and increased through training. The purpose of this study was to determine the change if any, which first responders undergo during Chemical, Ordnance, Biological, and Radiological (COBRA) training, in their self-confidence to operate in a toxic chemical or biological agent environment. That is to determine if there is a correlation between increased self-confidence and COBRA training. The methodology of this study was based on quantitative methods of analysis …