Digital Commons Network^™

Doubling Down On Sepsis: A Quality Improvement Project To Improve Sepsis Bundle Compliance On An Inpatient Oncology Unit, Kayla Slay

Dissertations

Problem: Sepsis is a leading cause of death worldwide, and the second most common cause of death in cancer patients. Early management of sepsis through use of sepsis bundles have been shown to improve patient outcomes, yet bundle adherence is unfortunately inconsistent.

Methods: A two-nurse team, called the Sepsis Sidekicks, was a process improvement initiative to increase compliance with the center for Medicare and Medicaid Services (CMS) sepsis bundle and improve patient outcomes related to sepsis. The observational quality improvement project utilized a Plan-Do-Study-Act (PDSA) model over a six-week period where quantitative data was collected using a retrospective chart review. …

Initiation Of Procalcitonin Screening As A Marker In Antibiotic Therapy De-Escalation, Briana Kile

Dissertations

Problem: The overuse of antibiotics has created antimicrobial resistance (AMR)

resulting in treatment failure for bacterial infections. To combat AMR, clinicians should

only prescribe antibiotic therapy when clinically warranted. It is easy to misdiagnose a

viral infection. However, any delay in the initiation of antibiotic therapy in a bacterial

infection may lead to increased morbidity and mortality. These patients with non-specific

clinical symptoms may be misdiagnosed without a rapid and definitive diagnostic test.

Methods: This quality improvement (QI) initiative utilized an evidence-based clinical

guideline for procalcitonin (PCT) levels for antibiotic therapy de-escalation. WBC counts

were collected two-days and one-day before …

Reducing Catheter-Associated Urinary Tract Infections In The Pediatric Intensive Care Unit, Maria Smith

Dissertations

Problem: CAUTIs (catheter-associated urinary tract infections) are a common hospital-acquired condition (HAC) that increase length of hospital stays, hospital costs, and risk for patient mortality. CAUTI rates in a PICU increased in 2021 from the year 2020. A rapid cycle PDSA revealed nurses were not using soap and water for foley catheter care, which is the recommended cleanser by the Centers for Disease Control and Prevention (CDC).

Methods: An observational descriptive design was used to evaluate foley catheter cleaning and CAUTI rates. PICU nurses completed behavior surveys regarding foley catheter cleaning practices. An education intervention occurred when nurses answered anything …

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

Dissertations

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

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

Dissertations

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

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

Dissertations

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

Characterizing Endogenous Dicer Products To Unravel Novel Rnai Biogenesis Pathways, Jacob Oche Peter

Dissertations

ABSTRACT

RNA interference (RNAi) is a pervasive gene regulatory mechanism in eukaryotes based on the action of multiple classes of small RNA (sRNA). Exploiting RNAi pathways in non-model systems have great potential for creating potent RNAi technologies. Here, we accessed RNAi-mediated control of gene expression in the two-spotted spider mite, Tetranychus urticae (T. urticae) using engineered dsRNA designed to modulate the host RNAi pathway and increase RNAi efficacy. Analysis of Dicer (Dcr) generated fragments revealed how exogenous RNAs access the host RNAi pathway in this animal, opening avenues for designing RNAi technology for their control. Further, some organisms …

Examining Digital Proficiency Perceptions And Differences In Achievement During The Covid-19 Pandemic In A Rural Mid-Western High School, Tiffany Rae James Young

Dissertations

In response to the Covid-19 Pandemic, schools worldwide were forced to react quickly to meet the needs of all students in an unprecedented time of change for all facets of society. Through a mixed-method approach, this study aimed to explore the effect of hybrid learning on student achievement, as well as the effect, if any, of teachers’ perceptions of their own digital abilities on student achievement. The research also examined the thoughts of students and teachers as it pertained to teaching and learning during the global pandemic. To analyze the effect of hybrid learning on student achievement, the researcher compared …

Repeated Low-Level Blast Induces Chronic Neuroinflammation And Neurobehavioral Changes In Rat Models, Arun Reddy Ravula

Dissertations

Blast-induced neurotrauma (bTBI) is a signature medical concern for military personnel when they are exposed to explosions in active combat zones. However, soldiers as well as law enforcement personnel are also repeatedly exposed to low-level blasts during training sessions with heavy weaponries as part of combat readiness. Service personnel who sustain brain injuries from repeated low-level blasts (rLLBs) do not display overt pathological symptoms immediately but rather develop cognitive impairments, attention deficits, anxiety, and sleep disturbances over time. An improved rat model of rLLB was developed in this thesis by applying controlled low-level blast pressures (10 psi) repeated five times …

The Role Of School Counselors In Advocating For Social Justice For All Students During The Covid-19 Pandemic, Amna Jaffer

Dissertations

The field of K–12 school counseling has evolved to embrace social–emotional and mental wellness aspects of students in addition to academic and career/college readiness. Social justice advocacy has been added to the role of school counselor by professional and educational entities. What is less clear is how well-versed school counselors are in social justice advocacy competencies, whether they are equipped to lead and advocate for social justice, barriers and accomplishments in doing so, and ways in which this role may be further developed and integrated into the field of school counseling, particularly in the context of the COVID-19 pandemic. As …

Cardiology Implications Of Ed Covid-19 Patients In An Underserved Rural Health Care Environment, Pedro Colio

Dissertations

Background/Purpose: Positive COVID-19 patients with chronic comorbidities have been associated with severe cardiac complications (e.g., STEMI, NSTEMI, myocarditis, pericarditis, AF) specifically among underserved communities. Acute STEMI and NSTEMI are cardiac conditions associated with ruptured atherosclerotic plaque leading to significant myocardial injury. AF, the most common arrhythmia leading to cerebrovascular accidents, is also common in hospitalized patients with severe illnesses. Myocarditis and pericarditis are inflammatory heart conditions associated with acute viral infections. According to the literature, these cardiac issues have been linked as complications of COVID-19. COVID 19 is an emerging, complex, and costly public health challenge globally with potential lifelong …

Understanding Families'/Surrogate Decision Makers' Experience Of Decision Making For Critically Ill Patients In Saudi Arabia, Omaimah A. Qadhi

Dissertations

Critical illness not only affects patients, but also may negatively impact the families and people who are responsible to make decisions for those patients. Making decision can be challenging for people when it is for someone else who is critically ill. This study explores the decision-making experience for family or a surrogate decision maker for critically ill patients in Saudi Arabia. This project also tested the presence or absence of regret after making serious decisions about a medical treatment for another individual. Goal Attainment Theory was used to guide this study. The concepts of the Interpersonal Interacting Systems were used …

The Covid-19 Experience: An Intensive Care Nursing Perspective, Adrianna Watson

Dissertations

In December 2019, a new virus reared its head and within a matter of months demanded the attention of the world as health care was challenged to full capacity. Frontline healthcare workers struggled to care for the patient after patient with limited knowledge of pathophysiology, risk of contagion, and resources. As the waves of patients became increasingly critical, the task of everyday human connection and care, as well as extraordinary life-saving measures, fell upon the shoulders of intensive care nurses. Little is known about how these nurses understand their experiences caring for patients with the novel coronavirus, or how their …

Acculturation, Self-Efficacy And Breastfeeding Behaviors In A Sample Of Hispanic Women, Ivonne F. Hernandez

Dissertations

Breastfeeding confers immunological, physiological and psychological benefits for the infant and mother as well as social and economic benefits to the nation. The United States Department of Health and Human Services (HHS), Healthy People 2020 has established national objectives for the initiation and duration of breastfeeding at 82% initiation, 61% at six months and 34% at one year. In addition, they have set goals for exclusive breastfeeding at 3 months to be 46% and 25% at 6 months of infant's age. Currently breastfeeding initiation is at the highest recorded level of 76.9%, yet significant disparities exist (CDC, 2012). The purpose …

The Critical Factors Influencing The Attitudes And Behaviors Of Nurses Caring For Patients With Substance Use Disorders, Suzan Blacher

Dissertations

Nursing is known to be an ethical and caring practice discipline, yet there is some evidence that nurses may have negative attitudes and behaviors towards persons with substance use disorders. Few nurses realize these undesirable attitudes and behaviors negatively impact the very patients they are caring for (Can & Tanriverdi, 2015). These attitudes and behaviors are also considered unprofessional and may place nurses in violation of the Nursing Code of Ethics (American Nurses Association, 2015).

The purpose of this qualitative constructivist grounded theory study is to develop a middle-range theory explicating the process of nurses caring for Substance Use Disorder …

Overcoming The Imposter Phenomenon: Exploring The Strategies Secondary Educators Used To Cope During The Covid-19 Pandemic, Barbra J.C. Bedwell

Dissertations

Purpose. The purpose of this descriptive mixed-method study was to explore and describe the coping skills used by secondary teachers who identified as experiencing the impostor phenomenon (IP) by the Clance Impostor Phenomenon Scale (CIPS) (Clance, 1985) to overcome the nine behavioral characteristics of IP during the transition to distance learning in response to the COVID-19 pandemic. Methodology. This descriptive mixed-methods research design used both quantitative and qualitative techniques to identify teachers with IP and explore the coping techniques they used during distance learning. First, a quantitative 20-question diagnostic survey, the CIPS, was used to identify teachers with IP. …

A Quantitative Study Examining Intentional Teaching Of Social Emotional Skills, Christina Scrivner Huse

Dissertations

In a world where children are likely to experience early-life trauma, relationships matter, and trust is a key in forming healthy working relationships. Intentionally teaching adults and teachers how to evoke calmness in ourselves and breathe to handle negative situations, trusted educators can then teach children to do the same. It is important that educational leaders, and other stakeholders, explore what works best to help children overcome trauma and become resilient and productive adults. This study examined the relationship between social, emotional, and behavioral skills of students entering kindergarten who have been intentionally taught skills needed for resiliency by highly …

Covid-19: A Review Of Random Testing As An Augmentation Of A Close-Contact Testing Regime In Response To The Covid-19 Pandemic, John Mcdonnell

Dissertations

The COVID-19 pandemic has presented the world with a huge challenge to balance the health of the population with the scale of stringent response measures. Policy makers need evidence based recommendations to inform their response to the pandemic and the ever changing landscape it creates. Testing and isolation of infected individuals plays a critical role in containing the spread of the disease, but is aimed primarily at detecting symptomatic individuals. However, asymptomatic individuals are much more difficult to detect. This study presents the augmentation of a close contact testing regime with random testing to examine the elect on the number …

Childhood Obesity Interventions In The Republic Of Trinidad And Tobago: A Qualitative Study Exploring Government Policies And Their Implementation By Health Practitioners, Phyllis Woolford

Dissertations

Because of the rising prevalence of childhood obesity and overweight in the Republic of Trinidad and Tobago, and the observation that efforts to address the problem were showing disappointing results, this study seeks to explore the experiences and views of policymakers, health practitioners, and parents of overweight and obese children, in order to inform leaders and policy makers regarding the current interventions.

Method

A qualitative research case study methodology is the research design used, which, with my research questions, I considered would best uncover knowledge and provide perspectives that would provide an increased understanding of the issues arising from the …

Nanomaterials In Theranostics : Therapeutics And Diagnosis Against Infectious Diseases, Unnatiben S. Patel

Dissertations

Nanomaterials-based hybrid nano therapy is gaining attraction as a promising way to treat intracellular bacterial infections. Gold-based nanomaterials have been widely used for biomedical applications such as photothermal therapy (PTT). This thesis discusses the development of a combination therapeutic approach that kills intracellular bacteria in conjunction with photothermal and antibiotic therapy using gold nanorod (GNR) based nano-assembly. This NIR laser-activated nano-assembly delivers antibiotics to the site of infection and offers PTT. The synergistic application of both therapies increases the efficacy of treatment. The protected delivery of antibiotics and their release in the proximity of the bacterial surface decreases off-target toxicity …

Functionalized Nanomaterials As Tailored Theranostics, Kavini M. Rathnayake

Dissertations

Theranostic nanoparticles are a type of biodegradable and biocompatible multifunctional nanosystems in combination with diagnostic and therapeutic capabilities for more specific and personalized disease management. However, difficulties still exist in engineering biocompatible theranostic nanoparticles with highly specific to intracellular bacteria and tumor. Development of nanoassemblies which can overcome these difficulties to achieve maximum therapeutic efficacy of the drugs will be discussed in this dissertation. Pseudomonas aeruginosa (PA) is an opportunistic pathogen, which causes serious lung infections in immunocompromised patients. Traditional oral intake of large quantities of small-molecule antibiotics to treat bacterial infections leads to off-target toxicity and development of drug-resistant …

B Cells In The Gut Associated Lymphoid Tissue (Galt), Ameera Bukhari

Dissertations

The gut-associated lymphoid tissue (GALT) is the largest mass of lymphoid tissue in the body, and it is a unique line of defense where immune cells are in constant contact with gut commensals and pathogens. B lymphocytes constitute most of the lymphatic tissues of the gastrointestinal (GI) tract and they play a critical role in protecting from infections, promoting tolerance, and shaping microbiota in the gut through the production of immunoglobulins (Ig). Previous studies on GALT B cells in human showed that large B cell clones in the body partition into two broad networks: one includes the blood, bone marrow, …

Leveraging Moral Foundations To Increase Covid-19 Vaccination, Cara Elizabeth Ray

Dissertations

Despite the vast majority of the eligible U.S. adult population being vaccinated against COVID-19, geographical clusters of unvaccinated individuals pose a substantial risk of outbreak. It is important to encourage as many individuals as possible to vaccinate against COVID-19 to reduce its spread and severity. Past research has identified endorsement of the purity and liberty moral foundations – intuitive domains of moral concern – as predictors of vaccine hesitancy and political conservatism, while conservatism is itself associated with vaccine hesitancy. Across two online surveys, I examined the effects of a message invoking the purity and liberty foundations as well as …

The Lived Experience Of Lebanese Oncology Patients Receiving Palliative Care, Myrna A. A. Doumit

Dissertations

The purpose of this study was to uncover the lived experience of Lebanese oncology patients receiving palliative care. The study design was based on the Utrecht School of phenomenology based on the Dutch school of phenomenology. This study followed purposeful sampling in which ten participants six women and four men with a mean age of 54.4 years were selected. The proposed research was approved by the Institutional Review Boards at the American University of Beirut and Duquesne University. In-depth semi-structured interviews along with observation-field notes were used as the source for data collection. Data were analyzed using the hermeneutic phenomenological …

A Nationally Representative Survey Of Depression Symptoms Among Jordanian Adolescents: Associations With Depression Stigma, Depression Etiological Beliefs, And Likelihood To Seek Help For Depression, Latefa Ali Dardas

Dissertations

Arab adolescents are considered a particularly vulnerable population to depression. The substantial lack of mental health services and the stigma associated with mental illness on the one hand; and poverty, unemployment, and lack of reasonable hopes for a decent future in the context of corruption of regimes and perceived social injustice on the other, call for establishing committed and effective policies to tackle depression and its associated stigma among Arab adolescents at risk for or diagnosed with depression. However, there is a substantial lack of research that can inform the current profile of adolescent depression in the Arab region. We …

Dicer Represses Antiviral Innate Immunity Pathways In Mouse Embryonic Stem Cells, Chandan Gurung

Dissertations

Recent studies have demonstrated that embryonic stem cells (ESCs) are deficient in expressing type I interferons (IFN), the cytokines that play key roles in antiviral responses. However, the underlying molecular mechanisms and biological implications of this finding are poorly understood. In this study, I used a synthetic RNA-based assay that can simultaneously assess multiple forms of antiviral responses in ESCs. Dicer is an enzyme essential for RNA interference (RNAi), which is used as a major antiviral mechanism in invertebrates but not clear in vertebrates. RNAi activity is detected in wild-type ESCs but is abolished in Dicer knockout ESCs (D−/−ESCs) as …

Covid-19 & University Stakeholders: A Faculty Perspective, Torie Fowler

Dissertations

The purpose of this study was to investigate faculty member perceptions of job satisfaction, response efficacy, organizational communication efforts, along with organizational trust and goodwill in relation to the COVID-19 crisis. A cross-sectional survey was conducted, using faculty members employed at their institution of higher education during the 2019-2020 and 2020-2021 academic years. A total of 285 responses were analyzed.

Results of this study suggest faculty member perceptions of job satisfaction and response efficacy were significant in predicting perceptions of trust and goodwill. The most significant predictor of organizational trust and goodwill was perceptions of organizational communication efforts. Also, this …

The Role Of Berberine, A Clinically Relevant Plant Derived Alkaloid, In T Cell-Mediated Immunosuppression, Alexandra Adorno Vita

Dissertations

The primary focus of this research was to determine the effect of berberine (BBR), a clinically relevant plant-derived alkaloid, on follicular T helper (Tfh) cell activation and differentiation, with implications for the generation of T cell-dependent humoral responses. This research revealed a novel function of BBR as a suppressor of Tfh cell proliferation in secondary lymphoid organs of BBR-treated mice that underwent immunization for arthritis induction in a collagen-induced arthritis (CIA) mouse model. Tfh cells provide signaling to B cells that is crucial for the generation of T cell-dependent humoral responses, such as affinity maturation, isotype class switching, and the …

National Council Licensure Examination For Registered Nurses (Nclex-Rn®) Success: Perceptions Of Accelerated Second-Degree Bachelor Of Science In Nursing Students, Vicki L. Brzoza

Dissertations

Most of the 50 states in the United States (U.S.) will experience a significant nursing shortage by the year 2030. Research finds that a bachelor of science in nursing (BSN) workforce is associated with better outcomes, fewer adverse events, and lower patient mortality than associate or diploma prepared nurses. BSN-prepared nurses are in great demand, and the accelerated second-degree bachelor of science in nursing (ABSN) programs may meet this need. This study investigates how to be successful in these ABSN programs. The purpose of this study was to describe the ABSN students' perceptions and experiences of what they believe to …

The Response Of A Rural Missouri Middle School To The Covid-19 Pandemic: A Case Study Of Instruction, Communication, And Access To Technology, Christian Scott Meier

Dissertations

The doors of a rural Missouri middle school were closed in mid-March for what turned out to be the remainder of the 2019‒2020 school year (Schremp Hahn, 2020). Many schools were unprepared for the swift nature with which the shutdowns occurred (Bernhard, 2020a). The purpose of this case study was to examine the opinions and perceptions of parents, teachers, and the principal at a Missouri middle school regarding the school’s response to the COVID-19 closure to determine the best possible strategies for mitigating learning loss during future extended closures. The summer slide was the lens through which the study was …