Digital Commons Network^™

Reducing Pediatric Morbidity Through Development Of A Clinical Practice Guideline, Deanna Kroh

Dissertations

Peripheral intravenous therapy is a commonly utilized treatment modality for the care of acutely ill pediatric patients. Two risk factors include infiltration and extravasation injuries. These injuries, peripheral intravenous infiltration or extravasation injuries (PIVIEs), can vary in their clinical manifestations from minor discomfort to harm as severe as loss of limb or disfigurement. Clinicians caring for patients at risk of developing PIVIEs need to be able to act quickly to reduce potential morbidity. The purpose of this project was to create a clinical practice guideline (CPG) that would guide staff intervention if a PIVIE occurs, with the ultimate goal of …

An Evaluation Of Mindstrong™ Implementation With Graduate Nursing Students, Angela B. Sabblut

Dissertations

Problem: Nursing graduate students are at increased risk of greater stress, anxiety, and depression (Hoying, 2020; Melnyk et al., 2020). Cognitive Behavioral Therapy is the gold standard in the treatment of anxiety and depression (Hoying et al., 2020; Melnyk et al., 2015; Melnyk et al., 2020). MINDSTRONG™, a CBT-based training program, has been proven in many studies to be effective in helping individuals prevent or cope with these issues (The Ohio State University College of Nursing, 2020).

Methods: This Quality Improvement (QI) project was a descriptive-observational, pre-post design. Sample and setting were nursing graduate students from a Midwestern, middle-sized urban, …

Evaluation Of An Education Program Implementation For Adults With Stage 4 And 5 Chronic Kidney Disease, Dana Marie Carter

Dissertations

Abstract

Problem: Patients with long-term medical conditions represent a significant public health issue. Therefore, patients diagnosed with a chronic illness must have a high level of health literacy (HL) to manage their condition effectively. This Quality Improvement (QI) project evaluated the impact of an existing education-based program for stage 4 and 5 chronic kidney disease (CKD) patients and its effect on laboratory values compared before and after an NP-led education program that included vascular access, and modality choices.

Methods: A retrospective chart review was completed on 20 patients with an inclusive diagnosis of CKD stage 4 or 5 from …

The Impact Of The Phq-8 On Referrals To Psychotherapy Services For Oncology Patients, Sarah Beckmann

Dissertations

Abstract

Problem: Nearly seven million individuals will be struggling with both cancer and depression by 2040. Patients with cancer face a multitude of challenges. These challenges can impact a patient’s mental health and ability to cope with a cancer diagnosis. Currently, there is a large treatment gap among patients who are coping with both cancer and depression. Healthcare providers are neglecting to use evidence-based screening tools to assess patients for depression upon admission to inpatient treatment.

Methods: This quality improvement project took place at a large metropolitan comprehensive cancer center in the Midwest. A descriptive observational design was utilized. Prescreen-post …

Healthcare-Associated Pressure Injury Prevention In The Intensive Care Unit, Ross Quinton

Dissertations

Problem: Healthcare-associated pressure injuries (HAPIs) occur when prolonged pressure is on the sacrum, coccyx, elbows, and heels, during a hospital stay. HAPIs can result in increased morbidity and mortality, and prolonged hospital stays, which consequently requires excess expenditure on treatment. Early specialty mattress placement can prevent HAPI acquirement.

Methods: This quality improvement (QI) pilot project aimed to increase specialty prevention mattress usage in the intensive care unit (ICU). A sleep surface decision tree was implemented into the admission process in a 30-bed ICU. A retrospective record review was used to examine demographics, comorbidities, HAPI risk, length of stay, and when …

Effect Of A Turn Clock On Hospital-Acquired Pressure Injury Incidence, Sydney Warren

Dissertations

Problem: Hospital-Acquired Pressure Injuries (HAPIs) are the only quality metric increasing in incidence and are preventable. HAPIs are wounds to bony prominences during a hospitalization and can increase hospital costs, morbidity, and mortality. HAPIs could be prevented through interventions, including repositioning patients every 2 hours and using a turn clock method. The aim of this quality improvement (QI) pilot project was to decrease HAPI incidence.

Methods: A turn clock method was implemented on a general medicine floor at a mid-sized, suburban medical center utilizing a descriptive retrospective observational design. Data was collected for the pre-intervention timeframe from June through August …

Implementing Patient Acuity Scale On A Medical-Surgical Unit, Coreen Ladd

Dissertations

Problem: Nurses commonly report dissatisfaction with their workload levels due to inequity of shift assignments. Imbalanced workload distribution has been shown to lead to missing or delayed care. Increased nursing workload has been linked to increased fall rates, healthcare associated infections, and avoidable deaths. Research has shown that patient classification is more accurate when an instrument is used. The purpose of this quality improvement project was to implement a patient acuity tool to aid nurse-patient shift assignments on a medical-surgical unit. The project aimed to provide a standardized and objective method of measuring patient acuity.

Methods: The project took place …

Evaluating The Rass And Cap-D In A Pediatric Cardiac Intensive Care Unit, Sarah Anderson

Dissertations

Abstract

Problem: Pediatric delirium is highly prevalent in the intensive care setting, as much as seventy to eighty-seven percent. Kalvas & Harrison (2020) found that sixty-six percent of critically ill children in a pediatric intensive care unit suffered from a diagnosis of delirium. Delirium has been widely linked with increased costs, mortality, and length of stay.

Methods: The quality improvement (QI) project used a descriptive design to collect retrospective and prospective data before and after an individualized bedside education session was completed. The QI project used a purposive convenience sampling to assess the ability to accurately identify the presence of …

The Mission System: An Electronic Health Record For Medical Treatment In Guatemala, Tawniece M. Curry

Dissertations

Abstract

Problem: The introduction of an electronic health record (EHR) system has become an essential component in monitoring and tracking patient information in most developed countries but are difficult to implement in underdeveloped countries. Guatemala is a country with poor health care and limited resources for patient tracking and monitoring. An organization in Guatemala, Nursing Heart Inc. (NHI), provides care to over 40 underserved rural communities but lacks the ability to monitor and track patient information. In order for NHI to properly monitor and evaluate their programs and track patients’ continuity of care, the introduction of an EHR system is …

Improving Saint Louis University Mental Status (Slums) Exam Adherence, Kelsie Patek

Dissertations

Problem: Mild Neurocognitive Disorder (MNCD) and dementia remain one of the most common debilitating problems facing the elderly. The Saint Louis University Mental Status (SLUMS) Exam is a screening questionnaire to assess for MNCD or dementia. With the utilization of the SLUMS, clinicians can detect cognitive impairment and provide early intervention resulting in improved function and delayed progression of illness. The aim of this project was to increase the rate of SLUMS completion by at least 75% at a long-term care facility in a rural Midwestern state and to assess changes in diagnoses and treatment plans resulting from use of …

The Effects Of Early Lactation Support On Breastfeeding Exclusivity Rates, Alexa Fleming

Dissertations

Abstract

Problem Breastfeeding exclusively for the first 6 months of a child’s life is the recommendation across medical professionals. Unfortunately, exclusive breastfeeding rates are on the decline due to insufficient support, lack of self-efficacy and inadequate hospital interventions.

Methods For this quality improvement (QI) project, a descriptive observational study design was used to identify appropriate participants who were planning to have a full-term, healthy, exclusively breastfed newborn. Within one hour after delivery, a lactation specialist provided the mother with breastfeeding education and assistance with the initial latching process. At the time of discharge, data was collected to examine if the …

Implementing A Child Friendly Menu Guide In A Pediatric Unit: Promoting Healthful Choices, Lauren Hull

Dissertations

Problem: Over 1/3 of children in the United States are overweight or obese and children’s nutritional status while hospitalized worsens rather than improves. Hospital meals have too many calories, too much sugar, and too few nutrients compared to recommended guidelines for children. The primary purpose of this quality improvement project is to increase the amount of healthy foods ordered by children in a southeastern pediatric hospital unit through implementation of a menu guide.

Methods: A quality improvement pre-post interventional pilot study was done through implementation of a child friendly menu guide promoting healthful eating. Data was collected by retrospective and …

Evaluation Of An Initiative To Increase Rates Of Exclusive Breastfeeding Among Rural Hispanic Immigrant Women, Naomi E. Pitcock

Dissertations

This project was a retrospective evaluation of the prenatal education component of a multi-component breastfeeding promotion intervention. The educational portion of this program, provided in Spanish using intercultural communication techniques, was designed to increase the number of Hispanic women who choose to initiate breastfeeding, using breast milk exclusively to nourish their newborns. The Hispanic women included in this program were all registered with a local prenatal-care coordination program for low-income women, had routine hospital births (both vaginal and C-section) and elected to participate in the prenatal education class. Data regarding intention to breastfeed and breastfeeding during hospitalization were gathered through …

We Eat, We Live, We Repeat: Reimagining Food Heritage Through Foodways And Sustainable Food Practices, Caitlin L. Crain, Amy L. Roznos, Britt L. Tate Beaugard, Darius L. Williams

Dissertations

The purpose of this co-authored, mixed methods descriptive research study was to examine how the intersection of foodways and sustainable food practices helps define the food heritages of St. Louis area residents. While prior research examines these concepts separately, and even shows connections with other factors such as health and discrimination, none look at all of these concepts together—a gap this research fills. To that end, this dissertation describes the intersection of cultural foodways and connection to sustainability in seeking a definition of food heritage and a path towards sustainable food heritage for St. Louis residents. Purposeful sampling using the …

Compassion Satisfaction And Compassion Fatigue Among Pediatric Nurses And The Impact On Patient Satisfaction, Maribeth Thornton

Dissertations

Compassion fatigue and compassion satisfaction are two inter-related concepts. Individuals in helping professions may occasionally face compassion fatigue from giving so much of themselves to others. Compassion fatigue has been studied in a variety of settings: medical, social work, nursing, law enforcement, and fire departments, to name a few. While some researchers have studied nurses, little published work has focused exclusively on nurses who care for specialty pediatric populations. Additionally, there is scant research on whether compassion satisfaction and compassion fatigue are associated with patient satisfaction. The purpose of this study was to determine the level of compassion satisfaction and …

Use Of Early Specialty Hesi Exams As Predictors Of Hesi Exit Examination Performance In Baccalaureate Degree Nursing Program, Cathy E. Hansen

Dissertations

This study explored standardized testing outcomes used early in a baccalaureate nursing (BSN) education program in traditional and second-degree students in order to identify predictors of outcome on the program exit examination (HESI E²). Defining early predictors of student outcomes may more accurately identify student need for early intervention, offer timely remediation, optimize success, and minimize attrition in nursing education programs. The purpose of this correlational quantitative study was to determine if a relationship exists between student outcomes on four HESI specialty exams (fundamentals, health assessment, pathophysiology, and pharmacology) and the performance outcomes on the HESI E^{2 …}

Utility Of The Motivation To Change Lifestyle And Health Behaviors For Dementia Risk Reduction Scale (Mclhb-Drr) Based On A North American Sample, Angelina E. Witbeck

Dissertations

As the population ages, the prevalence rates of dementia continue to increase. Without a cure or promising treatment for dementia, the best course of lowering the prevalence rates of dementia is through preventative measures. Through an electronic survey, the study utilized the MCLHB-DRR scale to determine whether (1) gender, age, educational background, and socioeconomic status will impact the motivational factors to change lifestyle and health behaviors to reduce the risk of developing dementia and (2) direct experiences with individuals that have a dementia diagnosis are likely to impact one's motivational factors to change lifestyle and health behaviors to reduce the …

Effects Of A Workplace Exercise Intervention On Cardiometabolic Health: Randomized Controlled Trial, Ali Muneer Al Rahma

Dissertations

Brief Introduction: The worldwide rising levels of physical inactivity, especially in the United Arab Emirates (UAE) and the Eastern Mediterranean region, are alarming. The UAE reports one of the highest rates of mortality due to non-communicable diseases, and insufficient physical activity is a major underlying cause. Therefore, action is required to reduce physical inactivity using evidence-based strategies.
/="/">Aims: To evaluate the effect of a 12-week workplace structured exercise intervention on cardiometabolic risk factors and to determine whether the workplace exercise intervention improves physical activity levels four weeks post-intervention.
/="/">Methods: This is a pragmatic parallel, randomized controlled trial with …

Diagnostics Of Dementia From Structural And Functional Markers Of Brain Atrophy With Machine Learning, Tetiana Habuza

Dissertations

Dementia is a condition in which higher mental functions are disrupted. It currently affects an estimated 57 million people throughout the world. A dementia diagnosis is difficult since neither anatomical indicators nor functional testing is currently sufficiently sensitive or specific. There remains a long list of outstanding issues that must be addressed. First, multimodal diagnosis has yet to be introduced into the early stages of dementia screening. Second, there is no accurate instrument for predicting the progression of pre-dementia. Third, non-invasive testing cannot be used to provide differential diagnoses. By creating ML models of normal and accelerated brain aging, we …

The Life Story Analysis Of Those Suffering From Autoimmune Thyroiditis, Azalea Di Nardi

Dissertations

The purpose of this study was to understand the pervasive impacts of autoimmune thyroiditis, specifically Hashimoto’s and Graves’ disease. To accomplish this, the life story methodology was utilized to gather individual experiences from 11 participants diagnosed with Hashimoto’s or Graves’ disease. The participants completed a background and general health questionnaire and 45- to-100-minute virtual interview disclosing their journey from the onset of symptoms, through diagnosis, to their most recent state. Themes were compiled from the interviews, which allowed identification of the largest areas of impact, needs, and future implications for practitioners and providers. Major themes identified were decreased quality of …

Design Of Self-Assembled Peptides For Wound Healing, Ka-Kyung Kim

Dissertations

According to the CDC, 15% of diabetic patients develop diabetic foot ulcers (DFU) and approximately 170,000 patients undergo non-traumatic amputation annually. DFU is a major complication of diabetes caused by non-healing full-thickness wounds through the dermis. The current treatments include blood sugar control, frequent debridement, offloading, moist wound care, infection treatment, and amputation. To achieve wound closure of DFU, appropriate wound care and antibiotic therapy are essential. Topical regimens include hydrocolloids, alginates, foam, silver-impregnated dressings, and hydrogels. Wound healing is a complex and dynamic interplay between the immune system, keratinocytes, and dermal cells (in case of cutaneous wound). Angiogenesis has …

Phenomenological Study Of The Lived Experience Of New Graduate Nurses Caring For Hospitalized Patients Living With Dementia, Geline Buenconsejo

Dissertations

Title. Phenomenological Study of the Lived Experience of New Graduate Nurses Caring for Hospitalized Patients Living with Dementia.

Purpose. This study explored new graduate nurses’ lived experiences in caring for hospitalized patients living with dementia.

Background. The first twelve months of transitioning from student to professional nurse in acute care settings are the most stressful, emotionally challenging, and mentally exhausting for new nurses striving to apply newly acquired skills into practice. Some of the most challenging patients for nurses to care for are hospitalized patients living with dementia (PtLWD). With the projected increase in the number of patients with dementia …

Impact Of Preoperative Psychological Evaluations On Bariatric Surgery Outcomes, Melanie A. Caustrita

Dissertations

Obesity is a major global health challenge affecting 603.7 million adults and is a risk factor for common illnesses such as diabetes mellitus II, chronic kidney disease, cardiovascular disease, gastroesophageal reflux disease, and poorly controlled hypertension. Americans have the highest rate of obesity. Patients with a body mass index (BMI) > 35 with one or more obesity related complications should be considered for bariatric surgery. Forty percent of patients seeking obesity treatment have at least one psychiatric illness with mood and anxiety disorders being the most common. Preoperative screening is recommended to identify patients with psychosocial risk factors that may lead …

Understanding Food Waste Behavior And Ways To Influence Positive Change And Waste Reduction, David Hubinger

Dissertations

Environmental problems such as pollution, climate change, and food waste can be influenced by social attitudes and human behavior. Solutions to address environmental problems involve a series of actions by society and individuals, which can prove difficult to implement because changes induced by pro-environmental behavior often cannot be seen immediately by individuals or may not generate appreciable, direct benefits. The purposes of the quantitative correlational study are threefold: first, examine environmental attitudes, subjective norms, perceived behavioral control, and overall behavioral intent to reduce household consumer food waste among a sample of consumers; second, to examine the extent to which select …

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 …

A Mixed Methods Approach To Exploring Relationships Among Professional Preparation, Professional Development, And The Implementation Of Sex Education In Mississippi, Joyee Washington

Dissertations

The state of Mississippi has led the nation in high rates of teen pregnancy and sexually transmitted diseases among adolescents, despite mandating sex education in public schools for over a decade (SIECUS, 2011; SIECUS, 2016; SIECUS, 2017). Although studies conducted among Mississippi sex educators in the K-12 setting have shown that teachers receive very little to no professional development and desire more training, there is little supporting evidence to understand the position of professional development relative to sex education implementation in the state (Kolbo, Werle, Ismail, Arrington, Harbaugh, & Esters, 2015; Arrington, Ismail, Werle, Esters, Frederick, Ellis, & Kolbo, 2018). …

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 …

Transitioning Eating Practices Of Older Adults, Michelle Lajoy Jackson

Dissertations

Purpose: The purpose of this descriptive qualitative study was to explore what factors may have influenced the transition of an individual older adult’s eating practices over a lifespan and the impact participants perceived those factors currently had upon their nutritional health in older adulthood.

Background: The older adult population is recognized as one of the fastest growing populations in the United States. One of many growing concerns for this population is the impact of dietary practices on the morbidity and mortality of this aging population. There is limited research to date that has explored the transitioning of appetite …

Posttraumatic Stress Symptoms, Anger, And Substance Use As Risk Factors For Trauma Revictimization, Hannah E. Walker

Dissertations

Maltreatment survivors are at an increased risk for adult revictimization. Yet, existing work has specifically focused on sexual revictimization, and it is unclear what factors increase one’s risk for revictimization more broadly. Posttraumatic stress symptoms (PTSS), anger, and substance use have been identified as potential risk factors for sexual revictimization. Still, the role of these variables is ambiguous in the broader revictimization framework. There is also a lack of understanding regarding the roles of the DSM-5 posttraumatic stress disorder (PTSD) symptom clusters and revictimization. This study aims to: 1) examine the links between maltreatment and revictimization and three factors (i.e., …

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 …