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Alert Driven Rescue: Do In-Hospital Sepsis Interventions Following An Advanced Early Warning System Alert Differ Substantially Between Decedents And Survivors?, Daniel T. Linnen

Dissertations

Patients with worsening sepsis on general hospital wards are at high risk for clinical deterioration, unplanned admission to the intensive care unit, and death. Many hospitals have begun to employ early warning systems (EWSs) to alert nurses and providers that a patient is predicted to deteriorate. Multiple papers in the rapid response team (RRT) and sepsis literature describe typical problems leading to an EWS alert (e.g., systemic inflammatory response syndrome, low blood pressure) as well recommended interventions such as intravenous fluid bolus, antibiotics, and transfer to the intensive care unit (ICU). Despite the evidence base, it remains unclear which actions …

Exploring Higher Rates Of Breastfeeding Among Civilian Military Wives: A Mixed Methods Study, Nicole Ann Ringo

Dissertations

As compared to the U.S. general postpartum population, civilian military wives (CMWs) encounter unique challenges that can impede their ability to breastfeed, including geographic replacement and physical and emotional challenges. Yet despite these challenges, CMWs demonstrate higher rates of breastfeeding initiation and duration in the U.S. postpartum population as a whole.

The purpose of this study was to explore factors contributing to the high rate of breastfeeding initiation and duration among CMWs and to determine what might be learned from these factors for intervention design for the broader population of postpartum mothers.

How Do Faculty Foster The Development Of Nursing Student Empathy In The Clinical Learning Environment?, Caroline E. Rae

Dissertations

The purpose of this qualitative case study was to explore how faculty foster the development of nursing student empathy in the clinical learning environment. While much of nursing education focuses on building technical knowledge and skills, the literature supports a growing need to focus on developing an empathetic practice. It is important to support the development of empathic skills to better prepare future nurses to provide high-quality patient-centered care.

Following The Yellow Brick Road: The Lived Journey Of Nurses Becoming Nurse Practitioners, Kathleen Theresa Ogle

Dissertations

In this phenomenological study, I explore the lived experiences of registered nurses who become nurse practitioners. Text for this study comes from narrative sources such as reflective writings, one-on-one conversations, and group conversations with seven new nurse practitioners.

The guiding question for this inquiry is: "What is the lived journey of nurses who become nurse practitioners?" Phenomenological philosophers such as Heidegger, Gadamer, and Casey guide this work. Other authors are drawn upon for grounding the study and to draw out the phenomenon for examination. The six research activities of van Manen (2003) provide the methodological framework for the research.

The Role Social Capital Plays In The Psychological Capital Of Registered Nurses Experiencing Second Victim Syndrome, Teresa-Lynn Hinkley

Dissertations

This study used an ex-post facto survey for data collection and structural equation modeling for data analysis to explore the combined relationship of psychological capital and social capital on the severity of second victim syndrome experienced by registered nurses. Specifically, this study sought to answer the following research question "To what extent does the relationship between psychological capital and social capital combine to predict the severity of SVS experienced by registered nurses following a precipitating event?" A second research question, aimed at explicating the relationships between the subconstructs of the three constructs of interest was "What are the relationships between …

Effectiveness Of An Educational Intervention At An Academic Medical Center To Reduce Stigma Of Accelerated Pre-Licensure Nursing Students Toward Patients Living With Hiv, James Strickland Miller

Dissertations

Some health care providers may be reluctant to care for patients with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). The inclusion of educational opportunities for students to advance knowledge of HIV transmission risks, while decreasing stigma, is important, and many health care providers have not participated in these types of activities, which could promote learning and the practice of unbiased care.

Impact Of End-Of-Life Education On Nurses' Moral Distress, Jenniffer L. Mullen

Dissertations

Moral distress is a state of concern or anxiety that occurs when there is a correct action to take but an individual's ability to take that action is constrained in some way. Nurses, especially those who work in intensive care units (ICUs), may struggle with moral distress due to feelings of futility when caring for end-of-life patients. The purpose of this 1-group pretest–posttest quasi-experimental study, guided by Lazarus's theory of stress, coping, and adaptation, was to determine whether End-of-Life Nursing Education Consortium (ELNEC) education reduces moral distress in ICU nurses caring for end-of-life patients. A revised Moral Distress Survey (MDS-R …

Qualitative Exploration Of Perceptions Of Nursing Undergraduates Regarding Family Care At End-Of-Life, Penny A. Alt-Gehrman

Dissertations

Family care at end-of-life is delivered by nurses and includes communication and explanations, providing emotional support for the family, creating an environment in which death occurs with dignity, providing privacy, facilitating visitation, and honoring and meeting cultural and personal family values (Beckstrand et al., 2011; Bloomer et al., 2013; Cronin et al., 2015; Heidari & Norouzadeh, 2014).

There appears to be a gap in the empirical evidence and literature on this topic. Regarding the knowledge and comfort of student nurses, and subsequently nurses, in family care at the end-of-life, there is disparity. To determine what must be taught to nursing …

The Relationships Among Self-Regulation, Cognitive Load, Decision Support, And Decision Making Readiness In Surrogate Decision Makers For The Critically Ill, Grant Alan Pignatiello

Dissertations

Chronic critical illness is expected to impact 600,000 Americans annually by 2020. Often, the chronically critically ill (CCI) experience persistent cognitive impairment. Thus, family members serve as surrogate decision makers (SDMs) to make complex healthcare decisions for their loved one. Decision support interventions have been developed to meet the informational needs of SDMs during this distressing period. However, past decision support interventions have not been effective in meeting the informational needs of SDMs. Current decision support interventions have not evaluated unique behavioral and cognitive factors that may influence an SDM's readiness to engage in decision making. Therefore, this study applied …

A Basic Qualitative Exploration Into The Academic Persistence Of Minority Nursing Students In Minority Nursing Programs, Marta S. Coleman

Dissertations

The academic persistence of minority nursing students has become a healthcare concern due to health disparities in minority groups. Evidence suggests that receiving healthcare from healthcare providers of the same ethnic or cultural background as the population served reduces health disparities, increases positive health outcomes, and decreases overall healthcare costs. Unlike previous studies of minority nursing students' persistence, this study was conducted solely in minority nursing programs. The problem addressed in this basic qualitative study was that a significant number of minority nursing students were not persisting to graduation in minority nursing programs. The purpose of this study was to …

The Impact Of Adverse Childhood Experiences And Forgiveness On Nurses' Capacity For Compassion Satisfaction, Anne D. Troy

Dissertations

The objective of this study was to examine the relationship between Adverse Childhood Experiences (ACEs), forgiveness and compassion satisfaction in nurses. In addition, the study sought to determine the impact of forgiveness, as a moderator on the relationship of adverse childhood experiences and compassion satisfaction. Lastly, this study explored which demographic characteristics serve as predictors of forgiveness and compassion satisfaction in a select population of nurses.

Quality Remediation Programs Lead To Successful Learning, Katherine T. Ralph

Dissertations

The mission of nursing programs is to prepare as many students as possible to pass the first-time attempt on the National Council Licensure Examination- RN (NCLEX-RN®). If a school's first-time pass rate drops below 80%, the school is at risk of being closed by the State Board of Nursing. Furthermore, a student's ability to work as a registered nurse (RN) depends on passing the NCLEX-RN®, and the overall impact on our nation's health due to the current nursing shortage.

The purpose of this study was to examine the policies and strategies used in nursing programs to increase NCLEX-RN® first-time attempt …

The Lived Experience Of Traumatic Amputation For Haitian Adults, Margarett Alexandre

Dissertations

Amputation of a limb is a traumatic and disabling condition that impacts the lives of people worldwide. Trauma remains the leading cause of major limb amputation, second only to Diabetes Mellitus and dysvascular complications (Ziegler-Graham, MacKenzie, Ephraim, Travison, & Bookmeyer, 2008). Little is known about the experience of traumatic amputation for Haitian Adults, therefore this study was to understand the lived experience of traumatic amputation in Haiti. The purpose of this descriptive phenomenological study was to investigate the lived experience of traumatic amputations as talked about by adults who suffered an amputation because of the 2010 earthquake in Haiti.

Preparing Nursing Students To Respond To Disasters: Faculty Perspectives, Melissa Jayne Freshwater

Dissertations

This mixed methods study explored emergency preparedness and disaster response in the concept-based learning curriculum adopted by the Alabama Community College System (ACCS) in 2016. The concept-based curriculum employs active learning in lieu of the traditional lecture-style teaching methods.

This study addressed the problem that educators may be unfamiliar with this content and are unsure how to present this material to students. The purpose of this study was to gain insight on teaching methodologies, to better prepare nursing students on this content.

Kolb's 1984 Experiential Learning Theory was the framework that parallels closely with this curriculum. Kolb emphasizes four stages …

Bedside Counseling For Medical Inpatients Who Misuse Alcohol, Lise Anne Cooper

Dissertations

This dissertation addresses the process and results of a program implemented to motivate patients that are admitted to a medical center with diagnoses of alcohol misuse to seek addiction recovery. The primary research question is: How does bedside addiction counseling reduce the patient's number of readmissions and length of stay? This is a comparative, interventional mixed methods study. This study also examines the methods used to identify the inpatients at the medical center that are admitted with alcohol misuse, and how that identification process initiates treatment.

A Qualitative Descriptive Study Of Novice And Advanced Beginner Nurse's Experiences Caring For Patients And Their Families At The End-Of-Life, Bethany A. Nasser

Dissertations

Nurses are the primary healthcare professionals that spend the most time caring for seriously ill patients. Nurses have a responsibility to care for patients at the end of their lives, to relieve pain, and promote dignity so that patients can experience a peaceful death. As our elderly population grows and chronic health problems increase, there is a need to teach nurses and nursing students End-of-Life Care (EOLC). New nurses must be properly prepared to provide sensitive, quality care to dying patients and their families. Nursing students do not have opportunities during clinical training to care for patients that are dying, …

Celiac Disease: Examination Of Executive Function And Social Phobia Among Female College-Aged Students, Jacqueline M. Arnone

Dissertations

This study compares traditional age female college students (18-25) diagnosed with celiac disease (CD) to age matched controls on measurements of executive function (EF) and social phobia (SP). Although previous research in this area has been mixed, a preponderance of the evidence from these studies suggests that CD impacts cognitive functioning as a whole; executive functioning in particular. However, most of the literature in this area focuses on age groups outside of the normal traditional college age range. No research to date has examined executive functioning or social phobia among 18-25-year-old female college students with CD. Bronfenbrenner's Bio-Ecological Systems Theory …

"It Was A Season..." Postpartum Depression In American Indian/Alaska Native Women, Jennifer Leigh Heck

Dissertations

Postpartum depression (PPD) is linked to diminished maternal, pediatric, and family health outcomes and is designated as the most common childbirth complication. PPD is found in most populations, and touts international status as a major public health concern. Clinicians define PPD as an episode of major depressive disorder with a "peripartum onset" that occurs within the first year after delivery. Studies suggest that American Indian/Alaska Native (AI/AN) women suffer higher PPD prevalence (14% to 29%) than other United States' women, revealing a racial/ethnic disparity. Health disparities research is a national public health priority and substantiates the need to explore PPD …

Elderly Partners' Lived Experience Of Bladder And/Or Colorectal Cancer Diagnosis Living With A Ostomy, Dinah R. Herrick

Dissertations

Bladder and colorectal cancer (CRC) are two of the most aggressive types of cancer with treatment creating physical and psychosocial comorbidities that affect the quality of life of patients affected by the disease. Numerous studies have been conducted about the experiences and needs of people who have had a bladder and/or CRC diagnosis, surgical intervention, and an ostomy, but studies about the experiences of the elderly partners are negligible. Specifically, the older adult (65-84 years old) group was found to be essentially unstudied with only 10 (0.51%) known 75- to 84-year old participants included in relevant studies that involved 1,750 …

Family Dementia Caregivers' Perceptions Of The Virtual Dementia Tour®: A Changed Reality, Candace Currie Harrington

Dissertations

Family dementia caregiving involves many challenges that often lead to stress and frustration. A subjective understanding of the daily struggles associated with dementia is not possible unless one has the disease; therefore, the family dementia caregiver's perception of dementia might be incongruent with their family member's lived experience.

The Virtual Dementia Tour® (VDT) provides a vicarious first-person perspective for six of the most common symptoms of dementia. Although extensive evidence supports the use of the Virtual Dementia Tour® in the healthcare profession and education, no research studies were found investigating the Virtual Dementia Tour® with family dementia caregivers.

American Association Of Diabetes Educators 7 Intervention In Managing Type 2 Diabetes In Older Home Health Patients, Anne N. Ohakosim

Dissertations

Management of chronic disease pathologies requires the patient to have the ability to understand and manage their care. This may be especially challenging in the aging population caring for themselves at home. The home care agency noted the patients had a knowledge deficit regarding T2DM self-management of blood glucose levels. The purpose of this quantitative quasi-experimental quality improvement project was to determine if the implementation of the American Association of Diabetes Educators 7(AADE7) diabetes self-management program improved glucose levels and diabetic management knowledge among adult diabetic home health patients aged 65 and older. The project took place in northwestern Illinois …

Dispositional Mindfulness In Senior-Level Nursing Students: Examining The Relationship To Situation Awareness And Clinical Outcomes, Deborah L. Struth

Dissertations

Experts in the study of ergonomics and human performance factors have described the 'collective mindfulness' of nurses as a critical element to the attainment of highly reliable safety within patient care delivery. Little research exists related to the construct of mindfulness and its impact on safe nursing practice and situation awareness by the nurse.

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

Dissertations

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).

The Feasibility Of Using A Theory-Based, Online Delivery Microlearning System To Educate Nurse Practitioners About Clinical Skin Examination For Melanoma, Delaney Baker Stratton

Dissertations

The purpose was to explore the feasibility of delivering and developing an evidence-based intervention to educate PCNPs about comprehensive CSE for MM. Aim 1 was to develop three evidence-based, brief skin cancer videos with content on comprehensive CSE skills (risk assessment, head-to-toe skin examination, skin lesion assessment) that are suitable for online, theory-based delivery to PNCPs in various formats. Aim 2 was to determine enrollment and retention rates, intervention adherence, and acceptability and usability of the intervention following completion of the one-week intervention. The exploratory aim was to explore preliminary associations among information, motivation and behavior skills for CSE behavior …

Associate And Baccalaureate Degree Nursing Students' Knowledge Of The Attitudes Toward Medication Errors And Reporting Medication Errors: Implications For Curriculum Development, Tabatha D. Teal

Dissertations

This paper evaluates senior nursing students' knowledge and attitudes of medication errors and reporting errors. This study was conducted to evaluate a need for improvements to nursing education on these two concepts. This mixed method study was conducted using a modified version of the Medication Administration Error Reporting Survey by Wakefield, Uden-Holman, and Wakefield (2005) and focus group sessions at four nursing programs in the Southern United States. Medication errors continue to be a threat to patient safety and underreporting exists due to the stigma surrounding admitting a mistake. Evaluating nursing students' knowledge and attitudes on these concepts is a …

You’Ve Got Mail: A Sequential Mixed Methods Linguistic Investigation Of Faculty And Advisor Email, Kevin A. Manley

Dissertations

Email is one of the most prolific forms of communication in the world. As colleges and universities move more student experiences online, faculty members and advisors need to understand how to best communicate with students. In an attempt to understand how faculty and advisors write, and, more importantly, how students read, I developed this two-phase mixed methods investigation. In Phase I, I collected nine writing samples from 19 faculty and advisor participants and dissected the samples with Pennebaker Conglomerate’s 2015 Linguistic Inquiry and Word Count (LIWC) program. In a transition phase, I leveraged Phase I data to create an instrument …

A Quality Improvement Project: Evaluation Of Teach-Back Training On Medication Adherence In Hypertensive Older Veterans, Chelsea Hall-Mcarthur

Dissertations

Hypertension remains one of the most common yet uncontrolled chronic diseases among older adults. Medication adherence is a vital part in managing uncontrolled hypertension. The purpose of this QI project was to evaluate the effectiveness of using the teach-back method on improving anti-hypertension medication adherence of hypertensive older adult patients age 65 to 75 with at least two uncontrolled blood pressure readings during their most recent clinic visit in the past 6 months. Medication adherence was assessed using the Hill-Bone Medication Adherence Scale (HB-MAS) before and after the intervention. Health literacy scores were also recorded prior to the intervention using …

A Hungarian Exotic Ingredient In Operetta: The Csárdás In Three Settings, Michelle Lange

Dissertations

The inclusion of the Hungarian National dance in Viennese operetta during the height of the genre’s popularity expresses an intricate relationship between two nations in the Austro-Hungarian Empire during a time of immense change. Examining the Hungarian elements of the Csárdás in the compositions of three operettas provides a deeper understanding of Hungarian influence in Viennese operetta culture and performance. While there is a wealth of information on Hungarian folk music, there is a gap in the application of this knowledge within the operetta genre. This document’s primary purpose is to explore the exotic Hungarian musical folk elements found in …

Music Listening: An Evidence-Based Approach To Help Manage Postoperative Pain, Tammie Ferguson

Dissertations

The current standard of practice to manage postoperative pain includes the use of opioids. The purpose of this evidence-based project was to evaluate the effectiveness of music listening as an adjuvant to traditional pain management strategies to relieve postoperative pain and to assess the dosage of opioids used to help manage postoperative pain. Kolcaba's Comfort Theory was used to guide this evidence-based project.

Evaluating Loneliness In An Older Adult Population, Kelli Rowland

Dissertations

Problem: Loneliness and social isolation are severe burdens on global public health and can impair overall health outcomes. Unfortunately, both loneliness and social isolation are prevalent in the older adult population. The purpose of this quality improvement project was to evaluate loneliness in older adults enrolled in a weekly socialization program and its impact on loneliness.

Methods: A descriptive cohort design was utilized to analyze surveys completed three months apart. A convenience sample was used with older adults already enrolled in a weekly socialization program. The Iowa Model of Evidence-Based Practice was applied to evaluate and promote quality …