Digital Commons Network^™

Depression Screening And Education For Immigrants To Increase Access To Care, Viktoriya Ivantsova

Dissertations

Abstract

Problem: Immigrants are at risk for developing mental health disorders due to multiple factors including social, cultural, or economic factors. This can result in a lower quality of life and an increased chance of further disabilities. Although immigrants are at increased risk for the development of mental health disorders, studies show that utilization of available services and resources are low. Additionally, organizations that provide services to immigrants may not be implementing screening and psychoeducation.

Methods: This quality improvement (QI) project followed a descriptive, observational design along with an educational intervention. Using convenience sampling for recruitment, Russian and/or Ukrainian adults …

Social Work In Pediatric Primary Care, Courtney Maxey

Dissertations

Social Work in Pediatric Primary Care

Abstract

Social determinants of health significantly impact a child's health, and pediatric primary care providers are in the optimal position to help provide treatment and resources to children in need. Studies have shown that integrating social work and nurse care managers has improved many health outcomes for children. This study attempts to answer how the presence of a social work led team impacts pediatric primary care. This project includes children ages 0-18 years seen at a pediatric office with select chronic conditions. Epic was used to perform a medical record review to identify the …

Addressing Daily Compliance Of Central Line Discussions In A Pediatric Cardiac Intensive Care Unit, Caitlin Sherwood

Dissertations

Purpose: The purpose of this project was to determine the impact of targeted education on the consistency of central line discussions during daily, multidisciplinary rounds in a pediatric cardiac intensive care unit.

Method: The Kellogg Logic Model was utilized to guide this project. Education was created and presented to bedside nurses working within the unit regarding the importance of daily central line discussion and the impacts of central line associated blood stream infection on patients. The rate of central line discussion was collected pre- and post-intervention to assess effectiveness of the education.

Findings: This project failed to …

A Guideline-Based Approach To Increase Early Mobilization In The Pediatric Patient Following Cardiothoracic Surgery, Kayla Keeven

Dissertations

A Guideline-Based Approach to Increase Early Mobilization in the Pediatric Patient Following Cardiothoracic Surgery

Problem: Prolonged bedrest during the post-operative period contributes to complications that lengthen hospital stay and increase mortality and medical costs. Early mobilization is recognized as safe and feasible in critically ill children. However, there is no standardized procedure nor method of identifying patients who are safe to mobilize in a pediatric cardiac intensive care unit (ICU).

Method: The quality improvement (QI) project employed a descriptive observational design utilizing a retrospective-prospective method to assess the effects of implementing an early mobilization guideline in a pediatric cardiac ICU. …

Increasing Rates Of Advance Directives In Primary Care, Lindsay Shahi

Dissertations

Abstract Problem: Advance directives (ADs) are legal documents which outline one’s medical wishes if they are unable to make such decisions for themselves. ADs have been shown to reduce cost and improve quality-of-life (Starr et al., 2019), (Wright et al., 2008). Only 1/3 of adults in the United States have a completed advance directive (AD) or living will (Yadav et al., 2017). However, 90% of Americans feel it is important to have conversations about end of life, but only 30% have had this conversation (Institute for Healthcare Improvement, 2020). The Five Wishes document addresses decisions at end of life and …

Management Of Post-Extubation Dysphagia Using The Yale Swallow Protocol, Nicole West

Dissertations

Abstract

Problem: Post extubation dysphagia (PED) increases the patient’s risk for long term complications contributing to increased healthcare cost. Intensive care settings rarely use standardized swallow screening assessments for patients post extubation leading to variation in the evaluation of PED. Variation in the assessment of swallowing post extubation can lead to the missed diagnosis of patients with dysphagia.

Methods: This quality improvement (QI) project was a prospective cohort study implementing an evidence-based swallow screening protocol, the Yale Swallow Protocol (YSP), in an intensive care unit. This study was conducted over four months, which included a pre survey, education, implementation, and …

Neonatal Hyperbilirubinemia And Phototherapy: The Implementation Of Seminal Clinical Practice Guidelines, Christina Coleman

Dissertations

Problem: On a postpartum care and pediatric unit from February 2022 to December 2023, the average monthly percentage of neonatal patients greater than 35 weeks gestation with hyperbilirubinemia who were treated with phototherapy before it was medically supported by the current guidelines was 42.855% (N=668). The department’s goal was to decrease this number to 10%. Initiation of phototherapy with a subthreshold bilirubin level exposes many infants to an unnecessary treatment modality which can prolong the infant’s length of stay in the hospital and can be associated with adverse effects, such as maternal-infant bonding and breastfeeding rates.

Methods: The …

Implementing A Brief Intervention For Smoking Cessation In An Inpatient Psychiatric Facility, Erika Gotway

Dissertations

Abstract

Problem: Smoking is a leading cause of various preventable diseases, and those who experience mental illness smoke cigarettes at a higher rate than the general population. Brief intervention is a type counseling that has proven successful in encouraging smokers to quit. The “5 A’s” is a type of brief intervention which stands for: Ask, Advise, Assess, Assist, Arrange. Addressing the smoking epidemic among individuals with mental illness is not only essential for improving their overall well-being, but also for reducing health disparities and enhancing the effectiveness of existing mental health interventions.

Methods: The approach to this project was a …

360 Degree Clinical Competence Evaluation For Pediatric Hospitalist Advance Practice Provders, Elizabeth A. Schickler

Dissertations

Problem: Advanced practice provider (APP) peer reviewed clinical competencies is an expected part of professional, organizational, and The Joint Commission (Joint Commission) requirements, however, is not well defined and subject to organizational application and interpretation. Providers favor peer review as a means to improve professional practice. There is a lack of data to support frequency of feedback and method of feedback to support readiness to change practice and comfort giving and receiving feedback.

Methods: The quality improvement project utilized an analytical experimental design.

The Cardin Hospitalist Advanced Practice Provider - Readiness Assessment (CHAPP-RA) tool was implemented to a convenience sample …

Implementation Of The Process Improvement Toolkit For Hospital Acquired Pressure Injuries, Christina Bearden

Dissertations

Problem: Approximately 2.5 million people within the United States receiving inpatient medical care will develop a pressure injury each year (Padula & Demarmente, 2018). Pressure injuries (PI) are a multifactorial complication that can often be avoided with general prophylactic measures. Despite this, inpatient settings around the United States continue to see a rise in PIs.

Method: The quality improvement initiative utilized a descriptive, observational design. The turn team toolkit was implemented and monitored over a two-month period. Patient descriptors and quantitative data were collected through a retrospective chart review. The primary data collected was on pressure injury rates and staff …

Implementation Of Quantitative Blood Loss In Cesarean Section Births, Madeline Skelton

Dissertations

Problems: Postpartum hemorrhage is a major complication following birth. Although some bleeding is normal after birth, excess bleeding can lead to maternal morbidities including, but not limited to, blood transfusions, admission to the ICU, emergency hysterectomy, and potential death. Postpartum hemorrhage is responsible for approximately 11% of maternal deaths in the United States and is a leading cause of death occurring on the same day as delivery (ACOG, 2019). Lastly, 54-93% of deaths occurring from postpartum hemorrhage are preventable (ACOG, 2019).

Methods: Quantitative blood loss was initiated in a large, midwestern, suburban hospital to increase identification of postpartum hemorrhage, decrease …

Evaluation Of A Smoking Cessation Program In Primary Care, Yolanda Duncan-Watt

Dissertations

Abstract

Problem: The adult tobacco smoking rate exceeds 12.5%. The problem is the insufficient attention given to smoking cessation education in low socioeconomic status(SES) communities. There is a lack of access to and awareness of smoking cessation programs for low-income populations.

Methods: This quality improvement (QI) study will use a descriptive, observational approach. A retrospective medical record review will be conducted to determine the rate of individuals who got the smoking cessation intervention and the rate of those who successfully quit one month after the intervention. Data was collected throughout the spring of 2024, during primary care visits and phone …

Improving Nurse Response To Seizure Events In A Pediatric Epilepsy Monitoring Unit With Use Of A Standardized Process, Stacey Obst Paule

Dissertations

Problem: Nurses responding to seizure events in the pediatric epilepsy monitoring unit (EMU) should initiate a neurological exam in addition to managing seizure activity. When nurses respond to these events, however, there can be significant variability, which can result in diagnostic inaccuracy and adverse patient outcomes. The purpose of this project is to implement a nursing response checklist and neurological assessment guide to standardize the process of response to seizure events in the pediatric EMU.

Methods: This quality improvement (QI) project utilized a cohort study design. Standardized tools were placed in an accessible area outside patient rooms. Education was provided …

Implementation Of Skin-To-Skin Immediately Post C-Section: A Pilot Study, Miah Vernor

Dissertations

Skin-to-skin contact during the golden hour is a practice that has numerous health benefits following the delivery of a newborn. These benefits include a healthy transition to extrauterine state, initiation of breastfeeding, thermoregulation, and more. However, the mode of delivery affects how often this practice is done. Parents who deliver vaginally are routinely offered the opportunity to perform skin-to-skin immediately after delivery whereas birth parents who deliver by cesarean section are not always offered this same benefit due to various reasons. A quality improvement project was conducted on an 18-bed labor and delivery unit at a Midwest hospital. This project …

Implementation Of Skin-To-Skin Contact Immediately Post Cesarean Birth: A Quality Improvement Project, Sophia Cooke

Dissertations

Problem: Skin-to-skin contact implemented within the first hour of a newborn’s life improves health outcomes for both mother and infant. One of these health outcomes includes exclusive breastfeeding. The purpose of this quality improve project was to implement an infant securement device within the operating room after cesarean section births to decrease the time to initiate skin-to-skin contact and increase exclusive breastmilk feeding rates at discharge.

Methods: This study utilized a descriptive, observational design and was guided by the Plan-Do-Study-Act framework. A pre-test, post-test design was utilized to compared retrospective and prospective data. The retrospective data was collected to assess …

Developing Expertise And Multiculturally Informed Supervision Practices, Mary Martha Abernathy

Dissertations

The American Counseling Association (Media Kit, 2023) records state that 62% of their membership is made up of master’s level clinicians, with 18.92% holding a doctorate and another 5.07% enrolled in a doctoral program. Membership is largely skewed toward master’s level professionals and only 7.44% of ACA members report working in a counselor education setting (Media Kit, 2023). However, most research regarding supervision is based on supervisors practicing in an academic setting (Cook et al., 2018; Jones et al., 2019; Kemer et al., 2014; Kemer et al., 2017; Kemer, 2020). The objective of these studies is to understand how master’s …

Evaluation Of The Grief Of Mothers Affected By Perinatal And Traumatic Loss, Landry Crabtree

Dissertations

Problem: The experience of a perinatal loss can be traumatic for mothers, and complicated grief reactions are common for those who have experienced a perinatal loss. An increase in perinatal loss resources is needed in the United States. The purpose of this program evaluation was to assess outcomes of a pilot perinatal loss support program on the grief of women who have experienced a perinatal loss.

Methods: This project was an evaluation of a perinatal loss support program that employed evidence-based strategies in both individual and group therapy sessions. A retrospective design was used, and data on perinatal …

Implementation Of Intentional Hourly Rounding At Pediatric Hospital, Margaret Bernard

Dissertations

Problem: Intentional hourly rounding improves patient safety and can impact patient fall rates. At a pediatric hospital in suburban Missouri, the fall rate is 25%. This quality improvement project worked to implement a standardized intentional hourly rounding process at a pediatric hospital to bolster their fall prevention program.

Methods: This quality improvement project was conducted using a descriptive, observational design utilizing patient chart review and hospital quality department records. The setting was a 60-bed pediatric hospital in the Midwest with 2 inpatient units that specializes in chronic, complex care. The sample was a convenience sample of 92 male and female …

Implementation Of Postnatal Depression Screening: A Pilot Study, Mollie Gulino

Dissertations

Abstract

Background: Postpartum depression (PPD) is a prevalent problem among women during their childbearing years, affecting approximately 1 in 7 women. Alarmingly, about 50% of PPD cases go undiagnosed and untreated, contributing to poor maternal outcomes, including suicide, which is a leading cause of maternal mortality in the United States.

Issue: Despite its prevalence and severe consequences, PPD often goes unrecognized due to inconsistent screening practices. Current guidelines vary by organization and lack consistent, evidence-based criteria.

Objective: This pilot program aimed to implement universal PPD screening with a validated tool at the six-week postpartum follow-up visit. The goal was to …

Implementation Of The Edinburgh Postpartum Depression Screening Tool For Postpartum Depression In A Midwest Primary Care Clinic, Makenzie Garrison

Dissertations

Problem: Postpartum depression is a prevalent health concern in postpartum women. Screening practices to identify postpartum depression are inconsistent. The purpose of this quality initiative is to determine if the implementation of the Edinburgh Postpartum Depression Screening Tool (EPDS) to screen for postpartum depression in the primary care setting increases the detection of postpartum depression in postpartum women from delivery to one year postpartum.

Methods: This quality improvement project utilizes a descriptive, observational design. A retrospective medical record review was utilized as well as a 12-week data collection period. Retrospective medical record reviews were conducted to assess the rate of …

Implementation Of Quantitative Blood Loss Following Cesarean Section Birth, Layna Victoria Schultz

Dissertations

Problems: Postpartum hemorrhage (PPH) is a significant problem due to potential harm and is a main contributor to maternal morbidity (ACOG, 2019). According to ACOG, of maternal deaths in the United States, 11% are caused by PPH and 54-93% of the deaths related to PPH could be prevented (ACOG, 2019). When institutions adopt quantitative blood loss (QBL) protocols for improved accuracy in blood measurement, PPH can be identified sooner, allowing for earlier intervention. Inaccurate estimation of obstetric blood loss by health care providers is a primary cause of delayed staff response to PPH (ACOG, 2019).

Methods: This quality improvement (QI) …

Symptom Burden, Identity Balance, And Emotional Distress In Cancer Survivors, Lynne Bentley

Dissertations

Emotional distress suffuses the experience of cancer survivors and is associated with adverse outcomes. Emotional distress is a response to a circumstance, which threatens the stability of identity. Of the antecedents to emotional distress in cancer patients, symptom burden accounts for the greatest amount of variance. Qualitative studies in populations of cancer survivors have shown that identity affects the experience of emotional distress related to symptom burden. The purpose of this dissertation research was to measure the relationships among symptom burden, identity balance, and emotional distress by testing whether identity balance mediates the relationship between symptom burden and emotional distress …

Influence Of Social Capital On Community-Based Health Care Programs In Rural Paupa New Guinea: An Ethnographic Study, Carol J. Bett

Dissertations

This descriptive, ethnographic study explored the influence of cultural health beliefs and social capital on the adoption of community-based health care interventions by rural villages in Papua New Guinea. The development of local level resources that lead to improved health indices requires an awareness of both the cultural context and the relational components of social capital that link people within the community. Social capital has been defined as resources that are an inherent part of a social group and the elements of social organization such as trust, networks, and norms of reciprocity that facilitate mutual cooperation (Billings, 2000; Carpiano, 2006). …

Use Of Flipped Classroom Learning Activities In Nursing: A Basic Qualitative Study, Tamara J. Steele

Dissertations

This study aimed to explore the experiences of nurse educators using flipped classroom methods with learning activities proven to be successful in students' achievement of learning outcomes. Specifically, it aimed to identify the learning activities that nurse educators have found to be most successful in terms of student achievement of learning outcomes. An additional focus of the study was to identify the flipped classroom and learning activity evaluation methods used by nurse educators and examine how those evaluation results were used to further enhance future nursing courses. An important gap in the extant literature related to a lack of in-depth …

Disambiguation Of Aerococcus Urinae Species Diversity, Brian Ian Choi

Dissertations

Aerococcus urinae is an uncommon inhabitant of the human urogenital tract. The Gram-positive bacterium has been implicated in a wide range of urinary tract diseases that, if left untreated or undiagnosed, can progress to severe disease such as infective endocarditis. Comparative analysis of 115 A. urinae isolates from infection episodes of urinary tract infection, bacteremia, infective endocarditis, urgency urinary incontinence, stress urinary incontinence, interstitial cystitis / painful bladder syndrome, and asymptomatic individuals reveal substantial diversity with respect to predicted virulence factors, metabolism, and observed biofilm behavior. Through whole genome sequencing analysis, these strains can be reorganized into six new taxonomic …

A Novel Use Of Social Network Analysis And Routinely Collected Data To Uncover Care Coordination Processes For Patients With Heart Failure, Sijia Wei

Dissertations

Effective patient care transitions require consideration of the patient's social and clinical contexts, yet how these factors relate to the processes in care coordination remains poorly described. This dissertation aimed to describe provider networks and clinical care and social contexts involved during longitudinal care transitions across settings. The overall purpose of this dissertation is to uncover the longitudinal patterns of utilization and relational processes needed for effective care coordination in transitional care, so we can redesign interventions that focus on informational and relationship networks to improve interaction patterns and system performance for people living with heart failure (HF) as they …

Unveiling The Path To Lgbtq+ Inclusive And Culturally Competent Healthcare: A Multi-Dimensional Examination Of Trainings, Policies, And Perspectives, Hyunmin Yu

Dissertations

LGBTQ+ individuals encounter enduring discrimination and adverse healthcare encounters within the healthcare system, with profound implications for their health and wellbeing. Policymakers have advocated for the adoption of LGBTQ+ inclusive and culturally competent healthcare, including training for health professionals, to promote health equity among LGBTQ+ populations. However, implementation of these policies within healthcare systems varies, posing structural and individual-level barriers. In this dissertation, I employ an ecological model of LGBTQ+ health disparities and a conceptual model of determinants of health disparities in vulnerable populations within the healthcare system to examine the impact of structural inequities on the implementation of LGBTQ+ …

A Quantitative Content Analysis On Juvenile Crime Rates In Comparison To Student Outcome Data In A Saint Louis Metropolitan High School Setting, Arron Nakia Whitt Sr.

Dissertations

Mental health is one of the most polarizing topics of the 21st Century. Mental health affects those from all economic statuses, races, age ranges, and genders. Since mental health can affect the youth population, the researcher investigated two Saint Louis metropolitan school districts that were listed in provisional accreditation status with the Department of Elementary and Secondary Education (MoDESE).

The purpose of this research was to identify relationships between the graduation rates, dropout rates, and enrollment rates of high school students and compare these data to the crime statistics obtained from the Saint Louis metropolitan juvenile courts. The researcher gathered …

Exploring Student Veterans Barriers, Alexandra Brandriff

Dissertations

The student veteran population in higher education is a unique group of individuals with different skills and life experiences not typically found among traditional students. Through a comprehensive analysis of quantitative and qualitative data, this study explores the complex challenges that student veterans face in higher education. It aims to explore the challenges, barriers, and support programs experienced by student veterans throughout their higher education journey, as well as compare the graduation and retention rates of student veterans and traditional students.

The researcher first gathered and analyzed qualitative data from student veterans’ responses to a survey utilized to gain their …

An Exploration Of Literacy Instruction In Higher Education Programs In Missouri, Melinda Odom

Dissertations

Literacy supports all content areas and is crucial to the academic achievement of all students (Birdyshaw et al., 2017). The International Literacy Association (ILA, 2017) posits that teachers are the most crucial factor in content and pedagogical achievement. The ILA (2019) stresses that students have a right to a highly effective and knowledgeable educator who can provide evidence-based reading instruction. Research illustrates that students who do not learn to read by the third grade continue to struggle throughout school (Rickenbrode & Walsh, 2013). Rickenbrode and Walsh (2013) confirm that most of these students will remain poor readers and are more …