Digital Commons Network^™

Exploring Primary Care Providers’ Compassionate Care And Their Evidence-Based Practice With Death, Grief, And Loss: Patient Experience And Perspective, Kathryn Krzykala

Dissertations

Research on primary care providers’ (PCPs) education regarding Death, Grief, and Loss (DGL) remains limited. Specifically, data is lacking regarding patients' perceptions and opinions on what they need and expect from their PCPs regarding grief and loss. This exploratory mixed-method study comprised 146 participants who had experienced death and non-death loss. It examined participants' perceptions of 1) PCP compassion, 2) PCP utilization of evidence-based grief and loss practices, 3) their own level of comfort discussing DGL with their PCPs during medical visits, and 4) their personal grief and loss experiences. The findings revealed that PCPs' grief-informed evidence-based treatment, as reflected …

Migrant Domestic Workers As Disposable Kin In Global Capitalism's Care Economy, Miguel Ceron Becerra

Dissertations

This dissertation examines the economic, emotional, and relational harms suffered by migrant domestic workers under global capitalism. These harms are systemic, stemming from labor and migration regimes designed to sustain capital accumulation in the care economy. Affluent regions benefit from the labor of migrant domestic workers at the expense of damage to their fundamental relationships. The result is the erosion of workers' kinship ties, rendering them "disposable kin" in the eyes of those who profit economically and emotionally from their work. The study is organized into four chapters. The first explores how global care chains are structured through labor and …

Exploring Detached Concern, A Dual-Process Emotional-Regulation Strategy, Among Intensive Care Nurses Providing End-Of-Life Care In The United States, Melissa Milton Miasek

Dissertations

Intensive care unit (ICU) nurses repeatedly provide end-of-life care (EoLC) and experience significant emotional distress, burnout, and moral distress that can lead to leaving the profession. Detached concern (DC), a dual-process emotional-regulation strategy which balances empathetic concern with emotional detachment, may support ICU nurses' emotional well-being; however, DC among nurses remains vastly understudied. This qualitative descriptive study gained deeper understanding of DC among ICU nurses providing EoLC in the United States. The study was guided by a conceptual model adapting Lampert and Glaser's dynamic DC process within Elfenbein's emotional regulation framework. The overarching research question explored ICU nurses' perspectives on …

Palliative Care Beyond Cancer: The Use Of The P-Cares Tool, Breslin E. Meyer

Dissertations

Emergency Departments (EDs) often lack the necessary resources and protocols to provide comprehensive palliative care, resulting in inadequate pain and symptom management (Stoltenberg et al., 2022). This study investigates the potential transformative impact of a palliative care consultation on patients with advanced disease who screen positive using the validated P-CaRES tool. The PICOT questions: Will patients with end-stage COPD, CHF, and or other chronic conditions benefit from P-CaRES screening in the emergency department over nine weeks and receive more palliative care consultations from their primary care providers?

This project was conducted over 9 weeks, utilizing convenience sampling to select 20 …

Remote Home Blood Pressure Monitoring For Management Of Hypertension, Kathleen M. Oliphant

Dissertations

Remote home blood pressure (BP) monitoring has the potential to improve patient engagement and adherence with the prescribed treatment plan for managing hypertension. This DNP project examined the effects of daily remote BP measurement using transmission of biometric data through a Bluetooth-equipped device paired to participants' smartphones. The clinical management of a chronic condition such as hypertension is a long-term process, but the findings of this DNP project supported the empirical evidence showing that remote BP monitoring improves patient outcomes.

Creating A Positive Social-Emotional Learning Environment For Transgender Students: A Post-Pandemic Participatory Action Research, Mark Christopher Maranto

Dissertations

This qualitative research employing participatory action protocols (PAR) engages a limited number of gender minority adolescents (current transgender, nonbinary, and gender-fluid secondary students) and allied staff members at one large Midwestern public high school district. The principal purpose is to improve transgender secondary student schooling experiences. This study extends the current educational discourse on SEL (social-emotional learning) in post-pandemic high schools as far as the commitment to improving students' sense of belonging, growth mindset, resilience, and well-being should be a top priority for all educators. The primary researcher positions all participants as co-researchers to explore ways that could improve the …

Dying Young, Brianne L. Overton

Dissertations

Death, often perceived as a disruption to daily life, is an inevitable part of the human experience. While older adults may develop familiarity with mortality through the collective experience of personal and familial losses, young adults generally have limited exposure to death. Despite this, young adults, defined as individuals aged 20 to 34, represent approximately 20% of the U.S. population (U.S. Census Bureau, 2020), and the mortality rate within this age group has been rising over the past decade (Woolf & Schoomaker, 2019). Death among young adults is often overlooked in societal narratives and medical research, which primarily focus on …

Resiliency Training For Music Therapy Students During Fieldwork Experiences, Crystal Weaver

Dissertations

All music therapy undergraduate and equivalency students in the United States must complete 1,200 hours of fieldwork experience to obtain degree conferment from an accredited and approved higher education program (American Music Therapy Association, 2023b, p. 1). While engaging in fieldwork had several benefits for music therapy students, such as the opportunity to build practical experience and refine skills, the experience also involved several challenges (Forinash, 2019; Tien & Trang, 2020). A challenge not yet thoroughly examined by faculty and staff within higher education music therapy programs was student mental health. To date, researchers had not examined the prevalence of …

Assessing Best Practices Of Facilitation Of The Free Exercise Of Religion By Army Chaplains Utilizing The Success Case Method, Geoffrey N. Bailey Phd

Dissertations

This mixed-methods study examined how U.S. Army chaplains experience and facilitate the free exercise of religion. The research explored compelling narratives of best-case facilitation experiences, identified leadership qualities associated with successful religious support, and analyzed similarities and differences between best and worst-case scenarios. Using Brinkerhoff's Success Case Method, the study distributed a quantitative survey to 1,478 active-duty chaplains (achieving a 23% response rate) followed by twelve guided interviews with participants representing diverse ranks and faith traditions. The research revealed six major themes: significant gaps in education for pluralistic ministry, tension between personal religious convictions and professional duties, crucial impact of …

An Exploratory Study Of The Barriers Of Pediatric Palliative Care Programs And Their Relationships To Funding, Mary Maureen Kirkpatrick Mclaughlin

Dissertations

This study, a sequential mixed methods design, used quantitative techniques and a qualitative, phenomenological approach. The quantitative phase addressed the research question: Does the reimbursement of services for the delivery of pediatric palliative care differ between types of funding, and is funding related to directors' perceptions of obstacles to the delivery of care? The qualitative phase addressed the research question: What are the barriers that CHI PACC directors' experience in their roles and how do they overcome them?

Compassion Fatigue And Satisfaction Among Nurses At A State Psychiatric Hospital: An Opportunity To Educate, Santhi Avula

Dissertations

This Doctor of Nursing Practice (DNP) project aims to bring awareness to psychiatric nurses at NOPH about CF and burnout and educate them on ways to improve resiliency and compassion satisfaction as professional nurses.

PICOT: How do psychiatric nurses at NOPH (P) who are at increased risk for CF benefit from a webinar-based educational intervention (I) to identify and reduce symptoms of CF and improve compassion satisfaction (O) one month after intervention (T) compared to preintervention (C)?

Relationship Of Stress, Family, And Social Support, And Job Satisfaction To Burnout Among Family Nurse Practitioners Employed In Primary Care Clinics In Mississippi, Laura-Jean Scott Brooks

Dissertations

In the realm of healthcare, burnout is the invisible monster that has infiltrated every facet of the industry with grossly visible results. From provider turnover to patient errors, burnout has lifelong effects on the healthcare provider and patient care. This researcher seeks to study variables and the relationship to burnout among Family Nurse Practitioners who practice in primary care in Mississippi. The Review of the Literature demonstrated a lack of findings in burnout among family nurse practitioners. Most of the literature reviewed focused on burnout among registered nurses. The guiding hypothesis of the research study was that social and family …

A Randomized Controlled Trial Comparing A Companion Dog Walking Intervention To An Attention Control Education Intervention On The Psychological Health Of Adult Intensive Care Unit Survivors: The Pooch Study, Lindsey Nelson

Dissertations

Intensive care unit (ICU) survivors are at risk for persistent anxiety and depression after hospital discharge that contribute to the psychological component of post intensive care syndrome (PICS). Quality evidence supporting innovative home and community-based interventions that improve psychological health in ICU survivors is needed. The use of companion dogs to improve the health and wellbeing of ICU survivors is a novel strategy not previously explored in the ICU survivor population. The purpose of this randomized controlled trial (RCT) was to evaluate the feasibility and acceptability of a companion dog walking intervention compared to an attention control education intervention for …

Iranian-American Older Adults' Attitudes And Proactive Actions Toward Planning Ahead For End-Of-Life Care, Zahra Rahemi

Dissertations

Ethnically diverse older adults are the fastest growing population in the U.S. This population may experience transitional processes associated with immigration, acculturation, aging, and end of life (EOL). Advances in technology lead to increases in care options, which can cause uncertainty to make decisions for EOL. Unmade decisions about care prior to becoming unable to communicate are associated with burdens of lastminute decisions at EOL, unwanted intensive EOL treatments for people who may die naturally of old age, financial and emotional costs, and decreased quality of life. In the U.S., a multicultural country with a variety of care options, advance …

Conceptions Of Latinos And Latinas About The Grieving Process And Associate Concepts Of Dying, Death, Bereavement, And Loss: A Covid-19-Post-Pandemic Case Study, Rosario Garcia Ortiz

Dissertations

The purpose of this study was to recognize the grieving process and the related concepts of Latinos who lost a loved one to the COVID-19 pandemic. Death and dying have been studied in the United States, with limited studies focusing on the Latino culture. The COVID-19 pandemic was a devastating experience for the world and continues to be studied for understanding and lessons in the aftermath. This research included four participants from the Latino culture who lost a loved one during the COVID-19 pandemic. An inductive approach and data analysis were used to form theoretical constructs. Three main categories were …

Examining The Adjustment And Coping Trajectories In Healthy Siblings Of Children With Life-Threatening Conditions, Joanne Tay

Dissertations

Siblings of children with life-threatening conditions are often referred to as "forgotten" mourners as focus tends to be on the ill child and parents. With limited knowledge about siblings' experience, it is challenging to provide appropriate supports.

The purpose of this dissertation was to examine and expand current evidence about siblings' experiences to guide research and clinical practice.

Exploring Home Health Nurse Decision Making: Development And Implementation Of The Visit Plan, Elliane Irani

Dissertations

Demand for home health services is increasing due to the growing aging population, increasing rates of chronic conditions, and advances in health care that support the provision of many health-related services in patients' homes. Home health agencies must adapt care delivery procedures to meet the needs of diverse and complex patients in order to keep them in their homes for as long as possible. However, it is unknown how home health nurses decide on visit patterns and implement their visit plans within the dynamic and unpredictable home health setting. This qualitative descriptive study was guided by an adapted nurse decision-making …

Reclaiming Healing Spaces: A Phenomenological Study On The Transformative Power Of Outdoor Therapy From The Lived Experiences Of Black Clinicians Working With Black Clients, Lynn Murphy

Dissertations

This phenomenological study involved assessing the experiences of Black therapists who engaged Black clients in outdoor therapeutic contexts. The study was founded on the existing literature that shows the quality of the therapeutic relationship is pivotal for client retention and the Western standards that have historically favored treatment within indoor environments. To contextualize this research, a comprehensive literature review was commenced, covering topics such as the decolonization of therapy, the historical and present-day relationship between Blacks and the outdoors in the United States, sedentary lifestyles, the psychological benefits of time spent in nature, various types of outdoor therapy, and the …

Using The Home Health Oasis To Promote Advance Care Planning Among Community-Dwelling, Frail Older Adults, Suzanne S. Sullivan

Dissertations

Despite an aging population with increasing proportions of frailty and decline, the rates of documented Advance care plans (ACP), meant to align goals for care with the level of treatment at end-of-life (EOL), are low (~30-40%). Patients expect clinicians to raise the question about serious illness goals for care when the time is right, however, there are a number of barriers to the initiation of these difficult conversations including provider bias and uncertainty. A review of the literature indicates that there are few prognostic indices available for use to identify the right time to initiate EOL conversations based on risk …

Resilience And Associated Factors In Pediatric Nurses, Benjamin M. White

Dissertations

The purpose of this dissertation was to explore pediatric nurse resilience and the contextual factors surrounding it, and propose a heuristic framework of pediatric nurse resilience. A convergent mixed-methods approach to secondary analysis was utilized and the resulting findings informed the heuristic framework.

Project Poppseed: A Mixed-Methods Exploration Of Parents' Lived Experiences With Anencephaly, Shandeigh N. Berry

Dissertations

One in four women who experience perinatal loss develop intense grief. Adverse outcomes of intense grief include depression, anxiety, posttraumatic stress disorder, substance abuse, suicidal ideation, obesity, hypertension, and diabetes. Congenital anomalies such as anencephaly are the leading cause of perinatal mortality in the United States. The purpose of this study was to identify the impact of common experiential themes on perinatal grief intensity by exploring parents' lived experiences with a pregnancy complicated by anencephaly.

Faculty Attitudes Toward The Preparation Of Baccalaureate Nursing Students For Practice In Hospital And Non-Hospital Settings, Lisa Radley

Dissertations

The ongoing nursing shortage worsened in recent years following the COVID-19 pandemic, has resulted in increasing concerns about future deficits in the nursing workforce. Many nurses are approaching retirement age at a time when the overall demand for healthcare services is expected to increase. Changes in nursing education have been recommended to ensure that the next generation of nurses are willing and prepared to meet the needs of an ageing population. Nursing faculty will have important roles in the education and mentoring of students to prepare them to care for diverse populations in a variety of practice settings. Understanding faculty …

Exploring The Degrees Of Ableism Nursing Students With Disabilities Experience, Elizabeth Ruth Brox

Dissertations

The Centers for Disease Control and Prevention (2020) estimated about 24% of adults in the United States live with a disability. However, the literature suggested only 4.4% of healthcare workers reported having a disability in the United States. Stigmatization and ableism have likely led to nurses hiding their disabilities while practicing, creating less diversity and representation in practice. When healthcare workers have little resemblance to the population they serve, it can lead to distrust, uncaring behaviors, and feelings of exclusion. Increasing diversity and helping to recognize the value of disability in practice could begin in nursing school. This study aimed …

The Implementation Of A Care And Communication Bundle For End-Of-Life Patients, Brendalee Carty Obiorah

Dissertations

Research studies have noted an improvement in end-of-life (EOL) patient's quality of life (QOL) from hospice. However, little research has been conducted to explore how the involvement of hospice care affects those in an assisted living facility (ALF). The purpose of this quantitative, pre and post-test quasi experimental design DPI project was to see to what degree a relationship exists between the care and communication bundle (independent variable) implementation and QOL (dependent variable) for 20 EOL patients on hospice in an ALF in Central Georgia. Jean Watson theory of caring and the theoretical domains framework (TDF) guided this project. The …

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 …

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 …

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 …

Development And Evaluation Of A Nurse Practitioner Directed Early Palliative Care Initiative And Its Impact On Goal-Concordant Care At A Cancer Center, Ashley V. Weinmann

Dissertations

Seriously ill patients often experience discordant care. Delivering high-quality healthcare requires effective communication to support goal-concordant care.

Pancreatic cancer has a 5-year survival rate of 12% with a high symptom burden. Pancreatic cancer patients often have unmet needs that lead to increased psychological, spiritual, social, and physical needs. Early integration of palliative care can provide high-quality communication and goal-concordant care. A retrospective analysis of MDACC's pancreatic patients found that 34% were referred to palliative care.

Distance Caregiving A Parent With Advanced Cancer, Polly M. Mazenec

Dissertations

Distance caregiving, which is the experience of providing instrumental and/or emotional support to an ill loved one who lives a long distance from the caregiver, is a recent caregiving phenomenon. Although much is known about caregiving a family member with cancer, there has been almost no research describing the experience of caregiving from a distance and intervention studies are non-existent. The purpose of this study was to investigate the effect of distance on caregiver reaction (benefit and burden) and to explore predictors of caregiver psychological well-being (depression, anxiety, and distress) in distance caregivers of parents with advanced cancer. A conceptual …

Patient Safety Culture, Compassion Fatigue, Compassion Satisfaction: Impact On Nurse-Sensitive Patient Outcomes, Debbie Anglade

Dissertations

The Institute of Medicine (IOM) defines patient safety as "freedom from accidental injury and ensuring patient safety involves establishing operational systems and processes that minimize the possibility of errors and maximize the possibility of intercepting them when they occur". For over a decade healthcare organizations have placed a great deal of effort into establishing operational systems and processes to minimize errors and achieve a culture of safety in their organization. This effort to improve patient safety has been one of the most highly publicized and critical issues facing the healthcare industry. In 1999 the IOM report To Err Is Human …