Digital Commons Network^™

The Impact Of Hourly Safety Rounding On Pediatric Fall Rates, Natalie Doskal-Poe

Dissertations

The Impact of Hourly Safety Rounding on Pediatric Fall Rates

Abstract

Problem: Falls are a common adverse event in the inpatient pediatric setting and are a significant risk to patient safety. Environmental factors, such as unclear pathways, bed rails down, beds in high position, and call lights out of reach, are considered avoidable causes of patient falls. The site’s fall data in a 12-month period from January 2023 to January 2024 showed (n=9) patient falls occurred with (n=5, 55.6%) due to environmental factors. The purpose of this Quality Improvement (QI) pilot project was to assess the …

Patient-Generated Health-Data Information Needs In Pediatric Asthma, Victoria L. Tiase

Dissertations

Patient-generated health data (PGHD) are data collected by patients that can be used to screen for health problems or monitor progress toward health goals. These data may be especially useful for those with chronic health conditions such as pediatric asthma, as PGHD reflect the day-to-day status and home behaviors. Without access to PGHD within clinical workflows, clinicians working to personalize care and treat patients at an individual level may have an incomplete picture of those patients. A thorough understanding of information needs and display preferences is required to present PGHD in the clinical documentation without causing information overload. The aims …

The Influence Of Misconceptions On Pedagogical Choices Of Secondary Science Teachers: An Embedded Case Study, Tracey Beyer

Dissertations

This case study, using phenomenography within science disciplines, examines how educators' experiences with misconceptions affect teaching methods in high school physics, chemistry, and biology. Based on constructivist and interpretive theories it highlights that personal experiences shape learning and involve continuously reconstructing knowledge. The shared misconceptions of 13 educators across science disciplines reveal how those experiences influenced both their content knowledge and instructional practices. The findings indicate that educators who openly acknowledge and learn from their past experiences with misconceptions are better equipped to recognize and address gaps in understanding, an asset to furthering student learning. This research highlights the importance …

The Investigation Of Collaboration Among First-Year Bachelor Of Science Nursing Students, Christie Marie Cavallo

Dissertations

Despite the benefits of collaboration, first-year nursing students prefer not to work together. It was important to find out why nursing students do not want to collaborate. The purpose of this study was to discover first-year nursing students' and faculty's perceptions of how instructor-created opportunities for collaboration contributed to first year nursing students' collaboration. Using Wenger's communities of practice (CoPs) model as a lens, the data were explored using a qualitative explanatory case study approach. This study consisted of individual interviews of 12 first-year nursing students and nursing faculty. Inclusion criteria included students enrolled in or faculty teaching first year …

Department Of Defense Project Management Team Leaders: Team Dynamics And Teamwork Strategies During Complex Construction Projects, Shane Frey

Dissertations

Purpose: This qualitative multi-case study explored the challenges, strategies, and recommendations that DOD project management team leaders experienced as they made complex decisions leading successful construction projects based on Parker’s (2008) model.

Methodology: A qualitative multi-case study research design described the challenges, strategies, and recommendations Department of Defense project management team leaders used as they made complex decisions leading successful construction projects.

Findings: Close examination of data collected from interviews and artifacts yielded 117 frequencies for DOD project management team leader's team characteristics, and six themes regarding the lived experiences, challenges, strategies, and recommendations. Five key findings and one unexpected …

Describing Nursing Care Of Severely Obese Patients In Critical Access Hospitals Using Total Quality Management Theory: A Qualitative Study, Amy M. Blankenship

Dissertations

The purpose of this study was to explore nurses' perceptions and experiences regarding caring for severely obese patients and factors that affect quality care of these patients in Critical Access Hospitals (CAHS).

Improving Hypertension For Veterans Utilizing Measure Properly, Assessment Of Pharmacology, Alternative Therapy Interest, Routine Outreach, Partner With The Veteran Protocol (Maarp): A Pilot Study, Alyssa S. Dudley

Dissertations

The purpose of this quality improvement (QI) project was to create a hypertension control protocol for the patient aligned care teams (PACT) to follow when a Veteran presents to the primary care clinic (PCC) with uncontrolled hypertension. Despite past interventions, uncontrolled hypertension was still problematic in the Department of Veteran Affairs (VA) Healthcare System. Past and present research suggested that the Veteran population was at higher risk of developing hypertension than those of the civilian population. In hopes to reduce uncontrolled hypertension in the VA's PCCs, the Measure Properly, Assessment of Pharmacology, Alternative Medication Interests, Routine Outreach, and Partner with …

Implementation Of A Standardized Nursing Handoff In A Pediatric Intensive Care Unit, Tori Keeven

Dissertations

Handoff communication is critical in healthcare and is associated with patient safety outcomes. Various tools and interventions are available to improve handoff communication as inadequate communication contributes to medical errors, patient adverse events, and increased mortality. The implementation of a standardized handoff tool has been shown to be effective. Findings revealed a significant 60% reduction in reported patient harm events, despite the study's limited sample size and lack of statistical significance (p = .614). Challenges such as low utilization (18.62%) were attributed to concerns about tool organization, spatial constraints, and staff resistance to change. Recommendations include refining the tool to …

Improving Identification Of Complicated Alcohol Withdrawal Syndrome Using The Prediction Of Alcohol Withdrawal Severity Scale, Kristin Hagopian

Dissertations

Problem: Individuals who drink alcohol excessively are at great risk for alcohol withdrawal syndrome (AWS) when hospitalized. Symptoms and their severity differ for everyone, and research shows that the identification and treatment of AWS is challenging and often inadequate. Mild AWS is often overtreated, while moderate to severe AWS is often underdiagnosed and undertreated, placing individuals at risk for longer hospital stays, more time needed in critical care units, and a variety of unintended consequences.

Methods: This evidence-based practice project had a pre-post intervention design in which the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) was implemented to promptly identify …

Implementation Of Home Blood Pressure Monitoring, Sarah Gutzke

Dissertations

Approximately 48.1% of adults in the United States have high blood pressure. Providers may encourage patients to monitor and log their blood pressure at home. Still, patients often fail to bring this information to appointments, leading to reliance on less comprehensive in-office measurements. This quality improvement project aimed to increase adherence to home blood pressure logs using a Blood Pressure Toolkit. A descriptive, observational design was utilized to record patient adherence of taking home blood pressure measurements and increase the number of patients who brought their blood pressure logs to their healthcare provider visits over two months. A convenience sample …

Bridging The Gap: Psychopharmacologic Education And Side Effect Screening For Non-Prescribing Mental Health Professionals, Elaine Fitzgerald

Dissertations

Abstract

Problem: The United States is experiencing a growing demand for pediatric mental health support. Surges in mental health diagnoses and psychotropic medication prescriptions have occurred, compounded by a shortage of psychiatric providers. Non-prescribing mental health professionals are well-positioned to recognize psychotropic medication side effects. However, psychologists and counselors lack formal pharmacology education.

Methods: The quality improvement (QI) initiative was guided by the Plan-Do-Study-Act (PDSA) model. The evidence-based psychopharmacologic education for non-prescribers utilized a quasi-experimental pre- and post- test design. Data collected from clinicians included knowledge, confidence, and skill concerning psychotropic medications. The Psychotropic Medication Monitoring Checklist (PMMC) screen clients …

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 …

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. …

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 …

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 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 …

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 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 …

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). …

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+ …

What Are The Odds? Integrated Stem And Student Conceptual Understanding Of Genetics Dihybrid Inheritance, Jessica Cooper

Dissertations

Integrated Science Technology Engineering Math (STEM) education allows students to build conceptual understanding by connecting material to other content areas and real-world contexts. Strong conceptual understanding allows students to move beyond factual recall and instead synthesize and transfer their knowledge to new applications. In high school biology, students need to develop a strong conceptual understanding of genetic inheritance in the context of dihybrid inheritance. This qualitative case study was designed to understand the influence of an integrated STEM approach on student conceptual understanding of genetic dihybrid inheritance. The situated STEM learning and conceptual change theoretical frameworks guided the research design …

Poly(Thioether) Thermosets With Gated Photodegradation, Surabhi Jha

Dissertations

Photodegradable polymer networks are attractive due to the precise spatiotemporal control and large-area applicability of light. Chemical linkages that enable these polymer networks to be photo-responsive, also hinder their applicability in ambient light. Photostable and photodegradable networks have recently been reported to overcome this challenge by combining other stimuli with light for degradation. We report the design of a network that responds to a simultaneous, dual stimulus for photodegradation. We design poly(thioether acetal) networks with benzylidene acetal moieties that are known to undergo β-scission in the presence of free thiols. By blocking these free thiols with a thermally labile protecting …

Student Perceptions Of Integrated Stem Education In A High School Geometry Class, Alyssa Noland

Dissertations

Integrated Science Technology Engineering Mathematics (STEM) education provides students with opportunities to solve integrated real-world problems. Integrated STEM instruction aims to develop 21^st-century skills in students and promote interest in STEM subjects through authentic real-world tasks. Student perceptions can help educators and administrators to understand the benefits and constraints of integrated STEM instruction. This qualitative case study was designed to understand student perceptions of integrated STEM instruction and student perceptions of the value or applications of mathematics. The situated STEM learning and social constructivism theoretical frameworks guided the design of the lessons and methods of the study. High …

A Qualitative Study Exploring The Management & Implications Of Power Differentials Experienced By Pre-Licensed Supervisees In Clinical Supervision Settings, Joyti Jariwala

Dissertations

The focus in this qualitative study was to explore how power differentials in supervision create positive and negative experiences between licensed psychologists and pre-licensed doctoral students. The study results provide insight into how supervisees navigate these dynamics during supervision, which typically involves experiential learning environments in which trainees discuss progress, receive feedback, and enhance their skills. The theoretical framework grounding the study was social learning theory, which is based on the idea that individuals learn from modeling, observation, and imitation in a social context (Bandura, 1986). Reflexive thematic analysis was used to recognize similarities in findings gathered via two sets …

Implementation Of Tai Chi Fall Prevention Program In A Community-Based Setting, Shabnampreet Kaur

Dissertations

The increasing rate of falls among older adults is a health concern that may lead to injuries and reduced quality of life. At the project site there was no systematic process to impact fall rates, so an evidence-based solution was sought. The purpose of this quality improvement project was to determine if the translation of Li et al.'s research regarding the Tai Chi fall prevention program would impact the rate of falls among adults 65 years and older. The project was piloted over 12 weeks in a community-based setting in urban New York. Imogene King's goal attainment theory and Kurt …

Exploring External Engagement In Higher Education Through Defining Partnerships, Colleen Reaney

Dissertations

This research study has been designed to be an evergreen project to help higher education institutions define their external partnerships. The action research model has been used to create and test a model of external engagement, which was later redefined as the Reaney Model of External Engagement with the intent for continuous improvement. Further modification of this research study will need to be tested to strengthen the Reaney Model of External Engagement core while considering external factors that create challenges within the higher education space. Challenges that may arise to help higher education institutions clearly define external partnerships may include, …

Gender Diversity In U.S. Adolescents: An Exploration Of Multidimensional Survey Measures Of Gender And Their Associations With Health And Social Outcomes Using A National Sample Of Adolescent-Parent Dyads, Christopher Hansen

Dissertations

The measurement of gender is an evolving area of survey research. Extant research has assessed different approaches for measuring gender identity and expression among adults; however, comparatively less research has evaluated their use among adolescents who are developing their gender identity and expression. This dissertation uses data from a nationally representative survey of U.S. teens and their parents to evaluate multidimensional measures of gender in adolescents. Three research questions represent separate empirical chapters of the dissertation. The first research question examines the measurement of femininity and masculinity in adolescents based on a comparison of different survey scales. The second research …

Synthetic Assembly Of Antibacterial Agents And Metal Chelating Ligands, Zachary Joseph Liveris

Dissertations

The exploitation of chemical synthesis exemplifies the notion of bridging both innovation and curiosity for the strategic assembly of sophisticated molecular infrastructures. By exerting this continuously evolving and versatile tool, synthesis has been applied in the development and influence of a myriad of ligands, biological probes, and persists to direct pharmaceutical innovation and modern medicine alike. Since pathogenic multidrug-resistant (MDR) microbial strains remain to be a persistent threat to both clinical healthcare and society, the need to develop selective and efficacious antibacterial agents that can impede microbe pathogenicity and regulate cellular mortality is paramount. In contrast to pharmaceutical development, organic …