Digital Commons Network^™

Depression Screenings In Older Adult Primary Care Patients: A Pilot Study, Karissa A. Rodriguez

Dissertations

Depression is a profound problem among people of all ages, but it is especially prevalent in older adults aged 65 and older. Identification and diagnosis of depression are obtained through screenings.

This project aimed to increase the frequency of depression screenings at all primary care office visits and analyze the agreement between the depression screening tools, the Patient Health Questionnaire (PHQ-9) or the Geriatric Depression Scale (GDS-15), when assessing depression in older adult primary care patients ages 65 and older. Theoretical Framework: The Plan-Do-Study-Act (PDSA) cycle is a problem-solving model used to create change and adapt to a project's needs. …

The Development And Testing Of An Instrument To Measure Perceptions Of Body Art Among Nurse Educators And Nursing Students, Deana M. Nunes

Dissertations

Increasing diversity in the nursing workforce is a national priority to better care for a diverse patient population and minimize healthcare disparities. Nurse educators teach students to practice with compassion and respect, recognizing the dignity, worth, individual choice, and unique attributes of all patients. Perceptions of nursing professionalism are heavily influenced by appearance. Many nursing programs restrict visible body art in their dress code policies based on long-held notions and negative stereotypes of individuals with body art. Shouldn't nursing students who choose to have body art receive the same respect and lack of judgment? A better understanding of nurse educators' …

A Culturally Informed Mentorship Model For Historically Underrepresented Ethnic Minority Advanced Practice Registered Nursing Students, Lonnie P. Herring

Dissertations

Ethnic minority students pursuing advanced practice nursing degrees often face unique challenges that hinder their academic success and persistence, such as limited mentorship opportunities that address their cultural considerations. A lack of culturally informed mentorship (CIM) may contribute to feelings of isolation, lower self-efficacy, and reduced retention rates among ethnic minority advanced practice registered nursing (APRN) students. Through cultural competency, CIM programs are emerging as a promising approach to address these challenges and support the needs of historically underrepresented ethnic minority (HUEM) students. The underrepresentation of HUEM APRN students in graduate nursing education and advanced nursing practice is a persistent …

Power And Control In Medicine And Nursing - Could Intrinsic Gender Beliefs Impact Interprofessional Education In Pre-Professional Programs?, Catherine Christine Delant

Dissertations

Examination of the power dynamics at work in perpetuating health care hierarchy-related interprofessional collaboration barriers is needed to rationally develop strategies for teaching collaborative skills to health care providers. A mixed-methods study employing critical realist grounded theory examined the implicit beliefs, assumptions and power hierarchies related to gendered perceptions of the professions of nursing and medicine by students of those professions.

Organizational Control And Technological Capabilities: The Moderating Role Of Family Influence On The Firm, Sean Leahy

Dissertations

This dissertation examines the influence of organizational controls on technological capabilities in privately owned U.S. corporations, with a specific focus on family-owned businesses. The primary objective of the study was to investigate how formal controls (process and outcome) and clan controls (informal practices) impact technological innovation and competence. Using a quantitative approach, data were collected from 177 individuals and analyzed through partial least squares structural equation modeling (PLS-SEM) path analysis. The findings indicate a significant relationship between formal controls and technological capabilities. However, the interaction of family influence on this dynamic was not supported. Results also revealed a robust association …

How Does Vr Affect Motivation, Engagement, Performance And Student Interest In High School Science?, Ann Marie Carrier

Dissertations

This study investigates the impact of virtual reality (VR) on high school science students' motivation, engagement, performance, and interest in STEM disciplines. Building on Huang et al. (2021), this research replicates and extends their findings, focusing on how different levels of VR immersion influence learning outcomes. The study aligns with the Next Generation Science Standards (NGSS) and the Georgia Standards of Excellence (GSE). Utilizing a quasi-experimental design, 123 high school students experienced varying levels of immersive VR via the Titans of Space Plus app on Meta Quest 2 headsets and desktop computers. Study population included 55% males, 45% minorities, and …

The Lived Experience Of Registered Nurses And Registered Midwives In St. Kitts And Nevis, Raiden Gaul

Dissertations

At the beginning of the 20th century, St. Kitts and Nevis had one of the highest infant mortality rates in the Caribbean. However, unlike some Caribbean nations with similar historical and socioeconomic factors that continue to suffer from significant health disparities, St. Kitts and Nevis implemented strategic health reforms that have led to dramatic improvements in maternal and neonatal health outcomes. One of the strategic reforms designed to address these poor health outcomes was to mandate that all registered nurses in St. Kitts and Nevis pursue certification in the post-basic midwifery program. The purpose of this study was to examine …

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 …

Self-Harm In Female Youth With Undiagnosed Adhd: Implementing American Academy Of Pediatrics Screening Guidelines, Roselie M. Woodard

Dissertations

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. If undiagnosed or untreated, ADHD can lead to severe psychosocial issues such as academic failure, substance abuse, unplanned pregnancy, and incarceration. The financial burden in the U.S. from diagnostic errors creates an immense, rising fiscal impact. Early diagnosis and management are crucial to prevent these complications.

Females with ADHD, particularly those with the inattentive subtype, often face diagnostic challenges due to symptom masking and over-compensation. This results in poorer cognitive functioning and self-esteem compared to males with ADHD. ADHD is linked to autonomic nervous …

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 Impacts Of Authentic Learning On Student Outcomes, Evan Sheppard, Cameron Conner

Dissertations

This dissertation explores the evolving American education system, emphasizing the role of authentic learning in bridging the gap between schooling and employment, especially in the context of the modern post-pandemic student. Authentic learning, characterized by hands-on activities and real-world applications, is posited as a solution to the skilled labor shortage impacting the economy. This study delves into the history and current practices of authentic learning, examining various programs and strategies implemented in educational settings. Utilizing a phenomenological approach, qualitative data was collected through interviews with recent high school graduates to assess the impact of authentic learning on their post-secondary trajectories. …

A Mixed-Methods Study On The Implementation And Perceptions Of Grading For Equity Practices In A Sixth Grade Science Midwest Middle School, Lisa Meacham Stein

Dissertations

Equitable grading practices were a focal point in present-day educational discussions and gained increasing attention in recent years due to concerns regarding fairness, inclusivity, and student success. This research study examined the principles and implementation of equitable grading practices within a sixth-grade science classroom. The researcher synthesized existing literature, examined case studies, and considered the perceptions of students, teachers, and the researcher study in order to contribute to the ongoing discussion on creating more equitable grading systems.

Key areas of focus included the history and development of the education system, the purpose and significance of grades, the examination of traditional …

Identifying Delirium In Hospitalized Patients Using Nursing Delirium Screening Scale, Christina S. Arockiam

Dissertations

Delirium is a sudden brain dysfunction that can affect the mental status of hospitalized adult patients. At the project site, there was no consistent screening tool for delirium, so an evidence-based solution was sought. The purpose of this quality improvement project was to determine if the translation of Heinrich et al.'s research regarding Gaudreau et al.'s Nursing Delirium Screening Scale (Nu-DESC) would impact the identification of delirium and subsequent provider notification within 30 minutes among adult patients in an acute care hospital in urban California over eight weeks. Virginia Henderson's need theory and the Iowa Model Revised: Evidence-based practice to …

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 …

Interdisciplinary Medication Reconciliation Approach For Arabic-Speaking Patients, Rebecca Rodman

Dissertations

Abstract

Problem: Limited English Proficiency (LEP), which includes Arabic speakers, presents challenges in healthcare and can impact medication reconciliation and adherence. Interdisciplinary collaboration involving patients and interpreters is crucial for improving medication reconciliation and adherence. This project aimed to examine the impact of an interdisciplinary medication reconciliation approach on medication adherence with Arabic-speaking patients ages 18-99 over three months.

Methods: This quality improvement (QI) pilot project utilized a descriptive cohort design. A translated validated Morisky, Green, and Levine (MGL) adherence survey consisting of four questions was administered pre- and post-implementation to a convenience sample of Arabic-speaking patients 18 years …

Implementation Of Chlorhexidine Gluconate Dressings And The Effect On Bloodstream Infections In Extracorporeal Membrane Oxygenation Patients At A Pediatric Hospital, Kaitlin Vernier

Dissertations

Extracorporeal membrane oxygenation (ECMO) is an advanced lifesaving therapy used for patients with significant cardiorespiratory failure not responding to conventional therapies. The most common and life-threatening complications associated with ECMO are blood stream infections (BSIs). In addition to increased mortality, BSI's increase patient length of stay and cost. Chlorhexidine Gluconate (CHG) is known to be a significant factor in BSI reduction. The purpose of this quality improvement project is to assess the utilization of CHG-impregnated dressings on the incidence of BSI rates in pediatric ECMO patients. The setting was a 40-bed pediatric intensive care unit (PICU) and a 30-bed cardiac …

Wiping Out Central Line Associated-Bloodstream Infections: Cleaning High Touch Surfaces In The Picu, Emily Heth

Dissertations

Problem: Central line-associated bloodstream infections (CLABSIs) are a significant, preventable healthcare-related complication of hospital admission and medical management of critically ill and medically complex patients. CLABSIs result in significant adverse outcomes such as increased morbidity and mortality, prolonged length of stay (LOS) in the intensive care unit (ICU) and in the hospital, increased cost of treatment, and increased rates of readmission. Direct and indirect contact within the patient’s hospital environment are potential means of transmission for microorganisms, increasing the inherent risk of acquiring a CLABSI.

Method: For this quality improvement (QI) project, a pre-post design was utilized to evaluate the …

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 …

Improving Mental Health Outcomes For Amputees, Zachary Elmore

Dissertations

Problem: depression, anxiety, and other mental health disorders are more commonly diagnosed in the amputee population related to changes in mobility, activities of daily living, and quality of life (Turner et al., 2020.) As the amputation population is projected to reach over 3 million Americans in the next 25 years, additional screening is imperative to identify patients at high-risk for mental health deterioration (Ziegler-Graham et al., 2018).

Methods: this was a project that included screening all patients with the Personal Health Questionnaire for Depression (PHQ-8) meeting the inclusion criteria of being admitted to 7500 Vascular Surgery at Barnes-Jewish …

Restraint Reduction Using The Brøset Violence Checklist, Deanna Kappelmann

Dissertations

Abstract

Problem: Patient aggression, restraint usage and assaults against healthcare workers have numerous negative health outcomes. Patient aggression and restraint usage on inpatient psychiatric units can be identified early with imminent violence predicative tools such as the Brøset Violence Checklist (BVC), where patient de-escalation interventions can subsequently occur.

Methods: This quality improvement project was conducted using a cohort design with a retrospective and prospective chart review. The IHI PDSA model was used for this project. The BVC was administered to male and female patients ages 18 to 64 years old on the adult inpatient psychiatric unit during the implementation period. …

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 …