Digital Commons Network^™

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) …

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+ …

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 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 …

The Effect Of A Contextualized Dosage Calculation Learning Intervention On Pre-Nursing Students' Math Self-Efficacy And Ability To Pass High Stakes Dosage Calculation Examination On First Attempt, Eileen V. Weatherby

Dissertations

Many students in pre-licensure nursing programs struggle with calculating accurate medication dosages even though they meet the numeracy requirements for application to the nursing programs. Most pre-licensure programs require that nursing students pass dosage calculation exams at a specified level of accuracy before progressing to the next term. Students typically have three tries to pass at the specified level and should they not succeed, they must withdraw. If they wish to continue in the program, they must complete the requirements for reentry which may include space availability restrictions. Factors influencing dosage calculation performance include fear of mathematics, low math self-efficacy, …

Emotional Intelligence And Critical Thinking In Practical Nursing Students: A Quantitative Study, Jennifer L. Knaack

Dissertations

The aim of this study was to understand if emotional intelligence was predictive of critical thinking in practical nursing students enrolled in a practical nursing program. The literature shows that nursing students' emotional intelligence and critical thinking directly affect student success; however, there is limited research focused on emotional intelligence and its predictability of critical thinking in practical nursing students enrolled in a practical nursing program. This quantitative, predictive study was designed to fill the gap in the literature on the relationship between emotional intelligence and critical thinking in nursing students enrolled in practical nursing programs.

Nursing Student Perceptions Of Presence In A Virtual Learning Environment: A Qualitative Description Study, Jason R. Thrift

Dissertations

Multifaceted approaches to learning are used for educating student nurses. One common teaching modality in nursing education, simulation, provides hands-on experiences in a safe environment to prepare student nurses for professional roles. High quality simulation standards recommend an engaging immersive experience, with physical, emotional, and conceptual fidelity to clinical practice. Presence is the perception of being there in a simulation as if it were real. Studies have reported improved learning outcomes with increased sense of presence. A simulation modality seldom used in nursing education is virtual reality simulation (VRSim) a three dimensional, immersive experience. VR-Sim with head mounted visual and …

National Identity Constructions In United States Foreign Policy Approaches To International Conflict, Frederick W. Tillman Ii

Dissertations

This study observes the role of national identity as a tool of the presidents of the United States in framing foreign policy approaches. Examining application for such phenomena reveals the puzzle of how strategic vs subjective decision-makers are when articulating policy addressing international conflicts. The interplay between the two aspects brings together the multiple traditions of national identity and the Wittkopf-Holsti-Rosenau approach model. Occurring over a longitudinal design, this study cuts across four administrations as they address events during the War in Afghanistan and the conflict regarding Taiwan. By coding and analyzing the statements from Presidents George W. Bush, Barack …

Factors Influencing Outcomes Of Undergraduate Nursing Student's Education, Patricia Jenkins Barnard

Dissertations

In 2021, approximately 509,000 undergraduate nursing students graduated from baccalaureate nursing educational programs. These new registered nurses (RNs) faced the same adversities as prior generations, including feeling unprepared to practice nursing, personal expectations did not match the reality of the situation, and working in an unwelcoming environment exacerbated by COVID-19 changes. During the time of COVID-19 changes in classroom delivery and settings brought these issues to the forefront (Dewart, 2020; IOM, 2010; NLN, 2015). There is a lack of information about nursing education modalities and their efficacy. Preliminary review documented that there was no clear evidence of which teaching modalities …

Evaluation Of A Clincally-Integrated Community Health Worker Program To Support Adults With Cardiovascular Conditions: Guided By The Prism Framework, Cynthia Orofo

Dissertations

Chronically ill individuals with cardiovascular diseases (CVDs) have been extensively challenged by the complexities of disease management. Cardiovascular disease remains the leading cause of death in the U.S. Although clinically integrated community health worker (cCHW) support interventions have been increasingly implemented to help manage CVDs, a comprehensive analysis of interventions implemented in real-world settings is lacking. The purpose of this study was to observe and evaluate a cCHW support intervention in a real clinical setting serving adults with CVD using an implementation science perspective, guided by the PRISM Framework.

Diagnosing Silent Forgiveness At The Dialogical Limit In Endō Shūsaku’S Novel Silence, Catherine Buescher

Dissertations

I situate this dissertation within the context of the rightly noted deficiencies of dialogue and dialogical hermeneutics, deficiencies that prevent dialogue from effectively addressing the pathological nature of many of today's social issues, e.g., white supremacy, sexual and gender inequality, and climate change. Using the lens and limits of Western dialogical hermeneutics as noted by David Tracy, I conduct a case study of the dialogues of the main characters - Rodrigues, Ferreira, Kichijiro, God—in Endō Shūsaku’s novel Silence, noting the silence active in each of the dialogues at the end of the novel. I then argue that the nature and …

“If They Can Help, They Will”: A Community Cultural Wealth Approach On Parent Support And Its Influence On The College Success Of First-Generation Latinas, Fabiola Rosiles

Dissertations

This study explores the parental support first-generation Latinas have received, and recognizes the skills, knowledge, and various forms of support that Latinx parents can and have provided their daughters when they seek a college education. Through a community cultural wealth framework, this study adds to the current literature on Latina and first-generation college students and specifically challenges the deficit approach that is often used when studying these student and parent populations. Furthermore, this study aids in better understanding the experiences of first-generation Latinas who receive parental support in ways that are outside of the traditional in-school presence and support. Through …

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 …

Jewish Laws For Gentiles: Purity In The Pseudo-Clementine Homilies, Joshua T. King

Dissertations

This dissertation is an analysis of the concept of purity in the Pseudo-Clementine Homilies. The argument proceeds in two parts. In the first, I argue that the Homilies’ presentation of purity reflects an ancient Jewish background. Thus, the Homilies, like other ancient Jews, divides its concept of purity in two domains: a domain related to the body (bodily purity) and a domain related to ethics (purity of the heart). I then track the differences between these two kinds of purity, noting particularly how they are defiled and how such defilements are removed. Thus, while bodily defilement comes from occasional bodily …

Factors Influencing Purpose In Life In Middle-Aged And Older Adults, Kelly Bergstrom

Dissertations

Purpose in life is an important dimension of psychological well-being with associated health benefits. The current study used a path analysis model to examine how perceived cognitive control, health locus of control- self, engagement in physical activity, and engagement in challenging cognitive activities relate to purpose in life longitudinally. Multimorbidity status was also examined as a potential moderator of paths in the model. Participants were middle-aged and older adults who participated in the Midlife in the United States (MIDUS) longitudinal national study (n = 2,481). After controlling for relevant covariates, engagement in physical activity, engagement in challenging cognitive activities, …

High Risk Medication Regimens And Medication Related Predictors Of Hospital Readmission In Elderly Home Care Patients, Mary T. Dierich

Dissertations

Adverse drug events are a primary cause of hospitalization in the elderly. Nearly 70% of the $177.4 billion dollars spent on drug related morbidity and mortality in the U.S. is due to hospitalizations. Polypharmacy, inappropriate medications or medication regimen complexity have all been implicated as precursors to adverse drug events and as indicators of high risk medication regimens. Understanding the relationship between medication regimens and readmission is important when evaluating potential errors in administration, risk-benefit ratios, and readmission risk. However, due to definitional and measurement issues, the high risk medication regimen remains an elusive concept. This study characterizes medication regimens, …