Effect Of The Diverse Standardized Patient Simulation (Dsps) Cultural Competence Education Strategy On Nursing Students' Transcultural Self-Efficacy Perceptions, Eda Ozkara San

Dissertations

Nursing students find it challenging to provide culture-specific care for patients representing diversity in ethnicity, race, language, socioeconomic status, religion, gender, sexual orientation, immigration history, and lifestyle and frequently lack confidence in their knowledge, skills, and abilities. Simulation has become a useful strategy for teaching nursing students assessment skills, technical skills, teamwork, delegation, self-efficacy, and professional communication. An alarming gap exists within the literature concerning innovative teaching and learning strategies that are carefully designed, implemented, and evaluated and follow a conceptual model, guidelines, and standards to enhance cultural competence development of diverse student groups, who must work with patients from …

Exploring The Development Process Of Undergraduate Nursing Students, Loretta J. Aller

Dissertations

Current healthcare trends such as greater technological advances, patients with higher acuity, and shorter employment orientation periods have impacted the work environment of newly graduated nurses entering the workforce. Evidence shows that these issues contribute to newly employed nurses leaving the workforce within 1-2 years of entering the profession (Cleary, Horsfall, Jackson, Muthulakshmi & Hunt, 2013; Flinkman & Salantera, 2015; Robert Wood Johnson, 2014; Tuckett, Winters-Chang, Bogossian & Wood, 2015). Current theoretical foundations for nursing education need updating within the context of a dynamic healthcare environment burdened by a nursing shortage that is already struggling to meet the demands of …

The Crisis Of Missouri’S Polity: How Privileged Interest Groups Influenced The Development Of Missouri’S 2014 Tax Reform Law, William Warren

Dissertations

Increasing wealth inequality has created a public discourse concerning its societal impact and the government’s role in its regulation. Should the government regulate and redistribute wealth through taxes and government programs, or should the market regulate it? To this end, one concern that has not been discussed is to what extent wealthy individuals have manipulated our government institutions to ensure their preference of market regulation of wealth distribution. Scholarly research has been conducted at the national level to determine the networks who are altering our political institutions to enable wealthy, minority interests’ access to our legislative process. Due to our …

Nicu Culture Of Care For Infants With Neonatal Abstinence Syndrome: A Focused Ethnography, Monica M. Nelson

Dissertations

The purpose of this ethnographic study was to describe the culture of care and nonpharmacological nursing interventions performed by NICU nurses for infants with NAS.

Maternal-Preterm Infant Interaction Subsequent To High-Risk Pregnancy, Beth P. Black

Dissertations

Maternal-preterm infant interactions affect cognitive and social development of the infant. Little research has focused on the unique contribution of maternal health to interactions. Using data from two NIH-funded longitudinal studies of preterm infants and mothers, this dissertation examined the effects of three high-risk maternal health conditions--chronic illness predating pregnancy, a history of infertility or reproductive loss, and pregnancy-related illness--on interactions. Three separate papers comprised the dissertation. Data between the two NIH-funded studies were analyzed separately as replications within each paper.

Evaluation Of The Efficacy Of A Telehealth Support Forum For Reducing Distress In Informal Caregivers Of Patients With Glioblastoma, Stacey D. Green

Dissertations

Glioblastoma is incurable, deadly, and disabling. Informal caregivers of glioblastoma patients face an unpredictable, laborious, costly, and distressing experience. Supported caregivers have less distress and improved caregiver mastery. Often times, caregivers are unable to attend support groups, increasing risk of adverse events for caregiver and patient. This increased risk highlights a need for increased access to support. The purpose of this project was to determine if distressed caregivers of glioblastoma patients at an academic medical center would report reduced distress after participating in telehealth support forums over a period of four weeks. The health belief model was used to implement …

The Lived Experiences Of Expert Nurse Clinicians Transition To Novice Nurse Educators: A Phenomenological Study, Sabrina L. Colbert

Dissertations

The literature is replete with information regarding the nationwide shortage of nursing faculty occurring in academia and practice. Due to the lack of available nursing faculty, masters-prepared nurses are being recruited into academia from clinical practice: expert clinicians with limited preparation in educational pedagogy. This descriptive phenomenological study explored the lived experiences of participants who transitioned from expert nurse clinicians to novice nurse educators in academia. The theoretical framework was Benner's novice to expert theory to explain and interpret the phenomenon as consciously experienced by novice nurse educators.

Positive Emotions And Sexual Desire Among Healthy Women, Elizabeth J. Brough

Dissertations

Sexual desire disorders are highly prevalent, account for a significant proportion of sexual problems, and affect important aspects of women's lives. Sexuality research has traditionally focused on dysfunction models, rather than human strengths approaches. Recently, positive psychologists have developed models and methods to examine human strengths. This study used Frederickson's Broaden and Build model to examine links between positive emotions and sexual desire among women. Positive emotions words were examined relative to sexual domains frequently cited in clinical studies, and compared to sexual cognitions which have been linked to positive sexual outcomes in past studies.

Standardized Reporting For Hospice Admissions, Courtney Davenport

Dissertations

­­Background: Effective communication should include the use of a standardized handoff reporting tool. Without the use of a standardized reporting tool in the hospice setting, there is the risk for a lack of communication between team members, which can lead to increased symptoms at end of life and less-than-optimal quality care.

Purpose: The purpose of this project is to implement a standardized handoff reporting tool, known as HAND-IT, to be used with hospice admissions. The primary outcome measure is to record the percentage use of the HAND-IT tool with admissions.

Methods: A quality improvement prospective design was used for this …

Breaking Cultural Stigma Associated With Mental Health Among Black Immigrants, Chika Ijioma

Dissertations

Abstract

Problem: Immigrants are the fastest growing segment of the United States population with 10% identifying as black and all are widely affected by mental illness especially, during the immigration process. The lack of health insurance impacts access to health and mental health care. The study aims to decrease perceptions of mental health stigma and improve knowledge with relation to mental illness in the black immigrant population after an educational program.

Methods: The project used a descriptive, observational pre-post-test design with an educational program. It collected quantitative data in the pre-post-survey via paper and pencil, using coded data …

Daily Sbar Sheet For Pediatric Patients With Central Lines, Jordan M. Enzwiler

Dissertations

Problem: The patient’s daily central line Theraworx baths were not being documented and completed at a mid-Missouri teaching hospital. After completing a retrospective chart review for 2022, 8.35% (n=90) of daily central line Theraworx baths were documented. Daily central line baths decrease central line-associated bloodstream infections (CLABSI), prolonged hospital stays, and costs.

Methods: The quality improvement (QI) project utilized a pilot retrospective and prospective pre-post-design. A retrospective chart review on daily central line Theraworx baths was conducted on patients two years and older within the pediatric service line who had a central line. A situation, background, assessment, and recommendation (SBAR) …

Vaccine Hesitancy, Provider Time, And Decision To Vaccinate, Kenneth Shackelford

Dissertations

Problem: To date, there is a significant gap in the literature involving studies evaluating the time healthcare providers spend educating vaccine-hesitant caregivers about the necessity for their child’s immunizations. Due to alarming resurgence rates of vaccine-preventable diseases in children, this project aimed to answer the following question: In vaccine-hesitant caregivers of newborns through six months of age, what is the effect of provider discussion time on vaccine administration (item) at well-child visits during the child’s first six months of life?

Methods: Using a descriptive observation design, pre-collected data on provider discussion time and vaccine administration was evaluated retrospectively from …

Implementation Of A Vestibular Disorder Screening Tool In An Urgent Care, Kathleen A. Probst

Dissertations

Implementation of a Vestibular Disorder Screening Tool in an Urgent Care

Kathleen A. Probst

M.S.N., University of Missouri-Columbia, 2007

B.S.N., University of Missouri-Columbia, 2004

A Dissertation Submitted to The Graduate School at the University of Missouri-St. Louis in partial fulfillment of the requirements for the degree

Doctor of Nursing Practice

August 2023

Advisory Committee

Susan Dean-Baar, PhD, RN, CENP, FAAN

Chairperson

Jennifer Vines, DNP, MSN, RN

Troy Dinkel, MD

Copyright, Kathleen A. Probst, 2023

Abstract

Problem: Vestibular disorders disrupt everyday living and can cause reduced quality of life. Guidelines developed to screen for vestibular disorders are not efficient to use …

Evaluation Of Dirfloortime® On Mother’S Depression, Anxiety, And Stress, Hailey Vanderleest

Dissertations

This paper reports the results of a retrospective record review and qualitative questionnaires of mothers of children with neurocognitive disorders such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). The aim was to examine the relationship between DIRFloortime® use in children with ASD and ADHD and PHQ-8 scores for depression, GAD-7 scores for anxiety, and PSS-10 scores for perceived stress among the children’s mothers. The results showed no statistical significance between DIRFloortime® use in children and PHQ-8, GAD-7, and PSS-10 scores for mothers. Qualitative questionnaires did report improvements in quality of life. Implications for the need of evidence-based developmental …

Intimate Partner Violence Screening In The Emergency Department, Rebecca Stuerman

Dissertations

Problem: Intimate partner violence [IPV] is a public health concern that affects one in three women worldwide. IPV can be addressed through identification and early intervention with minimal risk to the patient. The emergency department is an important setting for screening given the frequency with which people who experience abuse may present with IPV-related injuries and other related concerns (depression, suicidality, etc.). Successfully implementing a validated tool for screening and providing early access to resources and referrals may help to mitigate the longterm negative impacts of IPV. The need for increased staff education was a major barrier to screening for …

Orthostatic Vital Signs In Bone Marrow Transplant Patients, Julianne Tomac

Dissertations

Abstract

Background: Orthostatic hypotension is a potentially serious risk factor that can cause falls in adults, especially those receiving a bone marrow transplant. The odds of falling increase if diagnosed with a hematological form of cancer while receiving treatment due to side effects of chemotherapy and medications.

Methods: This retrospective record review investigated the completion rate of orthostatic vital signs in bone marrow transplant patient’s days 10 to 17. The aim was to discover 2% of positive orthostatic cases in a 6-month period. The primary outcome measures included the number of orthostatic vital signs obtained and secondary outcome measures included …

The Experiences Of Black American Older Adults Managing Pain: A Nursing Ethnography, Sheria G. Robinson-Lane

Dissertations

Pain can negatively affect quality of life for Black elders. They are less likely to report pain concerns and have voiced pain needs adequately met. To better understand the pain management experiences and concerns of Black elders, an ethnographic study was completed within an urban, low-income, elder housing facility.

Predicting Outcomes In Early Treated Spinal Muscular Atrophy (Sma), Natalie Goedeker

Dissertations

Background:
Early treatment of infants with spinal muscular atrophy (SMA) improves outcomes. Newborn screening allows for early treatment of infants with SMA, even before signs of the disease are evident. In spite of early identification and treatment, newborn screen and prenatally-identified infants with SMA may still suffer effects of their disease. Approximately half of infants have significant gross motor developmental delays, while others meet developmental milestones on time. There is no current objective method to identify early-treated infants with SMA at risk for gross motor delays who might benefit from modifications to current treatment practices.
Objectives:
This multicenter project reports …

Implementing Trauma-Informed Care Curriculum In A Doctoral Nursing Program, Mary D. Brown

Dissertations

Purpose: Trauma is highly prevalent with 70% of individuals encountering at least one traumatic event during their lifetime and approximately 30% experiencing four or more events (Wheeler & Phillips, 2021). Despite the dramatic impact of trauma, there is minimal literature to assist nurses in caring for patients with a trauma history. The purpose of this project was to evaluate the implementation of a virtual, asynchronous trauma-informed care (TIC) educational program for Doctor of Nursing Practice (DNP) students at a midsized, Midwestern public university using knowledge, attitudes, and competency scores as outcome measures.

Methods: This program evaluation (PE) project was an …

Evaluation Of Simulation On Medication Errors In The Pediatric Intensive Care Unit, Carrie Clark

Dissertations

Problem: Medical errors are the third leading cause of death in the United States, the most common medical error being medication error. Pediatric patients are at an increased risk of medication error due to medication dosage calculation and the use of frequent high hazardous drugs.

Methods: The quality improvement (QI) project implemented the use of descriptive observational design using retro and prospective data. The data was collected over a 4-week and 4-week period by gathering data via safety and environmental management survey (SEMS).

Results: The data gathered consisted of an increase in medication errors of 150%. The data collected yielded …

Screening For Food Insecurity In A Suburban Pediatric Urgent Care, Rachel Foutz

Dissertations

Problem: Screening for Social Determinants of Health (SDOH), including food insecurity (FI) should be done on a regular basis at a child’s pediatrician. Many children in the state of Missouri do not have a pediatrician or do not regularly see their pediatrician and are therefore never being screened for FI.

Methods: This observational descriptive quality improvement (QI) project utilized a prospective observational analysis to implement a voluntary FI screening tool in a pediatric only urgent care. The project sampled pediatric patients aged two days to 21 years of life. All participants were given local resources after completing the screening. The …

Prediabetic Screening Tool In Primary Care, Ashley Koon

Dissertations

Prediabetic Screening Tool in Primary Care

Problem: Diabetes mellitus is a chronic health condition that affects millions of individuals each year. In addition, it is known as the seventh leading cause of death. While guidelines recommend using evidence-based screening tools, many primary care practices do not implement them. Therefore, potentially resulting in delayed identification and implementation of primary and secondary prevention strategies.

Methods: This quality improvement (QI) pilot project utilized a descriptive, observational study design. The American Diabetes Association Risk Tool (ADART) was administered to a convenience sample of patients aged 18 to 44 years old without a previous diagnosis …

Acute Agitation Intervention Tool For Reduction Of Polypharmacy, Brooks J. Propst

Dissertations

Introduction: Patients with behavioral health diagnoses are among the highest risk for
aggression. For pediatric patients with behavioral health needs, urgent treatment is
needed for aggressive behavior, due to the potential unwanted outcomes. The purpose of this Quality Improvement (QI) pilot project was to implement an Acute Agitation Intervention Tool that uses the Broset Violence Checklist (BVC) to guide
pharmacological intervention for mild and moderate to severe agitation in pediatric
patients with behavioral health needs ages 8 to 18 to decrease the number of medications that patients are getting per agitation event over a 12-week period.

Methods: This QI included …

Pediatric Streptococcal Pharyngitis Testing And Treatment Practices, Amanda Welch

Dissertations

Objective: The purpose of this pilot quality improvement study was to implement SmartPhrases and assess its impact on adherence to the Infectious Disease Society of America (IDSA) guideline for Group A Streptococcus (GAS) pharyngitis testing and treatment in pediatric patients ages 1-16 years old. The aim was to use SmartPhrases to improve adherence with the IDSA guideline by 30% for GAS pharyngitis swabbing and 10% for appropriate antibiotic prescribing in three months.

Methods: A retrospective data analysis approach was used, in reviewing SmartPhrases data from the electronic health records (EHR) in a metropolitan Urgent Care. This data were collected from …

Encouraging Human Papillomavirus Vaccine Uptake: A Healthcare Improvement Project, Lauren E. Woll

Dissertations

Abstract

Problem: Human papillomaviruses are the causative agents of >95% of cervical cancers, most oropharyngeal and anogenital cancers, yet the vaccination status of the population remains critically low despite Gardasil9 offering robust protection against HPV-related disease.

Methods: This quality improvement project utilized a descriptive, observational design to assess the effect of the HPV Encouragement Bundle, a two-step intervention to improve HPV vaccine uptake. Quantitative data was collected via retrospective chart review to assess the effect of the intervention on first-dose administration of Gardasil9 (series initiation), as well as overall Gardasil9 vaccine uptake.

Results: Following implementation, Gardasil9 first dose uptake increased …

Implementation Of An Educational Teach-Back Program For Patients With Hypertension, Lakesha Hill

Dissertations

Implementation of an Educational Teach-back Program for Patients with Hypertension

Abstract

Problem: To improve health literacy and provide adequate health care to patients and their family, clear and effective dialogue is essential. The teach-back method is a technique utilized to confirm a patient’s level of understanding of care instructions done by relaying patient directions, and then confirming the patient understands by asking the patient to reiterate those directions. The purpose of this quality improvement project was to assess the effectiveness of using the teach-back method by health care professionals with their patients who have a diagnosis of hypertension or high …

Implementation Of A Situation, Background, Assessment, Recommendation (Sbar) Patient Handoff Tool In The Electronic Medical Record (Emr), Kristen L. Chandler

Dissertations

Abstract

Purpose and Problem: Handoffs that are poorly conducted are implicated in 80% of preventable adverse events in healthcare facilities. Within a Pediatric Rehabilitation Facility in Maryland Heights, Missouri it was observed that nurse handoffs were not conducted and lacked the use of a standardized evidence-based tool, resulting in nurse dissatisfaction with the handoff process and miscommunication. Recognized by the World Health Organization, The Joint Commission, and Agency for Healthcare Research and Quality, the Situation, Background, Assessment, Recommendation (SBAR) evidence-based tool is effective in improving handoff communication, improving nurse satisfaction, reducing adverse events, and promoting patient safety. The purpose of …

Implementing Obesity Management Guidelines In Rural Primary Care, Taylor Bell

Dissertations

Abstract

Problem: In the United States, obesity is one of the leading causes of death among Americans and rates of obesity continue to rise. Geographic location significantly affects the number of obesity cases, with rural areas being affected more than other locations. Despite this, obesity continues to be undertreated by rural primary care providers.

Method: This quality improvement (QI) pilot project utilized a descriptive, observational design to evaluate the implementation of an evidence-based clinical practice guideline algorithm for obesity management in a rural primary care clinic. An algorithm was implemented on patients aged 18-60 years and with a BMI of …

Improving Postpartum Depression Screening Practices In The Postpartum Setting, Courtney Lynn Cole

Dissertations

Abstract

Problem: Postpartum Depression (PPD) is frequently undetected in women due to barriers that limit effective recognition and diagnosis. Depression screenings and treatment referrals improve outcomes in the immediate postpartum period. Follow-up methods for positive depression screens are often missed by postpartum care teams.

Methods: A descriptive, observational design was used for this quality improvement project. A formalized depression screening protocol was created to help guide nursing staff on a Postpartum Unit when detecting a positive depression screen. Convenience sampling was utilized and the sample included patients aged 18-45. Data collected throughout this quality improvement project included Edinburgh Postnatal Depression …

Implementation Of A Structured Discharge Checklist For Children Admitted To The Hospital With Acute Asthma, Nicholas Fleming

Dissertations

Abstract

Problem: The transition process from a hospital setting to home is critical for pediatric patients and their families. However, there is no standardized process to ensure asthma discharge orders and asthma action plans are printed at the time of discharge

Methods: This observational quality improvement project utilized a pre-and-postimplementation of the Kamishibai Card (K-Card) process for pediatric discharge checklist compliance in an inpatient pediatric general medicine unit. This project used a sample of all children aged 2 years to 21 years with an asthma diagnosis admitted to the inpatient general medicine pediatric unit. This project included an …