Digital Commons Network^™

Improving Maternal Outcomes Through Quantifying Blood Loss In Cesarean Sections, Michelle R. Barrier

Dissertations

Abstract

Problem: Postpartum hemorrhage is a preventable, leading cause of maternal death in the United States and is a direct result of a delay in diagnosis, intervention, and treatment of postpartum hemorrhage. Inaccurate measurement of blood loss from the use of estimation instead of quantitative techniques leads to a failure to recognize and respond appropriately. While there are risk factors for postpartum hemorrhage, all pregnant women are at risk.

Methods: This Quality Improvement (QI) project used a descriptive cohort study design, utilizing a retrospective chart review, to evaluate the quantification of blood loss during cesarean sections on maternal outcomes. Data …

Decreasing Central Venous Catheter Usage For The Hemodialysis Patient, Antionette Jordan

Dissertations

Abstract

Problem: The central venous catheter (CVC) usage rate in a large urban dialysis clinic was 34.5% and the Centers for Medicaid and Medicare Services (CMS) goal is 10.7%. CVC usage is a quality metric monitored by CMS to assess whether dialysis facilities are providing quality services which can impact reimbursement for the clinic. Failure to meet this metric can result in a penalty of up to 2% in reimbursement. The purpose of this quality improvement project was to determine if an interdisciplinary team (IDT) approach to vascular access planning and care influenced the CVC usage rate by 10% …

The Relationship Between Nursing Unit Culture And The Use Of Evidence-Based Practice Among Nurses In Hospitals, Jin Jun

Dissertations

Evidence-based practice (EBP) has been the gold standard for clinical practice. However, the use of EBP by healthcare providers, including nurses, has remained at suboptimal rates. Though researchers have examined various factors that influence nurses' use of EBP, studies of more complex organizational factors are limited. Nursing unit culture, which encompasses unique shared values, beliefs, and assumptions, may be one of the driving forces in determining nurses' behavior, leading to variation in the use of EBP. The purpose of this study was to examine the association between nursing unit culture and the use of EBP among nurses in hospitals under …

From The Battlefield To The Classroom: An Exploration Of Post-9/11 Female Combat Veterans Who Completed Graduate School After Military Service, Arthur Littler Iii

Dissertations

Since 2011, approximately 200,000 service members transitioned from military service to the civilian sector each year (U.S. Department of Veterans Affairs, 2016). , 2014). According to the U.S. Bureau of Labor Statistics’ 2018 Employment Situation of Veterans Summary report, 8.9% of veterans were disadvantaged as they have little to no higher education. Without a financial support system to fall back on, transitioning veterans face the inevitable issue of homelessness. Research by Tsai, Hoff, and Harpaz- Rotem (2017) found the rate of homelessness among veterans has increased over the past decade with female veterans more likely than their male counterparts to …

An Examination Of Summer Melt For Trio Talent Search And Upward Bound Alumni, Jasmine D. Clay, Jasmine C. Lewis

Dissertations

College access programs provide middle and high school students with essential skills to prepare them for a successful transition to postsecondary education. TRIO Talent Search (TS) and Upward Bound (UB) are federally funded programs established to strengthen the likelihood that students from underserved groups will graduate high school and pursue higher education. Both programs offer support to low-income and first-generation students to ensure equitable access to higher education. While these programs offer a holistic approach to student development, including personal and professional support, some students from underserved groups experience challenges during the summer months that prevent them from enrolling in …

The Wheels On The Bus Go Round And Round: Rethinking The St. Louis Busing Program, Tango Walker, Ketosha Harris

Dissertations

This autoethnography shares our personal experiences and counter-narratives in the St. Louis busing program. Through our mission we expound on experiences and real-life situations as seen through our lens as a student and a mother in the St. Louis busing program. Critical race theory (CRT) was used as an essential framework allowing us to focus on the following four tenets: counter-stories, permanence of racism, whiteness as property, interest convergence. (Anderson, et al., 2017). Critical race theory (CRT) is the framework in social sciences that examines society and culture as it relates to categorization of race, law and power (Lynn & …

Perceived Learning Needs Of High School Teachers Regarding Suicide Prevention, Miranda L. Bevilacqua

Dissertations

Suicide is the second leading cause of death among youth in Canada. Though school-aged youth are surrounded by teachers, mentors, and school mental health nurses (SMHN), little is known about what teachers want to know regarding suicide and whether the teachers have the knowledge to recognize youth at risk. The purpose of this generic exploratory qualitative study, guided by the health belief model, was to explore the perceived learning needs of high school teachers in northwestern Ontario (NWO) regarding suicide prevention. The data collection process involved semistructured virtual interviews with 14 high school teachers in NWO recruited via social media. …

Predictors Of Early Rehospitalization Among African American And Caucasian Women Hospitalized With Heart Failure, Carolyn B. Sue-Ling

Dissertations

Heart Failure remains a complex clinical syndrome that affects all races and backgrounds. Periodically individuals with a heart failure diagnosis will require hospitalization during the course of the disease progression. Consequently, early and repeated rehospitalizations for acute exacerbations presents additional social and economic difficulties. Prior research demonstrated that elderly African-American and Caucasian women account for a large proportion of the population at risk for future heart failure hospitalizations along with readmissions within 60 days of discharge. Unfortunately, the literature remains unpredictable or largely non-existent regarding the unique associations between risk predictors for heart failure and early (31 to 60-day) heart …

Improving Postpartum Hypertension Discharge Education: A Pilot Project, Kathryn Barth

Dissertations

Problem: Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal morbidity, mortality, and postpartum readmission. Several evidence-based algorithms and protocols have been implemented in the inpatient setting to treat severe blood pressure and prevent complications. However, there remains an opportunity to improve the postpartum care transition and discharge education for patients with these conditions in an attempt to decrease 30-day postpartum hypertension readmissions.

Methods: This pilot project utilized a descriptive design and took place on a postpartum unit at a Midwest metropolitan high-risk obstetrical teaching hospital. Interventions included patient-specific discharge education, distribution of a home blood pressure …

Liquid Biopsies For Type 2 Diabetes Mellitus: Biomarkers For Disease Risk And Diagnosis, Stephanie Chidester

Dissertations

Background: Type 2 diabetes mellitus (T2DM) has reached epidemic proportions in the United States. There is a critical need for earlier and more effective screening and diagnostic tools. Innovative liquid biopsy technologies may play a key role in meeting this need. Liquid biopsies are a non-invasive, adjunctive tool for determining diagnosis, prognosis, and therapeutic response. This dissertation focuses on two potential applications of liquid biopsy technologies to T2DM: (1) epigenome-wide association studies to identify epigenetic markers of risk for T2DM, and (2) extracellular vesicle (EV)-based biomarker studies to identify and detect markers associated with T2DM development and progression. Dissertation studies: …

Heart Rate Variability Following Treatment For Ptsd: Testing The Polyvagal Theory, Brittany F. Goodman

Dissertations

Posttraumatic stress disorder (PTSD) has been linked to lower heart rate variability (HRV), including measures of vagal tone. Treatments targeting the autonomic nervous system (ANS) have demonstrated efficacy in improving vagal tone, but it is less clear whether similar effects can also be achieved with cognitive therapies. The polyvagal theory has suggested that symptoms of social dysfunction are linked to vagal tone through a phylogenetically organized response to stress. HRV was collected during rest, reactivity (exposure to personalized trauma scripts), and recovery using a scripted imagery paradigm in female PTSD positive physical and sexual assault survivors (N = 41) …

Lived Experiences Of Nurse Leaders, Catherine J. Mohammed

Dissertations

The National Academy of Medicine (NAM) has called for more leadership, more accountability, and increased education and training of health care leaders. The NAM has demanded that nurses participate in health care policy making, increase their knowledge of research and data collection, advise leaders across the business world, train and educate seamlessly, and practice to the full extent of their licensure. The purpose of this qualitative phenomenological study was to explore the lived experiences of 12 influential nurse leaders from the state of Arizona. Transformational leadership theory provided the framework for the study. Semi-structured interview data were transcribed, coded, and …

Quality Improvement: Improving Type 2 Diabetes Self-Management And A1c Levels In Older Adult Veterans Using An Automated Message System, Danielle Brunson

Dissertations

Background: Diabetes mellitus is prevalent among the US population; particularly type 2 diabetes. As the population ages, the number of adults 65 years of age or older with diabetes is increasing. Diabetes is also common among U.S. veterans. Approximately 25% of U.S. Department of VA patients have diabetes. Evidence demonstrated a prevalence of diabetes among older veterans. Innovative approaches to improve diabetes care and health outcomes for veterans are needed.

Aim: This quality improvement (QI) project examined the use of a unidirectional automated text message system (Annie) to improve self-management behaviors of veterans with Type 2 diabetes, as evidenced by …

Adaptation To Chronic Pain: Religious And Non-Religious Coping In Judeo-Christian Elders, Karen S. Dunn

Dissertations

The purpose of this cross-sectional, correlational study was to examine the relationships between chronic pain, the use of religious and non-religious coping, and the health outcomes of functional ability, depression, and spiritual well being. Specifically, three research questions were addressed: (1) What are the relationships between background contextual factors, pain intensity, and the use of religious and nonreligious coping, (2) What is the relationship between pain intensity and the three health outcomes, and (3) Does the use of religious and nonreligious coping strategies mediate the relationship between pain and the three health outcomes? Structural equation modeling was used to test …

Breadwinner Mothers Of School-Aged Children During Covid-19: An Interpretative Phenomenological Analysis, Rebecca D. Miller

Dissertations

Working mothers have long faced myriad challenges to optimal work-life balance, with evidence of negative consequences to their physical and mental wellbeing. During the COVID-19 pandemic, working mothers reported unprecedented difficulties, though inquiry into breadwinner mothers’ experiences remained lacking. This research focused specifically on the experiences of breadwinner mothers of elementary school-aged children who navigated remote working and remote schooling during the COVID-19 pandemic. A diverse sample of 12 breadwinner mothers across the United States completed semi-structured interviews focusing on the impact of the pandemic on their daily lives, as well as how they understood their experiences in light of …

Which Attributes Separate Top-Performing Outside Salespeople From The Rest?, Paul Niemann

Dissertations

For decades, sales organizations have faced the ongoing challenge of attaining the maximum sales results from their salespeople. Whether a salesperson has plenty of skill but lacks the will to reach their potential or has the will to become a top salesperson but lacks the necessary skills to reach their potential, the failure of sales organizations to obtain maximum results from their salespeople is a problem. Some salespeople have plenty of skill but lack the will to reach their potential, while others have the will to become a top salesperson but have not yet acquired the necessary skills to reach …

Postpartum Patient Teaching Success: Implications From Nursing And Patient Perspectives, Dawn Day

Dissertations

A recent examination of postpartum patient satisfaction scores in an inner-city hospital revealed decreased satisfaction of discharge teaching practices. Guided by Knowles' model of andragogy and Donabedian's model of structure-process-outcome, the purpose of this study was to gain an understanding of how the structure and process of discharge teaching practices impact successful postpartum teaching. This mixed-method, concurrent study examined the structure, process, and outcome of postpartum patient discharge teaching practices. A convenience sample was used to obtain 138 patient surveys, observations of 15 nurses completing discharge teaching, and 15 face-to-face patient interviews. Data analysis included the use of Spearman's rho, …

Breastfeeding Intention And Initiation Among Rural, Low-Income Native Americans And African American Adolescent Mothers In North Carolina: Testing The Theory Of Planned Behavior, Cynthia H. Herndon

Dissertations

Infant feeding practices can greatly impact a child's life with far reaching implications based upon decisions a mother makes for her newborn. Breastfeeding is the preferred method of infant feeding because of its association with health benefits to both the mother and child. The prevalence of breastfeeding among rural, low income, disadvantaged groups to include Native American (NA) and African American (AA) adolescent mothers is low. NAs and AAs bear a disproportionate burden of illness and health risks compared to other races and ethnic groups in the United States. Breastfeeding is a targeted public health strategy to improve the health …

Responses To Exercise In Elderly Mexican Women, Bertha Cecilia Salazar-Gonzalez

Dissertations

The purpose of this study was to test the effects of an exercise intervention on flexibility, exercise self-efficacy, exercise readiness to change, and perceived flexibility of elderly Mexican women. The theory used Roy's conceptual model. The context of the intervention was explored by examining health status and role load. Attendance and exercise repetitions represented a measure of the intensity of the intervention.

The Effect Of Epidural Bupivacaine And Fentanyl On Infant Breastfeeding Behaviors Within The First Day Of Life, Sharon Gides Radzyminski

Dissertations

The research project is a comparison study of term newborn breastfeeding infants delivered vaginally to mothers who receive no pain medication and those receiving continuous infusions of bupivacaine and fentanyl given through an epidural catheter, for labor analgesia. The overall premise of the study is that in-utero fetal exposure to maternal epidural-administered narcotics affects central nervous system functioning in the newborn post-birth. Although the effects are subtle, they may be sufficient to disrupt behaviors necessary for the infant to establish effective breastfeeding in the first day post-birth.

It has been reported clinically that there is a higher incidence of breastfeeding …

The Emancipatory Praxis Of Integral Nursing: The Impact Of Human Caring Theory Guided Practice Upon Nursing Qua Nursing In An American Nurses Credentialing Center Magnet® Re-Designated Healthcare System, Lura Wendy Marks

Dissertations

This qualitative study critically examined nurses' perception of nursing qua nursing in an American Nurses Credentialing Center Magnet® re-designated healthcare system in Albany NY. Watson's Theory of Human Caring is used by many Magnet® hospitals, including the site for this study, to inform and guide nursing practice. Watson's Theory supports concepts and practices of integral health, holism, caring, healing, and the education and integration of complementary health care modalities as independent therapeutic nursing interventions. This study aimed to understand the nurse's emancipatory experience, comportment and self-agency as she/he participated in a theory guided practice; and illuminate the nurses' acquisition, understanding …

Student Attitudes Towards Graduation: A Comparison Of Motivation Factors For Greek Life And Non-Greek Life Undergraduate Students, Crystal Sanders

Dissertations

Greek life is an activity that is part of student involvement on a college or university campus. Student involvement allows students to increase their knowledge outside of the classroom through interaction with their peers and faculty, which will hopefully lead to graduation. The creation of Greek life engaged students in activities outside of the classroom. Unfortunately, Greek life has carried negative references and has been associated with morally wrong activities. Colleges and universities received negative impacts from such activities and behaviors. Most research about Greek life conveyed dedication to focusing on hazing, academics, and graduation rates. Revealing the motivational influences …

Perioperative Experience Of Adolescents, Janean Carter Monahan

Dissertations

Research has shown that preoperative stress is associated with poorer health outcomes in adults and young children, but there is little in the literature about the stress experienced by adolescents. Clinical experience, however, has shown that adolescents behave differently throughout the perioperative experience than either adults or children. For example, common behaviors of adolescent's emerging from anesthesia include combativeness, thrashing, and crying. To promote adolescent health and to provide adolescents with appropriate interventions that will support a positive surgical outcome, research is needed to discover the perceptions and meanings adolescents attribute to the perioperative experience.

The purpose of this hermeneutic …

Modifiable Cardiovascular Risk Factors In The Early Adolescent Period, Julia A. Greenawalt

Dissertations

The purpose of this study is to describe patterns and relationships among the modifiable cardiovascular risk factors of smoking behavior, overweight, physical inactivity and poor dietary behaviors within a ninth grade population. Four modifiable cardiovascular risk factors; smoking behavior, overweight, physical inactivity and poor dietary behavior were analyzed from the 2003 Youth Risk Behavior Surveillance System (YRBS) to explore associations in early adolescents, a critical developmental time frame. The specific aims of this study were to: 1) conduct a factor analysis of questions selected from the 2003 YRBS to represent the constructs of smoking behavior, physical inactivity and poor dietary …

Research And Relationship-Based Curriculum – Exploration Of How Research And Relationship Experiences In Undergraduate Education Impact Students’ Employability, Graduate Education Intention, And Entrepreneurial Acumen, Michelle Pipes

Dissertations

After decades of shrinking financial research support (Smith, 2004), continuously rising tuition and student debt (Beal et al., 2019), and the induction of numerous alternatives (Garrett, 2021), traditional higher education is struggling to provide the value that students are demanding (Woodall et al., 2014). Student engagement has been positively linked to increased retention (staying in school until completion of a degree) and reduced dropout (leaving school and not returning) rates (Finn & Rock, 1997; Reschly & Christenson, 2012), both of which contribute to how students perceive the value of higher education (Alves, 2011). The purpose of this study was to …

Minimizing Workplace Violence By Initiating An Evidence-Based Community Meeting, Olivia Gabrielle Foster

Dissertations

Problem: Workplace violence (WPV) in healthcare has become an epidemic demanding change. WPV is three to four times higher in the healthcare industry compared to other workplaces. For this project, WPV will be defined as any act of physical violence from a patient to a staff member. Community meetings are one evidence-based approach to decreasing WPV in psychiatric inpatient hospitals. Methods: This descriptive observational project compared data before and after implementing a targeted WPV community meeting, including unit rules, staff and patient expectations, a definition of WPV, and medication options available to reduce anxiety and irritability. This project …

Addressing Racial Trauma In Counseling: Perspectives And Lessons From The Field, Claire Martin

Dissertations

Racism has permeated all aspects of American life (Bell, 1992) and many Black communities suffer racial trauma as a result. Mental health professionals have an ethical responsibility to develop strategies to serve the needs of diverse communities. The purpose of this qualitative study was to explore the experiences of Black mental health professionals who serve individuals experiencing racial trauma. Using Critical Race Theory as a theoretical framework and qualitative Thematic Analysis as a methodology, twenty-three (23) Black mental health professionals were asked the following questions: (1) What are the experiences of Black mental health professionals working with clients who have …

Certified Clinical Nurse Leaders Not Hired Into The Formal Role: Job Title Survey And Systematic Review, Jacqueline Alexander Clavo-Hall

Dissertations

The purpose of this study is to answer the following questions: (1) To what extent do NHA CNLs report engaging in CNL competency-based activities in their current positions? (2) Does NHA CNLs' engagement in CNL competency-based activities vary by job titles? (3) What roles were certified CNLs enacting if they were not hired into officially titled CNL roles?

A Mixed Methods Study Of How High School Principals Build Trust With Staff Using Weisman’S Five Domains Of Trust Model, Danielle Clark

Dissertations

Purpose. The purpose of this mixed method case study was to identify and describe how high school principals establish trust with teachers using the five domains of connection, concern, candor, competence, and consistency (TVI, 2010). In addition, it was the purpose of this study to determine the high school principals’ perceived degree of importance of the five domains for building trust.

Methodology. This mixed methods research design used quantitative and qualitative data to analyze the research questions related to trust between high school principals and their staff. The study combined surveys and in-person interviews. The quantitative data were gathered via …

The Knowledge And Attitudes Of Oncology Nurses On Advance Directives, Bailey Nettles

Dissertations

Advances in healthcare technology has changed how healthcare professionals care for patients, increasing the importance of Advance Directives (ADs). ADs are legal documents describing patient end-of-life care wishes. Despite the usefulness of ADs, particularly in oncology settings, most patients do not have one.

This qualitative content analysis study examined knowledge and attitudes of ADs among oncology nurses to obtain a better understanding of ADs. Literature on ADs and nurses is dominated by quantitative research. This study addresses knowledge gaps best filled by qualitative methods.

Ten experienced oncology nurses answered eleven open-ended questions using online video conference interviews. The eleven questions …