Digital Commons Network^™

Critical Access Hospital Nurses' Qualitative Reports Of Major Obstacles In End-Of-Life Care, Con K. Newman

Theses and Dissertations

Background: Critical Care Nurses have previously noted obstacles in caring for dying patients. Obstacles noted by nurses working in more urban settings have been reported. What is not known is the obstacles to providing end-of-life (EOL) care as perceived by nurses working in Critical Access Hospitals (CAHs). Objective: To determine the stories/experiences related to obstacles in providing EOL care as reported by nurses working in CAHs. Methods: This was an exploratory, cross-sectional study. Previous quantitative data has been reported. Documentation of the qualitative stories/experiences of nurses working in CAHs related to obstacles to providing EOL care for dying patients and …

Healthy Aging Beyond Sex And Gender Binaries, Nicole M. Lampe

Theses and Dissertations

An estimated 2.7 million sexual and gender minority (SGM) adults 50+ reside in the United States (US) with this number projected to increase to more than 5 million by 2060 (Flatt et al. 2022; Fredriksen-Goldsen and Kim 2017). Medical research, education, and practice in the United States (US) often erase sex and gender variation, thus ignoring the experiences of older adults living beyond Western sex and gender binary systems (e.g., female/male and women/men), particularly transgender, non-binary, and/or intersex (TNBI) populations. Such erasure stems from TNBI older adult structural incompetency or the failure to understand how macro-level systems, institutions, and structures …

Bells Like Hooves, Elizabeth Mixter

Theses and Dissertations

BELLS LIKE HOOVES is an exploration of grief and love. This play wrestles with what it feels like when someone disappears, or “ghosts”, and the complexities of survivorship. The play delves into what it means to be the one who’s left behind, our need for stories, and the limits of language.

Workers Of Iniquity: Stories, Isaac Huckaby

Theses and Dissertations

In her essay, “The Grotesque in Southern Fiction,” Flannery O’Connor notes, “Whenever I’m asked why Southern writers particularly have a penchant for writing about freaks, I say it is because we are still able to recognize one” (44). In the introduction to this collection, I investigate the importance of the grotesque, gothic, and surreal elements that tend to make up the depictions of the South in the works of authors such as Flannery O’Connor and Brad Watson and several horror writers, such as Stephen King, Edgar Allan Poe, and H.P. Lovecraft, exploring how horror can be used to emphasize the …

I Still Love You, Despite Everything, Amy Bravo

Theses and Dissertations

My practice seeks to reconcile the family—be it a found, queer family, or blood relatives. Addressing ancestral conflict, the complications of US/Cuba relations and my physical and cultural distance from the island I hail from, my work offers another world for communing with those you cannot physically reach.

Older Adults Home-Based Care In Cairo: Asset Mapping Towards Community Development, Yomna El-Taweel

Theses and Dissertations

The health and economic consequences of the rapid growth of the older adults’ population above 60 have led to new and more flexible forms of care, including home-based care. In Cairo, Egypt, there seems to be a high demand and preference for home-based care services over other care services like nursing homes. From a policy makers’ perspective, older adults’ needs are sometimes approached in a deficit-oriented way. This might contribute to the disempowerment of older adults and make them feel like people with needs that can only be met by external support. This mixed-method study aimed to contribute to the …

Stasis, Eric Pahre

Theses and Dissertations

Stasis is a collection of three short stories and a long novella. These stories examine settings parallel to our own lived reality and history.

“Verdugris” follows an infestation of vermin in a 20th century setting linked to European colonialism. Power dynamics and attitudes towards cleanliness are contrasted with natural beauty, habitat loss, parasitism, and the ‘fixed’ nature of the colonial town.

“Alpentraum” describes two foreign hospice caretakers seeing to an old woman in her small home in the mountains. This short story investigates uncertainty and acceptance, as the caretakers must change their plans when the mountain is struck by a …

Seven:Twentyfour, Peytin Fitzgerald

Theses and Dissertations

In my practice I aim to create a holding space for personal and communal traumas to reside through writing and the visual. I have longed to create a space of vulnerability, intimacy, shame and growth for others to exist. The practice of this work for me is releasing trauma from the body in an act of liberation.

Factors Associated With New Hospital Nurses' Self-Efficacy In Providing Palliative End-Of-Life Care, Penny Marie Brriese

Theses and Dissertations

Introduction: Self-efficacy is defined as confidence in one’s competence; the ability to successfully accomplish tasks and achieve favorable outcomes (Bandura, 1997). Many nurses today say they feel their undergraduate education was inadequate for them to feel competent to provide palliative and EOL patient care. (Chiplaskey, 2016; Scherlin & Quinn, 2016; Zheng et al., 2018).). Inadequate EOL preparation also results in nurses experiencing distress, death anxiety, burnout, feeling overwhelmed and leaving practice within just a few years (Friedman et al., 2011; Gaw, 2012; Kovner et al., 2006; Parry, 2008; Silverstein, 2017, November 28; Suzuki et al., 2008; Wilson & Kirshbaum, 2013). …

Music Interventions In The Treatment Of Adolescent Trauma: A Systematic Review, Diana C. Hereld

Theses and Dissertations

As multidisciplinary research continues to uncover the promise of non-invasive interventions such as music in mental health treatment, clinicians, researchers, and music scholars alike have increasingly come together through the field of music psychology. As such, it is unsurprising that some of the most significant findings have come from cross-disciplinary studies in music and medicine. The juxtaposition of music and mental health creates a unique and substantial need for integration of literature across multiple disparate settings, including clinical psychology, education, neuroscience, music therapy, behavioral medicine, and psychiatry. Through methodological application of a textual narrative evidence synthesis, this review examines multiple …

Implementation Of Teach-Back For Discharge Teaching In A Critical Access Hospital: A Quality Improvement Project, Katie Beth Notch

Theses and Dissertations

A lack of comprehension of discharge instructions may cause high readmission and emergency room revisit rates for organizations. At the project site, there was no current evidence-based practice to ensure patient comprehension of discharge instructions. The purpose of this quantitative, quasi-experimental quality improvement project was to determine if the implementation of the Institute for Healthcare Improvement (IHI) Always Use Teach-Back Toolkit would impact emergency room revisit rates among adult medical-surgical patients in a critical access hospital in rural Minnesota over four weeks. Afaf Meleis’ transitions theory and the Iowa model for evidence-based practice were the scientific underpinnings of the project. …

Music As Complementary And Alternative Medicine (Cam) Therapy: An Exploratory Literature Review, Amy Arlene Clary

Theses and Dissertations

Complementary and Alternative Medicine (CAM) is a broad term for treatment plans outside of conventional therapy or conventional medicine.1 The National Center for Complementary and Integrative Health (NCCIH) divides CAM therapies into three categories “Natural Products,” “Mind and Body,” and “Other Complementary Health Approaches.” The NCCIH places music in the category “Mind and Body.” This exploratory literature review provides a comprehensive review of the various ways music is being studied for its psychological, sociological, and physiological benefits.

The purpose of this study was to create a comprehensive literature review of music as a CAM therapy. The study codifies a current …

“How Do I Make Them Understand And Then Why Would I? ” Exploring The Impact Of Disclosure And Support On Coping Perceptions Among Nurses With Their Families, Madeline Katherine Witt

Theses and Dissertations

Nurses play a central part of healthcare in modern Western medicine, often taking on various roles and acting as liaisons in a multitude of situations. Especially in regard to the most recent global health crisis, COVID-19, more attention has been paid to the ways in which nurses handle the stress of the job. With the establishment of Cutrona and Suhr’s (1994) five categories of social support and Lazarus and Folkman’s (1987) Transactional Model of Stress and Coping, research has been able to address the role of social support in the coping process; however, little attention has been paid to the …

Shaping A Queer South: The Evolution Of Activism From 1960-2000, A. Kamau Pope

Theses and Dissertations

Queer activism dismantles and challenges normativity in spaces that criminalize, oppress, and perpetuate violence towards queer folks. Using Cathy Cohen’s model of radical queer politics, this thesis examines the South as a place that has been shaped over time by queer activism. Beginning with 1960 and the founding of SNCC sets the tone of how the South is non-normative and queer in the context of the United States, yet still a perpetrator of white supremacy, sexism, and homophobia. With a sole focus on the region of the U.S. South, this paper diverges from the narrative of urban queer movements, and …

A Multilevel Mixed Methods Examination Of Treatment Nonadherence Among Rural Cancer Survivors, Bonny Morris

Theses and Dissertations

While mortality rates have been decreasing over the last 40 years, cancer remains a leading cause of death in the United States. Over 1.7 million people were diagnosed with cancer in 2019, and there were more than 600,000 cancer deaths. Of the 15 million cancer survivors in the US, nearly 3 million reside in rural areas and experience 3% higher cancer incidence and 10% higher cancer mortality compared to their nonrural counterparts. During 2006-2015, the annual age-adjusted mortality rates for all cancer sites combined decreased at a slower pace in rural areas versus nonrural areas (-1.0% vs -1.6% per year, …

Sleep-Related Problems, Sleep-Related Distress, And Sleep-Related Functional Status Among Adult Inpatients Receiving Palliative Care, Lisa C. Sievers

Theses and Dissertations

Palliative care patients may be at a higher risk for sleep-related problems and their negative effects compared to the general population, yet limited sleep research has been done with this population. The purpose of this dissertation was to determine prevalence rates for excessive sleepiness, insomnia, restless legs syndrome (RLS), and high risk for sleep apnea (HRSA); examine relationships between the aforementioned sleep-related problems, sleep-related distress (SD), and sleep-related functional status (SFS); and to determine which sleep-related problem measures along with age and gender predicted SD and SFS among a sample of adult palliative care inpatients. Secondary aims were to understand …

Bawdy Tales, Emily R. Collins

Theses and Dissertations

Hansu Siirala is a Finnish-Canadian craftsperson currently based in Vancouver, British Columbia, Canada. Twelve years ago at the age of fifty-five, she suffered two strokes, which paralyzed her left side and required her relocation to a long-term residential care facility. Via writings to her family, Hansu shares hilarious, bitingly sharp observations about life in the assisted care facility in Vancouver. Her stories chip away at social stigmas, make us laugh at ourselves, and celebrate life in unexpected ways. “Bawdy Tales” is a project that utilizes her writing as the foundation of a series of pieces hosted via a website, providing …

Evaluation Of The Matadoc And Comparison Of Auditory Musical, Non-Musical, And Live Music Therapy Stimuli To Increase Awareness And Sense Of Self In Patients With Moderate And Severe Dementia: An Exploratory Case Study, Nicolas A. Espinoza

Theses and Dissertations

Background: The severe stage of dementia (SSD) can cause the loss of self-awareness, affecting the proper assessment, treatment, and care. The Music Therapy Assessment Tool for Awareness of Disorders of Consciousness (MATADOC) is a validated and reliable tool to measure awareness in DOC populations and it might be able to track awareness levels in people with SSD. Also, there is a need to identify effective treatments with people with SSD since pharmacological treatments have shown limited and even negative results. Both live music therapy and music listening of recorded songs have evidence of positive effects.

Purpose: The purpose of this …

The Role Of Beta-Hydroxybutyrate In Altering Adipose Mitochondrial Bioenergetics, Chase Mitchell Walton

Theses and Dissertations

The rampant growth of obesity worldwide has stimulated explosive research into human metabolism. Metabolic rate has been shown to be altered by diets differing in macronutrient composition, with low-carbohydrate, ketogenic diets eliciting a significant increase over other interventions. The purpose of this study was to determine the effects of the ketone β-hydroxybutyrate (βHB) on mitochondrial respiration and coupling status in adipose tissue. To explore this, we employed three distinct systems, namely cell, rodent, and human models. In every model, βHB robustly increased mitochondrial respiration. Furthermore, in cultured adipocytes and rodent adipose, we quantified the expression of genes involved in mitochondrial …

Beneath The Dry Teeth Of Mountains, Susan Doherty Osteen

Theses and Dissertations

In certain pockets of rural America time functions in different measure. This collection of stories focuses on one such anomaly, the rural ranching community in northeastern New Mexico. In the shadow of ancient Volcanoes, the soil is thin, rocky, arid, but surprisingly fertile for native dry land grass. Elevation fluctuates from to 9,000 feet to less than 4000, depending on whether one is on top of a mountain or down in a canyon. It is a place where wealth is measured in cattle and land, where horses are a necessity and pressed Levis are considered Sunday dress. Life continues much …

Quality Of Life Of Children With Spinal Muscular Atrophy: Parents’ Perspectives In Light Of New Treatments, Analyssa R. Tallas

Theses and Dissertations

Purpose: To directly compare parents’ perspectives of the quality of life of their children with Spinal Muscular Atrophy (SMA) who received supportive care, nusinersen (Spinraza®), onasemnogene abeparvovec-xioi (Zolgensma®), or both nusinersen and onasemnogene abeparvovec-xioi. Methods: The parents of children with SMA were recruited to complete anonymous online surveys. All surveys included qualitative questions about quality of life. Surveys regarding children in the 1-12-month and 13-24-month age groups included the Pediatric Quality of Life Infant Scales assessment. Surveys regarding children in the 2-4-year age group included the Pediatric Quality of Life Inventory 4.0 Generic Core Scales and the Pediatric Quality of …

Treatment With Protease Inhibitor And Development Of Diabetes Among Medicare Beneficiaries With Human Immune Virus/Acquired Immune Deficiency Syndrome (Hiv/Aids), Eric Ejike Chinaeke

Theses and Dissertations

Background: The possibility of an association between the use of protease inhibitors (PI) by HIV/AIDS patients and the occurrence of T2DM mellitus (T2DM) is largely debated. Medicare recipients are disproportionally affected by T2DM. Unfortunately, evidence is unavailable from that particular segment of the population. Clinical management of HIV/AIDS is progressively expanding to include chronic/metabolic complications, which may pose a significant economic burden to both the patients and the Medicare system, which are disproportionally impacted. Objectives: The aims of this project were to (1) examine the association between the use of PIs and the odds of developing T2DM among Medicare beneficiaries …

Physician Behaviors, Nursing, And Other Obstacles In End-Of-Life Care: Additional Critical Care Nurse Perceptions, Elizabeth Elouise Willmore

Theses and Dissertations

Background: Critical Care Nurses (CCNs) frequently provide end of life (EOL) care in intensive care units (ICUs). Barriers to EOL care in ICUs exist and have been previously published, but qualitative reports from CCNs themselves remain scarce. Qualitative data exploring barriers faced during ICU EOL care may increase awareness of obstacles and help remove them. Objective: Excluding family experiences, what are the major themes recounted by CCNs when asked to share common obstacles experienced in providing ICU EOL care? Methods: Members of the American Association of Critical-Care Nurses were randomly surveyed and responses to a single qualitative question were used. …

An Evaluation Of The Advance Directives-Live Action Simulation Training (Ad-Last) Program, Alexandra Rosa Spinelli

Theses and Dissertations

Advance Care Planning (ACP) is a process that captures a patient’s wishes in the case of future circumstances in which they are unable to express them. Studies show that less than one third of the general population has completed some type of formal Advance Directive (AD). There are barriers to completing ADs, and these barriers operate on multiple levels, including, patient, provider and institutional. To improve providers’ capacity to help patients complete ACP, and overcome these barriers, a provider-focused intervention was conducted. The current study is an analysis of archival data collected from the Advance Directives-Live Action Simulation Training (AD-LAST) …

Taking The Water, Alison Ho

Theses and Dissertations

“The baby boomer generation is about to transform into the largest elderly population in human history, changing how everyone lives, large and small. All of this will directly affect recreation and leisure professionals especially in leisure programming” (Sperezza & Banerjee, 2010, p. 197). In 2012, there were 43.1 million people in the United States that were aged 65+ and it is predicted that by 2050, that number will rise to 83.7 million (Ortman, Velkoff, Hogan, 2014). Baby boomers are more physically active than previous generations and many will now live 20% - 25% of their lives in active retirement. There …

Anticholinergic Burden And Risk Of Cognitive Impairment In Older Adults, Syeda Hashimi

Theses and Dissertations

Studies reveal that 10-27% of older adults chronically use anticholinergic medications. Increased cumulative anticholinergic burden scores are associated with increased risks of dementia. The mechanisms by which anticholinergic drugs negatively impact cognition remain elusive. However, researchers speculate that the drug’s impairment of cholinergic neurons promotes neuroinflammation.

We hypothesize that drugs with anticholinergic properties will induce inflammation in the brain. MCP1 and IL 6 are chemokines that contribute to neuroinflammation. We investigated the influence of diphenhydramine (Benadryl) on the production of MCP1 and IL-6 in Normal Human Astrocytes and Paroxetine on the production of MCP1 in Normal Human Astrocytes and Normal …

Is Direct Transport To A Level I Trauma Center Associated With Better Outcomes In Patients With Traumatic Brain Injury Compared To Patients That Are Transferred To Trauma Level I From Other Hospitals, Narad Mishra

Theses and Dissertations

Transferring patients with traumatic brain injury (TBI) to trauma level I hospital from other lower level hospitals has been shown to increase the mortality compared to when patients are directly transported to trauma centers. Despite the results from studies and the field triage recommendation of transporting the TBI patients to trauma center, nearly half of the TBI cases are transported to other hospitals before transferring to the trauma center. A retrospective analysis of patients with TBI in the state of Virginia was carried out to access if direct transport of patients with TBI to trauma center improves the outcome compare …

The Impact Of Occupational Therapy Acute Care Services On Readmission Rates For Patients In Medicare’S Hospital Readmission Reduction Program, Jessica M. Edelstein

Theses and Dissertations

The United States (US) health care system is faced with the daunting challenge to make healthcare payments commensurate with quality of care provided. To assess quality, metrics for reimbursement have been established by Medicare. One such quality metric is hospital readmissions (readmissions). Readmissions are associated with poor patient outcomes and costly. Associated poor patient outcomes include higher risk for mortality, deconditioning, nutritional issues and cognitive impairments. As a result, readmissions cost Medicare $26 billion annually. Current strategies for reducing readmissions in the US are fragmented and hospital-specific. While specific strategies may vary, hospitals that have low readmissions rates tend to …

An Online Mindfulness Training For Improved Eudaimonic Well-Being And Sleep Outcomes In Caregivers: A Preliminary Study, Tarah L. Raldiris

Theses and Dissertations

As the United States population continues to age, the number of older adults with dementia is projected to rise. Much of the care for those with dementia is provided by unpaid, informal caregivers who are typically family members. Unfortunately, these informal caregivers express significantly higher levels of negative psychological and physical health outcomes compared to non-caregivers. One potential pathway for improving caregiver outcomes may be through increased mindfulness. Using a two-week, online-based mindfulness training program and a structurally equivalent cognitive reappraisal training program, study aims were to: 1.) investigate the acceptability and feasibility of using an online intervention format for …

The Comparison Of Live Therapist Delivered Music To Original Artist Recording Interventions On Reminiscing Responses In Adults With Alzheimer's, Rajahna Desiree Schneekloth

Theses and Dissertations

Background: As the growing number of older adults diagnosed with Alzheimer’s disease is resort to living in residential care facilities, this population requires purposeful activities in which they can improve and maintain their quality of life. Studies have shown that music therapy positively influences older adults in typical settings such as hospice or other residential care facilities, by providing a source of investigation in to the reminiscing aspect of their memory.

Purpose: This study targets the qualitative and quantitative values of reminiscing responses by comparing the data received from a non-musical baseline response, an original artist recorded musical response, and …