Digital Commons Network^™

Pediatric Icu Nurses' Suggestions Forimproving End-Of-Life Care, Jeremy Ratliff

Theses and Dissertations

Of the 34,000 children who die annually, over 28,000 are four years old or younger. Nurses working in pediatric intensive care units (PICU) provide end of life (EOL) care before, during, and after death of these children. The purpose of this study was to determine thesuggestions PICU nurses have for improving EOL care for dying pediatric patients and their families. A sample of 1047 PICU nurses, who were members of the American Association of Critical-Care Nurses (AACN), were sent a 70-item questionnaire. One open ended item asked nurses to offer a suggestion for improving EOL care for dying PICU patients. …

Job Satisfaction And Intent To Quit Outcomes Among Home Health Aides In Home Health Care Industry Of The United States: A Multilevel Study, Seokwon Yoon

Theses and Dissertations

Backgrounds: Home health aides’ job satisfaction and intent to quit have been attributed to organizational and community level factors. The objective is to determine the effects of individual-, organizational-, and community-level factors on job satisfaction or intent to quit among home health aides.

Methods: This research used data from two subsets of the 2007 National Home and Hospice Care Survey and the 2007 National Home Health Aides Survey, sampling six eligible workers across the agencies in the Unites States. As another data source, the present study uses Area Health Resource File. The author used hierarchical linear modeling technique for handling …

Transcriptional And Post-Transcriptional Regulation Of Nrf2 In The Heart By The Deubiquitinase Cyld, Bryan J. Mathis

Theses and Dissertations

The cylindromatosis (CYLD) is a K63-linked deubiquitinase (DUB) that has been linked to the regulation of multiple physiological or pathological processes, such as neural development, inflammation and fibrosis. However, a novel paradigm for CYLD has been recently postulated; namely that of CYLD as a mediator of cardiac disease. Nuclear factor, erythroid-2 related factor 2 (Nrf2), a master antioxidant transcription factor, has been shown to suppress cardiac pathological remodeling and dysfunction via downregulation of reactive oxygen species formation (ROS). It is normally regulated by Kelch-like ECH associated protein 1 (Keap1). However, the regulatory link between CYLD and Nrf2 in the diseased …

Multi-Symptom Management In Hospice Patients During End-Of-Life Transition, Ashley N. B. Sirianni

Theses and Dissertations

The purpose of this quality improvement project is to compare the provider’s perception following an educational model of using single symptom management versus multi-symptom management during the end-of-life transition in adult patients for improved quality of life outcomes. The appraised evidence indicates that it is critical to have anticipatory medications at the patient’s residence to manage multiple symptoms rather than focusing exclusively on a single symptom management such as pain management. In February 2016, the author conducted an educational model among hospice providers for increasing knowledge and awareness of multi-symptom management. Thirty (n = 30) Clinical Nursing Directors, Licensed Practical …

Critical Care Nurses' Perceptions Of End-Of-Life Care: Comparative 17-Year Data, Nicole Lamoreaux

Theses and Dissertations

BACKGROUND: Nurses working in intensive care units (ICUs) frequently care for patients and their families at the end-of-life (EOL). Providing high quality EOL care is important for both patients and families, yet ICU nurses face many obstacles that hinder EOL care. Researchers have identified various ICU nurse-perceived obstacles, but no studies have been found addressing the progress that has been made over the last 17 years.
OBJECTIVE: To determine the most common and current obstacles in EOL care as perceived by ICU nurses and then to evaluate whether or not meaningful changes have occurred since data were first gathered in …

Describing The End Of Life Knowledge, Beliefs, And Preferences Of Alaska Native And American Indian Peoples, Colleen Marie Kelley

Theses and Dissertations

This dissertation is comprised of three manuscripts that will be submitted for publication, describing the end of life knowledge, beliefs, and preferences of Alaska Native and American Indian Peoples. The first manuscript is a literature review that examines what is known about the understanding about the end of life knowledge, beliefs, and preferences of Alaska Native and American Indian Peoples. The second manuscript offers results of an exploratory descriptive study designed to describe the end of life knowledge of hospice care services, beliefs about dying, and preferences for end of life care of Alaska Native and American Indian Peoples. Finally, …

Provision Of Hospital-Based Palliative Care And The Impact On Organizational And Patient Outcomes, Marisa L. Roczen

Theses and Dissertations

Hospital-based palliative care services aim to streamline medical care for patients with chronic and potentially life-limiting illnesses by focusing on individual patient needs, efficient use of hospital resources, and providing guidance for patients, patients’ families and clinical providers toward making optimal decisions concerning a patient’s care. This study examined the nature of palliative care provision in U.S. hospitals and its impact on selected organizational and patient outcomes, including hospital costs, length of stay, in-hospital mortality, and transfer to hospice. Hospital costs and length of stay are viewed as important economic indicators. Specifically, lower hospital costs may increase a hospital’s profit …

Meaningfulness And Job Satisfaction For Health Care Technology Workers, Christine Valladolid

Theses and Dissertations

Health care technology workers play an increasingly important role in meeting regulatory requirements, improving patient care and containing health care costs. However, their perceptions of work and job satisfaction are lightly studied in comparison to other health care workers such as physicians or nurses. This exploratory study used heuristic inquiry to investigate the perceptions of health care technology workers with regard to their feelings of task significance, mission valence, work meaning, and job satisfaction. Nine research participants representing three not-for-profit, secular hospital systems which were selected to have variation in geographic scope and organization size were interviewed. All participants were …

Nest - Caring For The Caregiver, Ashley Whitehead

Theses and Dissertations

Today, more than ever, there exists an overlap between hospitality and healthcare industries; with the impact being felt in the way hospital interiors are designed. This influence impacts the patient’s experience but focuses very little on the experience of the caregiver. Caring for a sick child takes an emotional, mental, and physical toll on a family. It is especially challenging to care for a sick family member when away from the comfort and security of the family’s private home. This project explores that challenge through the interior design of a space that, for both patient and family, is restorative, healing, …

Accountability In Mixed-Generation Teams, Angela D. Martin

Theses and Dissertations

In 2014, more than 1.6 million patients received services across the U.S. from hospice care agencies. The teams within these agencies are supporting each other to play a vital role in assisting a person’s transition from this life to the next comfortably, as well as catering to the family. Hospice care companies are comprised of a variety of roles that are divided into teams. Staff members vary in age from 21 to 70 years, indicating the presence of mixed-generation teams. Generational diversity can create challenges in understanding different points of view, learning styles, and communication. Generational differences are one of …

Teachers' Of Students With Visual Impairments Perceptions And Experiences Of Teaching The Expanded Core Curriculum, Renae T. Bjorg

Theses and Dissertations

The purpose of the qualitative research study was to explore the perceptions and experiences of teachers of students with visual impairments (TSVIs) in the state of North Dakota regarding the expanded core curriculum (ECC). This study included transcribed interviews from six TSVIs who taught in grades K-12.

The National Agenda for the Education of Children and Youths with Visual Impairments, Including Those with Multiple Disabilities was used to frame this study. Phenomenological methods were used to analyze the interviews into codes, categories, themes, and an assertion. Following were the seven themes supported by the data collected:

1. Teachers of students …

Toward A Situational Technology Acceptance Model: Combining The Situational Theory Of Problem Solving And Technology Acceptance Model To Promote Mobile Donations For Nonprofit Organizations, Yue Zheng

Theses and Dissertations

Using a nationwide survey of 994 respondents in February 2016, this study combines the situational theory of problem solving and technology acceptance model to refine the conceptual understandings of people’s motivations to make a mobile donation benefiting health-related nonprofit organizations. Findings provide empirical support for the combined model and an emerging situational technology acceptance model. Mobile phone users’ intentions to make a mobile donation are mostly influenced by their attitudes toward using technology and subjective norms. Practical implications are also discussed for nonprofit practitioners to better segment publics, design strategic messages, and disseminate communication campaigns to improve future fundraising.

Healthcare Utilization And Expenditure Patterns Among Older Adults With Functional And Medical Decline, Ashley Shields Robertson

Theses and Dissertations

Purpose. As the aged population of this country grows, the U.S. healthcare system will face increased pressure to provide long-term care services and supports to increasing numbers of elderly Medicare beneficiaries. Studies have indicated that unmet long-term care need can lead to increased, unnecessary utilization of the healthcare system, thus further taxing the Medicare system. Little is known about how type of long-term care, as well as how long-term care policies—specifically payment policies—affect health care utilization. The objective of this original dissertation research was to examine the effects of place of residence (community versus residential long-term care facility) and …

Footprints In The Hallways: The Effects Of Mentoring On The Career Path Of Women Deans, Adrienne Marie Robinson

Theses and Dissertations

The study explores the career path of women deans in higher education. The mentoring of female senior level administrators in higher education regarding leadership opportunities is significant. The study’s purpose is to explore mentoring opportunities through definitions and various programs. The survey chosen was the Alleman Mentoring Activities Questionnaire (AMAQ). This questionnaire is pertinent because of its ability to measure mentoring processes and the impact it may have on mentoring relationships. To collect data, 155 women deans were distributed the survey and 76 were completed and returned. This study yielded a 49% response rate. The survey was distributed to women …

Attachment Style And Motivation To Volunteer Among Emerging Adult College Students, Jennifer R. Smith

Theses and Dissertations

Viewing motivation to volunteer through an attachment theory perspective may enhance understanding of volunteering motivations. A questionnaire was administered to (N=155) emerging adult college students using a Lykert-type scale (1 - 7) to assess attachment (Bartholomew & Horowitz, 1991) and motivation to volunteer (Omoto & Snyder, 1994). Five forward linear regression analyses were conducted to identify significant predictors of attachment style on motivation to volunteer. For each analysis, one of the five motivations to volunteer variables (values, understanding, esteem enhancement, personal development, community concern) was regressed on the combination of four attachment style variables (secure, avoidant, anxious ambivalent, dismissing avoidant). …

Rural Emergency Nurses' Suggestions For Improving End-Of-Life Care Obstacles, Kelly Elizabeth Smith

Theses and Dissertations

Introduction: In 2010, of the 129 million visits to the emergency department (ED), 240,000 resulted in the patient dying or being pronounced dead on arrival. This number is likely to continue to increase as a significant portion of the American population ages and seeks care in the ED. Though care in the ED is focused on saving lives, death cannot always be prevented. Consequently, nurses face many barriers to providing quality end-of-life (EOL) care in the ED when death occurs. The purpose of this study was to identify suggestions emergency nurses have to improve EOL care specifically in rural ED's. …

Nicu Nurses' Perceptions Of Obstacles And Supportive Behaviors In End-Of-Life Care, Ann Rogerson

Theses and Dissertations

Background: Losing an infant is difficult for parents to face. To improve EOL care for dying neonates and their families, NICU nurses need to overcome obstacles and implement supportive behaviors. Understanding the size of obstacles and supportive behaviors will better enable NICU nurses to provide quality EOL care. Objectives: To determine the largest obstacles and supportive behaviors in NICU EOL care. Methods: A descriptive quantitative study of a random national sample of 1058 NICU nurses who were members of NANN (National Association of Neonatal Nurses). The National Survey of NICU Nurses' Perceptions of End-of-Life Care questionnaire was mailed twice yielding …

Increasing Palliative Care Referrals In Terminal Lung Cancer Patients, John Edward Roll

Theses and Dissertations

Late referrals to palliative care services for patients suffering from terminal lung cancer is an ongoing problem that unnecessarily shortens patient survival time by inadequate and poorly timed symptom control that affects the remaining quality of life for both patient and family. The latest mortality figures available (2011) showed approximately 157,000 people died due to cancer of the lung, trachea, and bronchus (CDC, 2014a). The purpose of this independent study was to review and effectively analyze the literature and understand the reasons and barriers to early referral of palliative care services by health care providers for their clients diagnosed with …

Economic Impact Of Waste In Prescribing, Dispensing, And Medication Consumption In The United States, Sarah Almanie

Theses and Dissertations

Abstract

ECONOMIC IMPACT OF WASTE IN PRESCRIBING, DISPENSING, AND MEDICATION CONSUMPTION IN THE UNITED STATES

By Sarah A. Almanie, M.S.

A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science at Virginia Commonwealth University.

Virginia Commonwealth University, 2015.

Major Director: David A. Holdford, R.Ph., M.S., Ph.D., FAPhA

Professor

Department of Pharmacotherapy and Outcomes Science

OBJECTIVES: This research examines waste associated with the medication use process which consists of unfilled prescriptions, abandoned prescriptions, or unused prescription medications. The aim of this study is to quantify the direct medical costs of medication waste in delivery of …

Using Music-Based Interventions With Adolescents Coping With Family Conflict Or Parental Divorce: A Resource Manual, Lori Meono

Theses and Dissertations

Listening to music is an activity that provides a range of physical and psychological benefits (e.g., tension relief, decreased depression) for people across cultures and age groups. Adolescents, specifically, are among the most active consumers of music, and music appears to be a natural coping strategy for this age group. Research suggests that both music and the family context play important roles during the developmental phase of adolescence. Family transitions such as divorce have become increasingly common experiences for adolescents and may have long-lasting negative effects on an adolescent's emotional well-being. However, research regarding music-based interventions for use with adolescents …

Neuropsychological Rehabilitation Specific To Anorexia Nervosa: A Critical Review Of The Literature On Executive Functioning Symptomatology And Cognitive Remediation Treatment Applications Tailored To This Patient Population, Kayleigh Elizabeth Hale

Theses and Dissertations

Engaging, maintaining, and treating patients with anorexia nervosa (AN) remains a significant challenge for clinicians, hypothesized explanations for which are thought to involve specific executive functioning impairments. The neuropsychological treatment paradigm Cognitive Remediation Therapy (CRT) represents the translation of neurocognitive research into practice, and is thought to remediate neuropsychological symptoms and associated maladaptive cognitive processes. Additionally, the etiological model of AN related to executive functioning provides a conceptual framework for this novel approach to treatment. This study identifies and examines such a model, in addition to CRT protocols. Methodology involved a comprehensive synthesis and critical analysis of the literature pertaining …

Voices From The Frontier: Stories Of Nurse Practitioners Working In Remote Areas, Lynn Marie Jakobs

Theses and Dissertations

Frontier communities are the most sparsely populated and geographically remote areas in the United States. Residents of these communities often lack access to healthcare resources of any kind. Nurse Practitioners (NPs) are more likely than physicians to practice in these areas and provide a vital link in the frontier healthcare safety net.

This narrative inquiry into the practice experiences of frontier NPs informs the discipline of nursing regarding the significant contribution frontier NP practice makes to the delivery of frontier healthcare. This inquiry creates a repository of stories upon which nurse leaders, health care policy makers, and nurse educators interested …

Women Leaders In Healthcare: Going Beyond The Glass Ceiling, Cortney Baker

Theses and Dissertations

Between 2004 and 2014, healthcare jobs were among the fastest growing occupations in the U.S., adding 4.3 million positions and expected job growth of 30.3%. The majority of the healthcare workforce is overwhelmingly dominated by women. However, when it comes to leadership positions, especially executive and board levels, females are considerably underrepresented. Interestingly, though, women, more than men, are reported to demonstrate traits such as transparency, compassion, and support for teamwork, which would benefit organizations as they venture into the future of healthcare delivery. In recent years, women have made minimal entry into the highest ranks of managerial positions of …

Examination Of The Association Of Receipt Of Opioid Therapy And Lung Cancer Patient Survival Rates Among South Carolina Medicaid Recipients, Jametta Sade Magwood

Theses and Dissertations

Introduction: Lung cancer is a high pain cancer that can require the attention of clinical specialists. Already vulnerable populations, like those that inhabit rural areas, when dealing with chronic diseases, like lung cancer, need and deserve adequate medical attention. However, rural communities often lack clinical specialists and are left without the needed care. It is necessary to investigate the current availability of treatment options (medications) available to cancer patients in rural communities. Gaining this knowledge can result in economic savings and improvement of the quality of life for rural populations.

Methods: Medicaid data from 1996-2010 was used to …

Grand Prix: A Trainer's Guide To Show Ring Success, Lauren Rebecca Allen

Theses and Dissertations

This is a memoir of my experiences as a horse lover and professional horse trainer, and the startling parallels I discovered in the Los Angeles equestrian and entertainment industries. Both worlds revolve around commodifying something that is rooted in beauty but somehow gets bruised in the process of spinning art into business. I found that my taste for romance and adventure spurred me to new heights and simultaneously crashed against reality. In pursuit of the big prizes, I was willing to slowly sell off the things I cared about most to get what I wanted, until I woke up to …

Analysis Of Risk Factors Contributing To Home–Based Direct Care Workers (Dcws) Occupational Injury In Long–Term Care, Hanadi Y. Hamadi

Theses and Dissertations

Home–based direct care workers (DCWs) provide care in a unique workplace environment: the patient’s home. The high rate of injuries experienced by this subcategory of healthcare workers compared to other industries and occupations make the need to understand the risk factors for these injuries vital. This study builds on prior research and specifically profiles occupational injury patterns among home–based DCWs who deliver care primarily in patient homes and the association of individual, perceived environmental and ergonomic characteristics on predicting occupational injury. The study used a cross–sectional analysis of secondary data from the 2007 National Home Health Aide Survey (NHHAS), sampling …

The Effects Of Exercise Training On Cognitive Reserve And Cognitive Function In Healthy Older Women, Katie Marie Becofsky

Theses and Dissertations

Cognitive reserve theory suggests that physical activity may protect individuals from cognitive decline. At the brain level, greater cognitive reserve may manifest as greater neural network efficiency. Our purpose was to investigate 1) whether participation in a 16-week walking program increased brain efficiency, and 2) whether increased brain efficiency correlated with change in fitness and task performance. Our secondary purpose was to investigate whether exercise training improved performance on a battery of cognitive tasks, particularly executive functioning performance. Seventeen healthy but sedentary women aged 60-75 years participated in a supervised walking program; eighteen women served as a non-randomized control group. …

The Effects Of Arthritis Foundation’S “Walk With Ease” Program On Cognitive Function, Ryan S. Falck

Theses and Dissertations

Physical activity (PA) is believed to improve cognitive function, particularly executive function, in older adults. However, few interventions in community settings have been performed to improve executive function through PA. The purpose of this study was to determine the effects of a community-based walking program on executive function in older adults (60+ years). Older adults from senior centers throughout Lexington County, SC were recruited for participation in this intervention. Exclusion criteria included currently exercising >30 minutes and exercising ≥2x/week or scoring ≤25 on the Mini-Mental State Exam. The intervention consisted of an evidenced-based community walking program, the Arthritis Foundation ’ …

Oncology Nurses' Suggestions For Improving Obstacles In End-Of-Life Care, Rosanne Johnson Oliver

Theses and Dissertations

The purpose of this paper was to determine the most important changes needed to improve the quality of end-of-life (EOL) care to terminal cancer patients as perceived by experienced oncology nurses. The study was designed as a cross-sectional survey, sampling 1,000 Oncology Nursing Society members from the United States with experience caring for inpatient cancer patients, who could read English, and had experience in EOL care. Eligible nurses responded to an open-ended item sent to them as part of a mailed questionnaire. Nurses were asked to respond to the following question: “If you had the ability to change just one …

Discovery Of Novel Serum Biomarkers For Diagnosing And Staging Alzheimer's Disease, Dipti Jigar Shah

Theses and Dissertations

Discovery of Novel Serum Biomarkers for Diagnosing and Staging Alzheimer’s DiseaseDipti Jigar ShahDepartment of Chemistry and Biochemistry, BYUDoctor of PhilosophyAlzheimer’s disease (AD) is an untreatable neurologic disease affecting more than 5 million Americans, most over 60 years of age. Protein plaques and neurofibrillary tangles typify AD brain pathology and are thought to cause the progressive dementia and brain shrinkage observed in AD. Currently there are no methods to diagnose the disease at a time before damage becomes irreversible.Biochemical tests for AD using cerebrospinal fluid analysis or neuroimaging are not yet sufficiently sensitive and specific, and they are invasive. This points …