Digital Commons Network^™

Barriers Primary Care Physician Assistants Face In Referring Patients To Palliative Care Services Early In The Disease Process, Claire Petersen

Theses and Graduate Projects

Background: Medical specialties such as hospice and palliative care have been proven to improve quality of life for patients facing end-of-life and chronic illness. Though increasing awareness of these specialties has resulted in greater availability, it is essential to investigate the barriers clinicians, such as Physician Assistants, face in making these referrals in order to provide quality healthcare to those who need it. Physician Assistants specifically are an essential clinician group to evaluate, as they continue to become more prevalent in the healthcare system.

Purpose: To determine barriers primary care Physician Assistants face when identifying candidates for and referring to …

Home-Based Primary Care In Patients With Dementia: Impact On Cost, Medication Use, And Patient Satisfaction, Megan O'Leary

Theses and Graduate Projects

Background: Individuals living with dementia deserve affordable, accessible, and effective healthcare. These patients often face barriers that make it difficult to consistently access traditional in office primary care. Home-based primary care (HBPC) holds the opportunity to bridge the gap between individuals with dementia and preventative healthcare resources.

Purpose: Dementia rates are increasing as the population ages, and additional research is needed to determine the optimal treatment model for individuals with dementia. This literature review evaluates if patients with dementia receive improved care with HBPC vs in office primary care through examining cost, medication use and compliance, and patient satisfaction.

Methods: …

A Unique Hiv Harm Reduction Perspective From Costa Rica: Hogar De La Esperanza An Ethnographic Case Study And Comparative Examination Of Approach To Hiv Treatment Between The United States And Costa Rica, Kim Marie Day

Theses and Graduate Projects

This case study presents a real, currently operational scenario of harm reduction in action in Costa Rica, focusing on its success and the challenges faced by healthcare professionals, the experiences of those who live at Hogar de la Esperanza, and the implications for healthcare policies and interventions in the United States. By examining this specific case of a Costa Rican community-based HIV treatment model, the aim of this ethnographic report is to shed light on the complexities and factors contributing to the success or failure of harm reduction treatment strategies within the United States and what can be learned by …

Impact Of Provider Cultural Competency On Latino/Hispanic Patients During End-Of-Life And Hospice Care, Nicholle Nacionales

Theses and Graduate Projects

Background: Cultural competency in healthcare means delivering high quality care to patients with diverse beliefs, attitudes, values, and behaviors. Latinos/Hispanics are one of the fastest growing ethnic group and with an aging population, there is an increased need for providers to deliver culturally sensitive end-of-life and hospice care. Latino/Hispanic patients face many disparities that affect their quality of care which cultural competency aims to address. Purpose: The purpose of this literature review is to identify factors that affect Latino/Hispanic patient’s end-of-life and hospice care and how cultural competency of providers can influence management of their pain and quality of …

Does Transitioning To An Omi/Nomi Model For The Evaluation Of Acute Coronary Syndrome In Adult Emergency Department Patients Improve Outcomes Compared To Contemporary Stemi/Nstemi Model?, Ismar Terzic

Theses and Graduate Projects

Acute coronary syndrome (ACS) continues to be the most common cause of death in the United States, and nearly every 34 seconds one American has a coronary event. Based on 12- lead electrocardiogram (ECG) findings myocardial infarction (MI) patients are treated, according to guidelines, emergently with reperfusion therapy if presenting with ST elevation myocardial infarction (STEMI), versus delayed revascularization if presenting with non-ST elevation myocardial infarction (NSTEMI). However, the evidence shows there is a lack of recognition of which patients require immediate catherization utilizing the current guidelines. In recent years, approximately 70% of acute MI (AMI) patients are classified as …

Exercise As Self-Care To Combat Nurse Burnout, Jessica Petefish

Theses and Graduate Projects

The demands on nurses continue to grow, inducing stress and other symptoms of burnout. Nurse burnout can cause short and long term physiological and psychological symptoms. Nurse burnout not only affects nurses but has implications for patients and hospitals as well. Exercise has been proven to have many health benefits and the ability to alleviate symptoms of burnout. Nurses on a hematology/oncology unit cited burnout as their reason for leaving the unit. This project proposes a walking program as a self-care method to reduce symptoms of nurse burnout. Utilizing Jean Watson’s Theory of Human Caring and her idea of self-care …

Improving Family Nurse Practitioners’ Knowledge Of Palliative Care Resources, Michelle L. Bond

Theses and Graduate Projects

The shift in healthcare indicates Americans are living longer with progressive chronic illnesses subsequently reducing quality-of-life. Primary care providers have opportunities to assess the need for and implement palliative care to offer holistic symptom management to improve patient’s quality-of-life. The purpose of this scholarly project, guided by Jean Watson’s Theory of Human Caring, is to assess primary care providers knowledge and comfort regarding initiating palliative care while determining if additional education improves their familiarity. The objectives were to review current palliative care literature identifying barriers and inadequacies, determine evidence-based practice to develop an educational presentation and resources to improve communication, …

Advance Care Planning Education For Older Adults, Jamie E. Seaquist

Theses and Graduate Projects

Advanced care planning guides health care professionals and surrogate decision-makers choices on end of life (EOL) care when individuals are no longer able to speak for themselves. Advanced care plans can benefit patients in their last six months of life by improving their quality of life and by reducing family members anxiety, depression, and stress when dealing with EOL treatment options. Aside from these benefits, poor communication and knowledge deficits often create barriers when medical staff, families or patients try to broach the subject of EOL care. Barriers can be overcome when health care professionals facilitate advanced care planning conversations …

Impact Of Music Therapy On Hospice Patients, Amie M. Tipton

Theses and Graduate Projects

Music therapy is an adjunct healing modality designed to alleviate symptoms of existential pain and suffering hospice patients may experience as they transition into the final stage of life. The complexity of existential pain and suffering in hospice patients is a challenge for a hospice care team to treat and manage and emotionally testing on the patient’s support system. The purpose of this scholarly project is to evaluate a music therapy program at a local community hospice center as an aid to relieve patients’ existential pain and suffering they incur from their terminal illness and to increase hospice care providers’ …

Education For Health Care Providers: Medical Cannabis, Morgan C. Rohl

Theses and Graduate Projects

Health care providers are consistently unaware of the implications, efficacy, and resources correlated with medical cannabis and cannabidiol. Thus, patients are uninformed about medical cannabis as a treatment option for their qualifying conditions. Informative educational sessions present a method to facilitate specialty knowledge development regarding medical cannabis and cannabidiol. In this scholarly project, six nurse practitioners and two allied staff members, attended a PowerPoint presentation followed by an open discussion regarding cannabinoids. Examination of post-presentation survey results indicated that felt more informed about the physiology and efficacy of cannabidiol, more aware of the resources for them, and had increased comfort …

An Evaluation Of Home-Based Primary Care (Hbpc): Impact On Cost And Outcomes And Patient Satisfaction In The United States And Abroad, Isaac Pierre

Theses and Graduate Projects

Over the past century, the role of medical home visits in patient care has undergone significant changes. Historically, physicians routinely delivered medical care to sick patients in their own homes. In 1930, for example, such calls represented 40% of physician-patient encounters. As healthcare providers developed an increasing reliance on technology and as payment models began to prioritize volumes and efficiency, the provision of health care shifted to hospitals and office-based settings. An analysis of house calls in 1972 found that the number of in-home visits amounted to a mere 5% of physician-patient encounters and these rates continued to decrease to …

Using Music Therapy As An Adjunct To Pharmacologic Therapies For Chronic Pain, Andrea L. Rosenberg

Theses and Graduate Projects

Chronic pain affects more than 1 in 4 individuals in the United States. Many patients are being prescribed opioids to manage this pain, leading to an immense problem involving addiction, overdoses, and preventable deaths. Music therapy has been shown to provide “music analgesia,” improving anxiety, depression, and mobility problems associated with chronic pain conditions. The most benefit was seen when the music was known to the patient, the patient had a role in choosing the music, and when the music had a beat of less than 120 beats per minute. These promising results include a wide variety of chronic pain …

The Effectiveness Of Video And Other Electronic Media On Dnr/Dni Decisions Within Advance Care Planning, Peter Seebarg

Theses and Graduate Projects

Advance Care Planning is used to ensure patients’ wishes and preferences for treatment are in line with their medical situation. Its use has increased over the past years, but it has been implemented in a piece wise and unorganized fashion. Changes in provider billing capabilities and a recent consensus definition and implementation strategies of Advance Care Planning have created an opportunity to research and explore best use practices. A key feature of Advance Care Planning is creating autonomy for patients’ decisions. Autonomy is especially important for the use of cardiopulmonary resuscitation (CPR) in the event of a medical crisis.

Research …

Early Integration Of Palliative Care For Patients Diagnosed With Life-Limiting Illness, Jennifer M. Rivers

Theses and Graduate Projects

There are numerous reasons conversations regarding the early implementation of palliative care for patients diagnosed with life-limiting illness do not occur early in the disease trajectory. A literature search was conducted to support the benefits of earlier implementation of palliative care, specifically, implementation by patient’s primary care providers upon a qualifying disease diagnosis. The literature review revealed generous benefits of early implementation of palliative care and provided support for this scholarly project. For this scholarly project, a palliative care questionnaire and PowerPoint presentation were designed, administered, and presented to health care providers including nurse practitioners, physician assistants, pharmacists, and consultants …

Exploring The Lives Of Retired Nurses Using The Lens Of Legacy, Verliss L. Keller-Miller

Theses and Graduate Projects

Legacy can be viewed as a summary of life. Legacy develops over a lifetime and changes and grows as one ages. How do retired nurses view their legacy? This paper looks at a select group of five female retired nurses and how each views her legacy at this time in life. Each was a professional nurse, and each is fully retired. Imogene King’s Goal Attainment Theory discusses the concepts of self and role. Through individual conversations, each retired nurse shares her life story of self and the roles she held during her working years. Literature yields little information about this …

Does Music Therapy Decrease Agitation In Patients With Dementia?, Clinton Billhorn

Theses and Graduate Projects

Dementia is an encompassing word that includes specific symptoms which alter a patient’s problem-solving ability, decision making capacity, and personality.1 Personality changes, otherwise known as Behavioral and Psychotic Symptoms of Dementia (BPSD) can have negative impacts on caregivers and families. BPSD can include agitation, depression, elation, and hallucinations. Music therapy has been proposed as a non-pharmacologic treatment for BPSD in patients with dementia. This research is intended to identify whether or not music therapy decreases agitation in patients with dementia. Although evidence for efficacy varies, there are no side effects in the literature. Widespread use may provide an increase in …

Parent Perspectives On Homeschooling In Minnesota, Danielle Miller

Theses and Graduate Projects

This paper explores the perspective of parents who have experience homeschooling their children in the state of Minnesota. Five families participated in the study in an interview format. In each case the mother was interviewed as she was primarily responsible for homeschooling. Data collected from interviews showed themes among all participants in the areas of: continual assessment of the choice to homeschool, the positive affect homeschooling had on the preservation of family structure, a dissatisfaction with other education options, the importance of support systems and the issue of socialization, and the benefits of Post-Secondary Enrollment Options (PSEO). All families in …

A Phenomenological Investigation Of Music Therapists’ Experiences When Working With Actively Dying Hospice Patients: An Analysis Of Words, Mandalas, And Music, Erin I. Fox

Theses and Graduate Projects

This phenomenological study explored the lived experiences of three music therapists when working with actively dying hospice patients. The participants spoke of their experiences, drew mandalas, and improvised music. Through the lens of Interpretive Phenomenological Analysis the interview transcripts were coded two main themes emerged: clinical experiences and personal experiences. Subthemes under clinical experiences included use of ongoing assessment, clinical reasoning, clinical use of music to meet patient needs, roles as music therapist, facing challenges in the work, and working with patients’ spirituality. Subthemes under personal experiences included awareness of needs for self-care, physical and sensory experiences, emotions and new …

Nurse Burnout: When The Flame Goes Dim, Brittany M. Barden

Theses and Graduate Projects

Anticipating and responding to the needs of others is the forefront of the nursing profession. Nurses all too often place the needs of patients, patient's families, and organizations ahead of their own. The constant care of others without proper attention to one's own needs can lead to nurse burnout. There is little education being provided to nurses regarding the danger and effects of nurse burnout and how one can create a healthy balance between meeting their own needs as well as those of others. The purpose of this project is to develop an educational module that will raise awareness of …

Empowering Home Care Nurses To Begin End-Of-Life Conversations, Angela Oujiri

Theses and Graduate Projects

In the United States, some people find the discussion of death and dying a difficult topic to discuss. This difficulty has often delayed conversations about goals and wishes until very late in the healthcare journey. Delays come with a significant cost to both patients and the entire healthcare system. Palliative care is a special type of care meant to provide an extra layer of support to patients and families who are living with serious illness; however, the practice of such care encounters has many challenges for patients, families, physicians, and nurses. Home care nurses are instrumental in the delivery of …

Exploring The Transformational Impact Of Baccalaureate Education On Vocation A Hermeneutic Phenomenological Study Of Rn-Bsn Graduates, Libby Henslin

Theses and Graduate Projects

Four-year liberal arts colleges seek to expand knowledge and prepare undergraduate sfudents for vocational service to an increasingly complex and global society. This requires colleges to lead transformatively, in keeping with their vision, mission and values, to maintain institutional integrity. As a regionally accredited, Christian affiliated liberal arts college Augsburg College should provide a baccalaureate degree that is potentially transformative. A hermeneutic phenomenological study, informed by Transfotmational Leadership Theory, was conducted by interviewing four Bachelor of Science in Nursing completion graduates to explore the change in their call to professional caring service through their educational journey. Four essential themes emerged …

Advance Directives Educational Program For Nurses, Rose R. Pappas

Theses and Graduate Projects

Advance directives (AD) are legal documents outlining a patient's preferences for treatment at the end of life. AD allow people to communicate their end-of-life (EOL) decisions about medical care to family, friends, and health care professionals in the event that they are unable to make those decisions themselves. Many nurses observe patients and their families waiting until the patient is at the end of their life before they initiate an AD. With the current rate of aging baby boomers in the United States, AD would appear to be a phenomeron that should be encouraged. Assisting patients with completion of AD …

Utilizing Watson's Theory Of Caring To Develop A Palliative Care Proposal For Olmsted Medical Center, Tammie Johnson

Theses and Graduate Projects

Palliative care is aimed at alleviating the suffering of patients with serious or chronic illnesses. Literature examined to determine the needs of seriously or chronically ill patients and their farnilies found patients to have physical, psychosocial, and spiritual needs while coping with their illness. In addition, patients' family needed support in physical care of their loved ones, as well as information and psychosocial needs for themselves. The purpose of this project is to develop a proposal for an inpatient palliative care program for Olmsted Medical Center's (OMC's) consideration, Watson's Theory of Caring was utilized in the development of a palliative …

Reducing Anxiety In Pediatric Bone Marrow Transplant Patients Using Reiki, Robyn Ait Ali

Theses and Graduate Projects

Reiki, meaning universal life force energy, facilitates the flow of energy that travels naturally in and around the body. Blockages in energy flow create disease and or pain in the body; the Reiki practitioner facilitates the removal of blockages which allows for healing and restoration of balance. Anxiety in children undergoing Bone Marrow Transplant (BMT) manifests itself across all body systems and effects the care they receive during hospitalization. Children are open to the concept of energetic healing therefore, the use of Reiki for children undergoing BMT to reduce anxiety, facilitate relaxation, and ease pain makes sense. The introduction of …

Communication Metaphor Of Patient Prognosis In The Spirit Of Hope, Dory Hanks

Theses and Graduate Projects

Prognosis for terminally ill patients is intended to serve the purpose of educating patients on the expected clinical outcome of their illness. This information is generally communicated to a patient by their primary physician when options for fufiher treattnent or "cure" are limited. Learning a prognosis may be helpful to some patients, while burdensome to others. A review of the literature reveals many barriers to effective communication of prognosis. The purpose of this project is to develop a metaphor for enhanced communication of prognosis to be used by hospice nurses that incorporates a caring perspective on living with hope during …

Staying Alive: A Nursing Care Model In The Technical Delivery Of Dialysis, Sylvia Moe

Theses and Graduate Projects

The purpose of this project is to develop a model of a caring-healing transformational relationship by using Watson's caring theory to enhance the patient's experience on dialysis. The nursing model in a large tertiary hospital in the Midwest uses relationship-based care to identify nursing roles that will be used in the mentoring model. Transpersonal caring promotes the caring practice which is the essence of nursing and is associated with a greater sense of self-knowledge, self-control and well being with increased nurse satisfaction. It is the authentic caring knowledge and caring practice integrated in the environment for the delivery of the …

Brad: A Model Of Caring For Persons With Frontotemporal Dementia, Jennifer Mcguire

Theses and Graduate Projects

Frontotemporal dementia (FTD) is caused by u progressive degeneration of the frontal and temporal lobes of the brain (Boxer & Miller, 2005), This degeneration causes profound alterations in personality, social behavior, and language skills. FTD is particularly devastating due to the fact that it commonly affects people during mid-life or earlier. Evidence has shown that caregivers face higher rates of burden, distress and isolation when providing care for someone with FTD than other forms of dementia (de Vugt, Riedijk, Aalten, Tibben, van Swieten, & Verhey,2006; Kumamoto, Arai, Hashimoto, Ikeda, Mizuno, & Washio, 2004). The Behavioral Recognition, Assessment and Delivery (BRAD) …

Giving End Of Life Care To Persons With Intellectual Disabilities: A Model Of Support For Community Based Caregivers, Emily K. Gress

Theses and Graduate Projects

Persons with intellectual disabilities are living longer lives, often outliving family caregivers, and experiencing chronic illnesses known to the general aging population. Ultimately, this translates to a need for end of life care. Hospice care seeks to provide individualized physical, emotional, and spiritual support to assist persons and their families in attaining the highest quality of life in the face of a life limiting illness. Hospice services have been underutilized for persons with intellectual disabilities and little has been studied about end of life care provided by community based residential caregivers. The purpose of this project is to use Margaret …

Oncology Nurses' Perceptions Of Self-Compassion: A Pilot Study, Miriam R. Lindell

Theses and Graduate Projects

Oncology nurses face extraordinary stressors in their work. If this stress becomes prolonged, these nurses are at risk for burnout and compassion fatigue. One effective way for nurses to manage stress is to care for themselves, body, mind, and spirit. The concept of self-compassion reflects a meaningful approach to self-care. This pilot study explored the perception'of self-compassion by hospital based oncology nurses. A convenience sample of 37 oncology nurses was surveyed using four demographic questions and the Self-Compassion Scale by Kristin Neff. The results demonstrated positive correlation between years of nursing experience and years of oncology nursing experience with common …

Nurse Influence In Policy Development: A Model Using Storytelling, Michele Anderson

Theses and Graduate Projects

This project will explore how nurses' stories of social injustice can be used to influence legislative action on health policy. Nursing history has proved the profession's roots in political activism and social justice, Role models and trailblazers like Lillian Wald solidified the nursing intervention of political involvement, but somewhere along the way it has lost its value. Using Newman's Health as Expanding Consciousness theory as a guide, nurses can use stories to illustrate the patterns of disruption in the current healthcare system and then lead policy into reform.