Digital Commons Network^™

Accuracy In Reporting Of Kentucky Certified Nurse-Midwives As Attendants In Birth Registration Data, Kendra Marie Chesney Adkisson

Yale School of Nursing Digital Theses

Abstract

Introduction: Birth certificate data is used nationally to determine healthcare policy, allocation of funds, and to demonstrate the legitimacy and value of Certified Nurse-Midwives (CNMs) in maternal and neonatal outcomes. However, the validity of birth certificate data is questionable, in part because of the data collection process. This data is particularly crucial for midwife-attended births as the correct birth attendant is not always accurately identified. The purpose of this project was to examine the number of CNM reported births as compared to the number recorded by the Kentucky office of vital statistics and to look at the process used …

Development And Implementation Of A Simple Wound Care Guideline For Minor Skin Lesions: A Quality Improvement Project, Alexandra Bates

Yale School of Nursing Digital Theses

Purpose: The purpose of this QI project was to use the best available evidence and expert opinion to develop and implement a simple inpatient nursing care guideline for minor skin lesions.

Participants and Setting: This wound care guideline was developed for nurses working on inpatient adult acute care units. The setting was a large community hospital in southwest Minnesota.

Approach: The guideline was validated for its clarity and appropriateness by external and internal expert wound care nurses. It was implemented through in-person unit rounding on the nursing units, distribution of badge cards with the guideline, and a required online education …

Implementing Real-Time Computerized Clinical Decision Support During Trauma Resuscitations: Lessons Learned From Simulation., Nathan Arnold Miller Christopherson

Yale School of Nursing Digital Theses

Through the combination of clinical expertise, research, and patient values evidence-based practice (EBP) is becoming the new standard of patient care. Despite the main benefits of EBP medical providers are hesitant to implement based on a multitude of barriers. In order to increase adoption of EBP we need to develop deliver systems that bring best evidence in an easy to use format to the bedside.

We tested the implementation of a computerized clinical decision support documentation platform during trauma team resuscitations. The simulation sessions were geared to help identify opportunities for improvement in our implementation methodology.

During the simulation sessions …

How The Five Rights Are Wrong: Development Of A Nursing Medication Safety Science Curriculum, Melissa Ann Davis

Yale School of Nursing Digital Theses

Medication errors, now thought to be four times greater than previous estimates, pose a serious threat to nurses, patients, and health care institutions. Current nursing education lacks any coherent medication safety framework other than the classic “Five Rights” construct. This project piloted an educational intervention with senior nursing students based on systems-thinking safety principles. Students evaluated the learning experience positively and improved pre- to post-testing scores by 74%. This study demonstrates students’ ready acceptance and comprehension of systems thinking medication safety theory, an alternative to the “Five Rights” construct.

Comparison Of Surgeon Perception Of Preoperative Patient Risk With The Acs Nsqip® Surgical Risk Calculator, Jeffrey Scott Cudd

Yale School of Nursing Digital Theses

Introduction

Surgeon perception of surgical risk varies. The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP®) Surgical Risk Calculator (SRC) estimates risk of postoperative outcomes and can assist with communicating risks to patients preoperatively. We compared surgeon risk estimates with calculations of risk from the SRC.

Methods

In this project in 2 medical centers, 10 surgeons completed a tool in which they estimated the risk of complications for patients undergoing elective surgical procedures. A NSQIP-trained reviewer determined SRC estimates for the same patients. Agreement was determined using Bland-Altman and Lin’s concordance statistics.

Results

In the evaluation of …

Nurse Practitioner Reimbursement Parity: An Advocacy Strategy For Washington State, Justin Gill

Yale School of Nursing Digital Theses

Nurse practitioners (NP) play a vital role in the United States health care system. Nurse practitioners belong to a category of Advanced Practice Registered Nurses (APRN). APRNs in Washington State, licensed as Advanced Registered Nurse Practitioners (ARNP), are able to practice without the requirement of physician supervision or oversight. This facilitates NP practice ownership. NPs are qualified, autonomous, clinicians that can help address the primary and mental health care needs in Washington State. Washington State, unlike Oregon, does not require third-party insurers to reimburse NPs the same rate for the same services provided by a physician. This has financial implications …

Veteran Suicide Risk Reduction Through Targeted Dissemination Of An Easy To Use Risk Screening Instrument, Joshua Faucett

Yale School of Nursing Digital Theses

On August 3, 2016, the United States Department of Veterans Affairs Office of Suicide Prevention published the most comprehensive analysis of Veteran suicide in the nation’s history. The Office of Suicide Prevention examined more than 55 million Veteran healthcare records from 1979 to 2014 from all 50 states and four territories (Office of Suicide Prevention, 2016). The study results found that although Veterans account for only 8.5% of the U.S. adult population, they are responsible for 18.5% of all U.S. suicides (Office of Suicide Prevention, 2016). After adjusting for differences in age and gender, the risk for suicide was 21% …

An Educational Module To Improve Pre-Hospital Stroke Assessment: Stroke Mimics And The Field Assessment Stroke Triage For Emergency Destination (Fast-Ed) Scale, Susan Elizabeth Hunt

Yale School of Nursing Digital Theses

ABSTRACT

Introduction: Studies show that up to 30% of acute stroke patients brought to the emergency department (ED) are diagnosed with a stroke mimic. With more stroke systems adopting a prehospital large vessel occlusion (LVO) stroke scale that includes bypass protocol, it is imperative that emergency medical service (EMS) personnel be educated on how to implement the scale, identify stroke mimics, and accurately determine the time of last known well. Studies show that LVO stroke scales demonstrated low specificity when scored by EMS personnel, as compared to those scored by physicians. In 2018 the Massachusetts Office of EMS updated the …

Creation Of An Interdisciplinary Evidence-Based Advocacy Tool: Promoting Medicaid Reimbursement For Pasteurized Donor Milk For Very Low Birth Weight Neonates, Christopher Schmaltz

Yale School of Nursing Digital Theses

An interdisciplinary approach to remove cost barriers associated with full utilization of pasteurized donor human milk in the neonatal intensive care unit. This scholarship produced an evidence-based advocacy tool which allows the user to enter state-specific data to demonstrate the fiscal advantages of implementing pasteurized donor human milk reimbursement policies from a Medicaid payor perspective.

Curricula For Empathy And Compassion Training In Medical Education: A Systematic Review., Sundip Patel, Alexis Pelletier-Bui, Stephanie Smith, Michael B. Roberts, Hope Kilgannon, Stephen Trzeciak, Brian W Roberts

PCOM Scholarly Works

BACKGROUND: Empathy and compassion are vital components of health care quality; however, physicians frequently miss opportunities for empathy and compassion in patient care. Despite evidence that empathy and compassion training can be effective, the specific behaviors that should be taught remain unclear. We synthesized the biomedical literature on empathy and compassion training in medical education to find the specific curricula components (skills and behaviors) demonstrated to be effective.

METHODS: We searched CENTRAL, MEDLINE, EMBASE, and CINAHL using a previously published comprehensive search strategy. We screened reference lists of the articles meeting inclusion criteria to identify additional studies for potential inclusion. …

Mta3-Sox2 Module Regulates Cancer Stemness And Contributes To Clinical Outcomes Of Tongue Carcinoma., Zhimeng Yao, Liang Du, Min Xu, Kai Li, Haipeng Guo, Guodong Ye, Dianzheng Zhang, Robert P Coppes, Hao Zhang

PCOM Scholarly Works

Cancer cell plasticity plays critical roles in both tumorigenesis and tumor progression. Metastasis-associated protein 3 (MTA3), a component of the nucleosome remodeling and histone deacetylase (NuRD) complex and multi-effect coregulator, can serve as a tumor suppressor in many cancer types. However, the role of MTA3 in tongue squamous cell cancer (TSCC) remains unclear although it is the most prevalent head and neck cancer and often with poor prognosis. By analyzing both published datasets and clinical specimens, we found that the level of MTA3 was lower in TSCC compared to normal tongue tissues. Data from gene set enrichment analysis (GSEA) also …

Delta-Aminolevulinic Acid-Mediated Photodiagnoses In Surgical Oncology: A Historical Review Of Clinical Trials., Joseph F Georges, Amber Valeri, Huan Wang, Aaron Brooking, Michael Kakareka, Steve S Cho, Zein Al-Atrache, Michael Bamimore, Hany Osman, Joseph Ifrach, Si Yu, Carrie Li, Denah Appelt, John Y K Lee, Peter Nakaji, Kristin Brill, Steven S. Yocom

PCOM Scholarly Works

Fluorescence imaging is an emerging clinical technique for real-time intraoperative visualization of tumors and their boundaries. Though multiple fluorescent contrast agents are available in the basic sciences, few fluorescence agents are available for clinical use. Of the clinical fluorophores, delta aminolevulinic acid (5ALA) is unique for generating visible wavelength tumor-specific fluorescence. In 2017, 5ALA was FDA-approved for glioma surgery in the United States. Additionally, clinical studies suggest this agent may have utility in surgical subspecialties outside of neurosurgery. Data from dermatology, OB/GYN, urology, cardiothoracic surgery, and gastrointestinal surgery show 5ALA is helpful for intraoperative visualization of malignant tissues in multiple …

The Feasibility Of A Behavioral Group Intervention After Weight-Loss Surgery: A Randomized Pilot Trial, Michelle R. Lent, Laura K Campbell, Mackenzie C Kelly, Jessica L Lawson, Jessica M Murakami, Sasha Gorrell, G Craig Wood, Marianne M Yohn, Stephanie Ranck, Anthony T Petrick, Krystal Cunningham, Megan E Lamotte, Christopher D Still

PCOM Scholarly Works

BACKGROUND: Formal psychosocial support programs after weight-loss surgery are limited in scope and availability.

OBJECTIVE: This randomized pilot study evaluated the feasibility of a postoperative behavioral intervention program.

MATERIALS AND METHODS: Postoperative weight-loss surgery patients (N = 50) were recruited from February 2017-July 2017 and randomized to a four-month behavioral program or usual care wait-list. Outcomes evaluated in addition to feasibility included health-related quality of life (Short Form -36), psychosocial functioning and adherence. Secondary outcomes included within-group changes for each outcome.

RESULTS: Out of eight possible sessions, intervention participants attended a mean of 4.2 sessions. Intervention group participants experienced greater …

In Memoriam

Art Inquiries

In Memoriam: Charles (Randy) Mack, long-time SECAC member and past president of the organization, died in Columbia, SC on October 31, 2018. He was 78. Here, four SECAC members offer memories of Randy, to whom this issue of Art Inquiries is fondly dedicated.

Art Inquiries, Xvii:4, Full Issue

Art Inquiries

No abstract provided.

Addressing Teacher Shortage: A Historical Policy Study On Teacher Credentialing In California, Liza Moritz Mastrippolito

LMU Theses and Dissertations

Teacher education enrollment has decreased 74% since 2013. Simultaneously, attrition rates have increased, with 20-50% of new teachers quitting within the first five years. These combined factors have brought California into a new teacher shortage, necessitating fast-track pathways to credentialing. Fast tracks and lowering of requirements often result in teachers not being prepared to teach as they begin their careers, and as data illustrates, children in high-poverty communities of color are those who are predominantly taught by non-credentialed teachers. This dissertation is a historical policy study on how educational policies enacted in California to address shortage have affected the supply …

Supporting Breastfeeding Among Women Residing In Homeless Shelters, Tracy Renee Webber

Yale School of Nursing Digital Theses

In general, homeless women face many challenges including intimate partner violence, abuse history, mental illness, chemical dependence, alcohol abuse, smoking, medical co-morbidities, lack of permanent address, or any combination of the aforementioned (Vijayaraghavan, et al., 2012). Adding pregnancy and a newborn into shelter living further heightens the vulnerability for this population. Women who reside in homeless shelters are likely to have minimal access to breastfeeding support services and thus low rates of sustained breastfeeding. The purpose of this DNP capstone project is to examine current breastfeeding support within homeless shelters in Brooklyn, New York by conducting assessments of services through …

The Development Of An Evidence-Based Anti-Emetic Tool For The Management Of Post-Operative Nausea And Vomiting In Patients At High Risk For Qt Prolongation And Patients Taking Neurotransmitter Modulating Medications, Nicole Danielle Mancini Hymel

Yale School of Nursing Digital Theses

Abstract

Peri-operative care providers have a myriad of medication options when developing and implementing a plan for the management of post-operative nausea and vomiting (PONV). However, the provider must be aware of the potential side effects, complications, and interactions of those medications, especially when managing high-risk populations. While a peri-operative antiemetic algorithm exists for the management of PONV in the general population,1 an evidence-based antiemetic tool has not been developed for patient populations at risk for prolonged QT interval or patients who are routinely taking neurotransmitter modulating medications. Safe practice recommendations exist but are scattered throughout the literature. The goal …

Started From The Future Now We're Here: The Effect Of Planning Direction On Motivation, Kaylee Boulton

Theses and Dissertations (Comprehensive)

Planning for a future goal in reverse chronological order (i.e., backward planning) can result in increased task motivation for relatively specific, short-term goals, such as academic assignments (Park et al., 2017). Although sometimes backward planning is advocated for shorter-term, concrete event planning (e.g., planning a project timeline), it is also promoted for longer-term, identity-based, “visioning” exercises in which people imagine a desired future-self more generally, then backward plan the path to attaining it. The purpose of the present research was to empirically test this type of applied goal-setting program that promotes the use of backward planning when thinking about one’s …

Access To The Healthcare System For Acb People Living In Waterloo Region, Ontario: A Racial And Socio-Ecological Examination, Tiyondah Fante-Coleman

Theses and Dissertations (Comprehensive)

Little research has investigated the barriers and facilitators to accessing healthcare for African, Caribbean, and Black people in Canada. This thesis identifies barriers and facilitators using a socio-ecological framework in two papers. Five focus groups were held with 22 ACB participants in Waterloo, Ontario. Thematic analysis guidelines informed the analysis of focus group data. The first paper identified barriers at the social (racism and employment, immigrant status) and institutional (wait times, out-of-pocket expenses) levels. Community connections was the sole facilitator at the social level. The second paper identified four barriers at the interpersonal level: physicians’ style of care, lack of …

Sense Of Community In Young Adulthood And Its Relation To Early Childhood Experiences, Madeline Gritzan

Theses and Dissertations (Comprehensive)

The present study focused on sense of community and community involvement in emerging and young adulthood and examined how these relate to involvement in an early childhood developmental (ECD) program. This study explored the effects of early childhood participation in the Better Beginnings Better Futures (Better Beginnings) program on entrance into communities later in life. The research objectives were to (i) identify factors related to developing sense of community in emerging and young adulthood and (ii) understand differences in adulthood sense of community based on early childhood experiences. The sample consisted of young adults who participated in three …

“Invisible” Parent Experiences Of Homelessness And Separation From Their Children In Canada, Rachel A. Caplan

Theses and Dissertations (Comprehensive)

Family homelessness includes a sub-group of individuals whose experiences remain largely hidden or “invisible” within Canadian homelessness systems: parents who have been separated from their children. Yet, to date, little research has focused on the experiences of “invisible” parents who have experienced homelessness, mental illness, and separation from their children in Canada. The purpose of this dissertation was to help fill this notable gap in the literature, as well as to inform community psychology and family homelessness theory, research, practice, and policy in Canada.

The Canadian At Home/Chez Soi (AHCS) research demonstration project included a subset of parents with mental …

Reconciliation: Facilitating Ethical Space Between Indigenous Women And Girls Of A Drum Circle And White, Settler Men Of A Police Chorus, Kelly Laurila

Theses and Dissertations (Comprehensive)

Abstract

The purpose of this dissertation was to seek understanding of how a singing partnership between Indigenous women and girls of a drum circle and white, Settler men of a police chorus (i.e., representing public relations for Waterloo Regional Police Services)^[1] has been sustained within a local context for five years. Knowing the historical and ongoing colonial systemic violence in policing practices with Indigenous peoples in Canada, it seems unlikely that such a partnership would take place. Song provided this partnership with a bridge for engagement and a means to disrupt enduring perceptions of one another that have fuelled …

Border Disorder: 'Irregular Bangladeshis', Xenophobia And Crimmigration Control In India, Sujata Ramachandran

Theses and Dissertations (Comprehensive)

In India, the crisis of migration tied to the entry, presence and assimilation of the so-called ‘irregular’, ‘illegal Bangladeshi migrants’ is now an undisputed reality, seemingly affecting all geographical areas located within the national territories in multiple adverse ways. A decidedly strident xenophobic rhetoric attaches the presence of such migrants in an indiscriminate fashion to unending anxieties and urgent problems, whilst constantly drawing attention to the inefficacies of immigration enforcement and deficiencies of (interior and exterior) borders controls. This dissertation addresses key moments in the making and deepening of this national crisis and its management by state authorities over the …

Functional Characterization Of O-Acetyltransferase Wssi: Role In Bacterial Cellulose Acetylation Of Achromobacter Insuavis And Pseudomonas Fluorescens, Alysha Burnett

Theses and Dissertations (Comprehensive)

Cellulose biofilms consist of a community of bacterial cells encased in a self-produced matrix of polymers (e.g. exopolysaccharides, such as cellulose) that facilitate a firm adherence to surfaces. The acetylation (addition of an acetyl group on carbohydrates) is crucial in virulence; thereby in some cases allowing opportunistic bacteria to cause harmful diseases. Pertaining to this research, the wrinkly spreader (WS) genotype of Pseudomonas fluorescens colonizes the air-liquid interface on food, water sources and human tissue to form a robust biofilm with the ability to spread across surfaces. The composition of this biofilm largely consists of bacterial cellulose polymers …

Never Seen Before--Again: Aesthetic Adaptation And Transmedia Storytelling Networks In The Age Of Digital Cinema, Mike Mccleary

Theses and Dissertations (Comprehensive)

The primary purpose of this study is to re-evaluate the theorization of the narrative/non-narrative divide in cinema because there is still far too much rich information that is being lost in the chasm left between these two positions, particularly when it comes to the study of spectacular imagery. Working beyond the binary construction of a narrative/non-narrative divide allows for a more nuanced and dynamic analysis of the information that is conveyed by the cinematic image and, more specifically, by way of its aesthetic design. By no means is this study championing image over story or any other such formulation; rather …

Spatial Big Data Analytics: The New Boundaries Of Retail Location Decision-Making, Joseph M. Aversa

Theses and Dissertations (Comprehensive)

This dissertation examines the current state and evolution of retail location decision-making (RLDM) in Canada. The major objectives are: (i) To explore the type and scale of location decisions that retail firms are currently undertaking; (ii) To identify the availability and use of technology and Spatial Big Data (SBD) within the decision-making process; (iii) To identify the awareness, availability, use, adoption and development of SBD; and, (iv) To assess the implications of SBD in RLDM. These objectives were investigated by using a three stage multi-method research process. First, an online survey of retail location decision makers across a range of …

Using Paleolimnology To Establish Baseline Conditions For Metal Contaminants In Advance Of Proposed Mining To Inform A Northern Community-Led Aquatic Monitoring Program, Tłı̨Chǫ Lands, Northwest Territories, Canada., James Telford

Theses and Dissertations (Comprehensive)

The Marian Watershed Stewardship Program (MWSP), a community-driven aquatic ecosystem monitoring program, was developed by the Tłı̨chǫ Government to address concerns regarding the cumulative impacts of multiple potential stressors. In particular, the MWSP aims to develop methods that will be effective for detecting potential pollution from the proposed cobalt-gold-copper-bismuth NICO mine within Tłı̨chǫ Lands. In collaboration with the MWSP, paleolimnological methods and geochemical normalization are used to establish pre-mine baselines of lake sediment metals concentrations in the Marian River watershed prior to mine development. This baseline framework can be used to assess for pollution from surficial sediment once the mine …

Biogeochemical And Hydrological Impacts Of A Low-Severity Wildfire In The Wetland-Dominated Zone Of Discontinuous Permafrost, Caren J. Ackley

Theses and Dissertations (Comprehensive)

Northern regions are experiencing rapid climate warming. As these regions warm, the occurrences of naturally ignited wildfires are increasing in frequency, severity and area burned, calling for a more thorough understanding of post-fire eco-hydrological impacts. Changes in runoff chemistry, and soil moisture and thermal regimes, have been attributed to the significant loss of organic matter (OM) and exposure of deeper soils, leading to enhanced permafrost degradation, ground surface subsidence and the conversion of peat landscapes from long-term C sinks to sources. However, low-severity wildfires often result in minor OM loss. Due to the significant and immediate threats posed to the …

Psychosocial Development And Well-Being In Retirement: The Relationship Between Generativity, Ego Integrity, And Regret Among Canadian Retirees, Shauna Spirling

Theses and Dissertations (Comprehensive)

Transitions such as retirement may facilitate change in social and psychological dynamics, perhaps encouraging what Butler (2002) refers to as a life review: an introspective process encouraging reflection on the life course, potentially eliciting regret(s). Older adults may especially be tasked with coming to terms with the life they have lived given time constraints and perceivably less opportunity to rectify paths not taken. Drawing upon Erikson’s (1950) stages of generativity and ego integrity, the purpose of the present study is to understand the role of psychosocial development in the presence or absence of regret as well as to further understand …