Medicine and Health Sciences Commons^™

Feasibility Study Among Military Personnel With Traumatic Amputation During Military Combat Or Training, Michele (Shelly) R. Burdette-Taylor Phd, Msn, Rn-Bc, Cwcn, Cfcn

Dissertations

Military operations have resulted in a significant number of mangled extremities leading to traumatic amputations. Extremity injuries predominate, representing 50% to 70% of all injuries treated (Melcer, 2010). The majority of injuries sustained in Operation Endearing Freedom/Operation Iraqi Freedom (OEF/OIF) are combined penetrating, burn and blast injuries, traumatic amputation, and infections from the multi-drug resistant organism, Acinetobacter (Melcer, 2010). The purpose of this study was to measure the quality of well-being and impact of events in a group of adults who served in the U.S. armed forces and sustained the loss of one or more limbs during any combat or …

Shrouded In Stigma: A Heuristic Study Of Living With Hiv, Neal Stacy Rosenburg

Dissertations

HIV-related stigma is a serious hindrance to addressing the recruitment, maintenance, and follow-up nursing care of HIV-infected persons. This study was anchored within the heuristic research model, which engaged both the researcher and participants in a dialogical and aesthetic manner to unveil the stigma of HIV. The close proximity of the researcher and study participants revealed the most visceral, emotional, and self-reflective nature of gathering data, while maintaining the integrity and rigor of a qualitative study. The purpose of this heuristic study was to examine the lived experiences of HIV-infected individuals relating to internalized stigma within an existential context. This …

The Cultivation And Practice Of Spiritual Care Expertise In An Inpatient Palliative Care Setting, Gail Elaine Pittroff

Dissertations

Caregivers involved in palliative care seek to understand problems and challenges at end of life through research to determine the best care for patients and their families. Spiritual care is a key component of quality end of life care, yet there is a paucity of research on spiritual care in inpatient settings at end of life in nursing literature. The purpose of this study was to examine the personhood and spiritual care practices of inpatient palliative nurse consultants. This study describes expert nurse’s experience of delivering spiritual care for patients and families at end of life in inpatient palliative care …

The Mother's Perspective: Understanding More About The Health Care Needs Of The Preschool Child With Autism, Margaret W. Bultas

Dissertations

Background Information: The prevalence of autism spectrum disorders (ASD) has dramatically risen over the last decades. It is known that children with ASD visit health care providers (HCP) more frequently than typically developing peers. Given behavioral and medical complexities of these children, mothers may experience barriers in this process. Purpose: The purpose of this study was to gain a better understanding of mothers’ experiences of taking their children to the HCP. Aims of this study were to reveal mothers’ concerns related to these experiences, examine resources and barriers affecting the quality of the visit, and discover more about the effect …

Spermatogenesis: Laser Microdissection Optimization, Deborah Ann Hansen

Dissertations

Studies link paternal environmental exposures to pesticides, herbicides, and radiation to adverse reproductive outcomes such as developmental delays, malignancies, and structural birth defects. To date, 900 children of Vietnam veterans with presumed Agent Orange exposure receive VA presumptive service connected benefits because these children have Spina Bifida. To date, there are limited data to explain the underlying causal mechanisms whereby paternal environmental exposures result in adverse reproductive events. Laser microdissection (LMD) is the only technology that allows the isolation of cell subpopulations from complex tissues such as the testes without disturbing the cell’s bimolecular signature. LMD is essential in the …

Direct Care Workers Perceptions And Practices Related To Quality Of Life In Long Term Care, Karen M. Kinyon

Dissertations

The focus of this case study was to discover how DCWs define success in their practice and what institutional and individual factors contribute to their successful practices. It describes how DCWs perceive quality of life for NH residents and how their practices reflect quality of life indicators. The conceptual model for which this research is based on was developed around the concepts that individual and institutional factors contribute to the successful practices of direct care workers; and, how these DCWs perceive quality of life influences how they practice to promote quality of life for nursing home residents. Using a case …

Student Persistence In Associate Degree Nursing Programs At Mississippi Community Colleges, Kathryn Lee Fleming

Dissertations

The purpose of this study was to examine factors of student persistence and attrition in addition to strategies that may help students persist in associate degree nursing programs at community colleges. Data were collected from nursing students enrolled in first-year associate degree nursing programs at participating Mississippi community colleges and analyzed using multiple regression and repeated measures ANOVAs. Tinto’s Classic Model and Bean & Metzner’s Nontraditional Model of Student Attrition were utilized in this study. This mixed methods convenience sample yielded 564 participants, and the results were as follows: environmental factors and demographic factors of student persistence were found to …

Perceived Levels Of Nurse Educators' Attainment Of Nln Core Competencies, Julie Kinney Higbie

Dissertations

Nurse educators need to be well-prepared with essential competencies, to prepare nurses for their future in health care. Nurses who are recruited to teach, must meet at least minimal competencies and be provided appropriate resources to assume their roles in academia. The recently published National League for Nursing (NLN) Core Competencies for Nurse Educators (2005) identify the skills, knowledge and attitudes necessary for both novice and experienced faculty.

This research study explored faculty's perceived attainment of these competencies utilizing Benner's Novice to Expert theory as a framework. It examined several areas of interest related to nurse educator competency, years of …

The Relationship And Effects Of Mindfulness On Comfort, Work Satisfaction, And Burnout Among Nurses Who Provide Direct Patient Care, Pamela Lichtenberg Heard

Dissertations

This study proposed to examine the problem of burnout in the nursing profession and ways to ameliorate burnout. Many burnout studies in the past focused on the problem and possible solutions that managers and/or hospital administrators could incorporate into their organization. The focus of this study is to evaluate ways that nurses can decrease their own propensity to burnout through the use of mindfulness. Therefore, this study examined burnout in a non-traditional manner. It is not assumed that others must assist nurses with decreasing their levels of burnout. Mindfulness is a means by which nurses can empower themselves to combat …

Assessing Mississippians’ Preparedness For Disasters Using The Citizen Corps National Survey 2009, Carl Huston Mangum Ii

Dissertations

Disaster preparedness, a shared responsibility of all citizens and disaster agencies, is the most critical component in minimizing risk and damage from disaster. Mississippi has been affected by some of the most devastating disasters in American history, both in terms of physical destruction and human life. The purpose of this study was to assess Mississippians’ disaster preparedness by replicating The 2009 Citizen Corps National Survey (CCNS). The 65 question 2009 CCNS was slightly modified to survey 678 randomly selected Mississippians about the Citizen Corps Personal Disaster Preparedness Model: Demographics, Volunteering, Drills/Exercises, Community Plan, Household Plan, Disaster Supplies, Prevention, Self-efficacy, Reliance, …

A Critical Reflection On Advanced Practice Nursing, Patricia Quinn Phd

Dissertations

Legitimation of the Nurse Practitioner (NP) and advanced practice nursing is explored using the framework of critical theory and the case study methodology of Yin. Three different cases are analyzed using classic themes of critical theory - oppression, alienation and ideology and false consciousness. Three publishable articles comprise this portfolio. First is "Looking for love (legitimation) in all the wrong places - A critique of Nurse Practitioner effectiveness literature". This article reviews the literature of NP effectiveness and offers an analysis of the failures and problems of these positivistic studies. Article two is "At least some of us are still …

Thai Patients' Experiences Of End-Stage Renal Disease: A Path Through An Unknown World, Chuleeporn Piyasut Phd

Dissertations

The purpose of the study was to explore how Thai end-stage renal disease (ESRD) patients manage the challenges of living with hemodialysis. The participants were Thai ESRD patients, who were receiving hemodialysis in one of the central provinces in Thailand. A grounded theory approach was employed in this study as it focuses on social processes grounded in individual experiences of participants in the study. The participants included 30 ESRD patients, aged 26-75, who had been undergoing hemodialysis from 6 months to 12 years. Individual in-depth interviews were audio-recorded and transcribed. Data were analyzed by using Atlas.ti. Data analysis revealed "a …

Breastfeeding And Mothers With Chronic Health Conditions, Blanche Landis Phd

Dissertations

Breastfeeding and Mothers with Chronic Health Conditions Breastfeeding may be most beneficial for women with specific chronic illness and may decrease the risk or prevent those illnesses from developing in their children. This study examined the initiation and duration rates of mothers identified as having asthma, hypertension, and diabetes; differences between the three groups in their efforts to breastfeed, and associations between determinants/outcomes of breastfeeding and behavioral beliefs, normative beliefs, and perceived control of mothers using Ajzen's Theory of Planned Behavior (TPB). A retrospective quantitative methodology was used to compare rates of initiation and duration, the differences between the three …

The Effect Of Shapedown On Habits And Self-Esteem For Overweight And Obese Children, Susan Bonnell Phd

Dissertations

Obesity in children is increased in the United States and globally which creates both physical and psychological health risks and co-morbidities affecting the development of positive self-esteem (Sinton & Birch, 2005; Whetstone, Morrissey, & Cummings, 2007). The development of poor self-esteem in children increases the risk of problem behaviors such as aggression, crime, teenage pregnancy, drug and alcohol use, tobacco use, and eating disorders (Brook et al., 2007). Treatment of childhood obesity is multifaceted, requiring behavioral and lifestyle changes for both child and family to achieve a healthy weight (De-Santis-Moniaci & Altshuler, 2007; Plourde, 2006; Ritchie, Crawford, Hoelscher, & Sothern, …

Battery And Abuse In The Elderly: A Forensic Analysis, Amy Y. Carney Phd, Mfs, Np

Dissertations

Elder abuse is a recognized social problem in the United States. First labeled as "granny battering" and originally studied under the umbrella of family violence, maltreatment of the elderly has received more funding and research in recent years. Multiple aspects of elder abuse have been examined in the literature including measures for detection, assessment, and documentation. Although studies have examined the circumstances surrounding abuse as well as theories of causation and characteristics of the abuser and the abused, studies of the relationship between the abuser and the abused are less well documented. The purpose of this research was to examine …

Application Of Systems Engineering Science To The Healthcare Environment, Jonathan Mack Phd, Msn, Anp, Rn

Dissertations

This Doctoral dissertation consists of a research portfolio examining the application of systems engineering techniques to the healthcare environment. The portfolio consists of three final publishable articles submitted to meet the program requirements for the, Doctor of Philosophy in Nursing degree from the University of San Diego, Hahn school of Nursing and Health Sciences. Article one is titled; "Use of a bed projection tool to predict ICU bed needs." This article describes the dissertation research study in which a bed projection tool was piloted on an ICU unit to determine the tool's ability to predict inpatient bed requirements. Article 2 …

Predictors Of Job Satisfaction And Burnout In Travel Nurses, Marcia Faller Phd, Msn, Rn

Dissertations

This study examined various individual and work environment characteristics and their influence as predictors of travel nurse job satisfaction and burnout. In addition it described travel nurses; a population of nurses that has not been previously studied. An explanatory sequential mixed methods design was used in order to take advantage of the exploratory nature of the qualitative portion in describing the attitudes and motivations of travel nurses in detail; and to further explain the findings from the quantitative portion of the study. The quantitative portion of the study used a descriptive correlational methodology with secondary data analysis of a cross-sectional …

Violence, Depression, Parental Stress, And Child Neglect Among High Risk Postpartum Women, Kristen D. Lambert Phd, Msn, Rn

Dissertations

The purpose of this study was to characterize a vulnerable population of postpartum women at risk for family violence and maladaptive outcomes and to determine the degree the identified attributes increase the risk of child neglect and psychological aggression. Lazarus' Appraisal Theory and Scaer's Traumatic Spectrum framework provided a conceptual basis to examine the interrelationships between intimate partner violence (IPV), depression, previous traumatic history, and child neglect. A descriptive correlation design using secondary analysis of longitudinal data collected for the Healthy Families San Diego Clinical Trial was used. Standardized measures including the CTS, CTS2, CTSPC, CES-D and PSI were administered …

Grade Point Average As A Predictor Of Timely Graduation From Associate Degree Registered Nursing Programs, Delores J. Jackson

Dissertations

The purpose of this study was to determine if admission selection strategies that utilize cumulative and/or pre-requisite GPA are predictive of timely graduation for associate degree nursing (RN-AD) students. Data were obtained from de-identified records of 437 associate degree nursing students enrolled in three Midwest community colleges from 2003-2006. Of the total sample, only 44% of the students graduated on time (i.e., in four semesters or two years). Although a statistically significant difference was found for timely graduation rates between colleges (ranging from 29% in College B to 54% in College A), no relationship was found for cumulative GPA, pre-requisite …

The Impact Of A Clinical Mentor Program On Patient Outcomes, Cynthia M. Steckel Phd

Dissertations

The increasing complexity of patient care requires an expert nurse to navigate the hospital stay, yet today's workforce brings a declining supply of seasoned nurses, creating a patient need/nurse expertise gap. The clinical mentor role was developed to bridge this gap and create a safety net, using expert nurses, relieved of a patient assignment, to provide oversight for quality patient care. Results reported elsewhere showed improvements in failure to rescue and pressure ulcers six months before and after implementation. The purpose of this study was to examine the long-term impact of this new care model over the subsequent three years …

Neurodevelopmental Outcomes Of High Risk Infants, Lisa E. Miklush Phd, Msn, Rnc, Cns

Dissertations

Background: Infant developmental research has revealed amazing physical, cognitive, and social capacities of the human infant. Along with this knowledge is a growing appreciation of numerous factors that have the potential to impact the individual infant's developmental trajectory, either enhancing or compromising the eventual outcome. Enhanced understanding of those factors that shape infant developmental trajectories will provide an evidence base for the establishment of a supportive environment for the youngest members of society. Purpose: To determine the relationship between neurodevelopmental outcome and gestational age, birth weight, Apgar scores, NICU admission, infant gender, maternal depression, home environment, and parent-child interaction. Methodology: …

Shared Presence: Caring For A Dying Spouse, Lana Sue Mclouth Kanacki Phd, Ms, Rn

Dissertations

There is limited research on female spouses and their end-of-life experience with their dying husbands. The purpose of this study was to explore wives' perceptions of hospital and hospice care at their husbands' end-of-life. The grounded theory method was used for this study. Data were collected over thirteen months and then transcribed and coded for meaning. Participants were 25 elderly widows (62-103 years of age) with 19 husbands' deaths in a hospice setting and 6 in the hospital. They were widowed from 6 months to 10 years after the death of their spouses. They were good informants with excellent recollections …

Quality Of Life, Hope, Social Support, And Self-Care In Heart Failure Patients, Karen A. Mcgurk Phd, Mn, Rn

Dissertations

Heart failure is a significant, chronic health problem. Much is known about physiological factors related to this condition. Less is known about the psychosocial aspects that influence disease risk, progression, and treatment. The purpose of this study was to describe the relationships between quality of life, hope, social support, and self-care. A descriptive, correlational study was conducted. The participants were 65 heart failure patients who attended 2 military-based heart failure clinics. Quality of Life was measured using the Left Ventricular Dysfunction Questionnaire (LVD-36), Hope was measured using the Herth Hope Index (HUI), Social Support was measured using the Medical Outcomes …

Quality Of Life, Religious/Spiritual Coping, Demoralization And Depression In Heart Failure Patients, Terry Larsen Phd, Rn, Cns

Dissertations

Background: Research suggests that the heart failure (HF) population is particularly vulnerable to depression. Other factors may also affect quality of life such as religious/spiritual coping, and demoralization. Purpose: The purpose of this descriptive correlational study was to examine factors that predict health-related quality of life (HRQoL) in adults with heart failure. Specific Aims: (1) to examine level of religious/spiritual coping, spiritual distress, demoralization, depression and HRQoL among adults with heart failure; (2) to examine the relationships of religious/spiritual coping, spiritual distress demoralization, depression and selected demographic variables (age, gender, race/ethnicity and length of living with HF) with HRQoL. Methods: …

Tuberculosis Awareness And Public Opinion On Expanding Health Insurance Coverage, Belal A. Saadeh Phd, Msn, Rn

Dissertations

This quantitative descriptive cross-sectional study examined the effect of TB awareness and demographic variables on the level of support for expanding health insurance coverage for all residents, including undocumented immigrants. A modified 13-item tool developed by Morisky et al. (1990) was used to measure TB awareness; a single item created by the researcher assessed personal opinion regarding expansion of health insurance coverage; and a demographic questionnaire was used to collect data from 281 registered voters in San Diego County. The majority of San Diego County voters participating in the study supported at least some expansion of health insurance coverage. ANOVA …

Quality Of Life And Health Outcomes In Overweight And Non-Overweight Children With Asthma., Amy Becker Manion

Dissertations

Over the last two decades the number of children and adolescents who are overweight has more than doubled. Currently, an estimated 18 percent of children and adolescents ages 6-19 years are overweight. Following this trend in childhood overweight, there has been an alarming increase in the number of children with asthma who are overweight. The increasing trend in both asthma and overweight has led to the suggestion of a causal relationship between the two. Childhood overweight has been found to have a profound negative impact on quality of life (QOL), yet there is a dearth of research regarding the impact …

Depressive Symptoms In Women Being Screened For Cardiovascular Disease Risk, Suzanne Marie Savoy

Dissertations

Background: Depressive symptomology is an independent risk factor for cardiovascular disease. Over 15% of persons with cardiovascular disease have depressive symptoms, and women are twice as likely to experience these symptoms as men. Depressive symptoms in women “ at risk ” for cardiovascular disease has not been well studied.

Purpose: This study investigated the relationship between depressive symptoms, health-promoting lifestyle behaviors, heart disease risk awareness, cardiac risk, and quality of life in women at risk for cardiovascular disease. Whether the effect of depressive symptoms on quality of life was mediated by cardiac risk and/or health-promoting lifestyle behaviors was also examined. …

Moral Distress And Avoidance Behavior In Nurses Working In Critical Care And Non-Critical Care Units, Mary Jo De Villers

Dissertations

Significance: Nurses facing impediments to what they perceive as moral practice may experience inner turmoil, frustration, and moral distress. These scenarios may culminate in resignation from employment at the individual level, increased attrition at the systems level, and poor patient outcomes, including increased morbidity and mortality.

Purpose: To explore the relationships between moral distress and avoidance thoughts and behavior between nurses currently practicing in critical care and non-critical care settings.

Methods: A descriptive cross-sectional comparative design was used. The sample was comprised of a randomized subset of 370 critical care nurses, a convenience sample of 87 nurses from a nursing …

Pushing On: A Grounded Theory Study Of Maternal Perinatal Bereavement., Patricia Wright

Dissertations

Over 1 million American women experience the unexpected loss of a pregnancy each year (Ventura, Abma, Mosher, & Henshaw, 2009). The care and support they receive from family members, friends, and health care providers is often inadequate. Despite nearly 3 decades of research, very little is known about women's experiences of loss and the trajectory of perinatal bereavement. This classic grounded theory study was undertaken to discover a substantive theory of maternal perinatal bereavement, which was empirically derived from the words of the participants.

Data were collected from interviews with 19 women who had experienced the loss of a pregnancy, …

Pressure Ulcer Risk Factors For Patients With Hospital Versus Community Acquired Pressure Ulcers, Margaret Talley Phd, Mn, Rn, Cns, Cwcn-Ap

Dissertations

Purpose: Pressure ulcers are a major health problem in the United States. Patients who develop pressure ulcers have longer hospital stays, significant increase in morbidity and mortality, added pain and suffering. The purpose of this study was to examine community versus hospital specific pressure ulcer risk factors to identify whether the most severe pressure ulcer stages can be predicted from the knowledge of an individual's risk factors as has been reported in the literature. Methodology: The sample of patients with stageable III-IV and unstageable pressure ulcer patients included in the analysis was extracted from a Microsoft Access database developed by …