Medicine and Health Sciences Commons^™

Central Line-Associated Bloodstream Infection Prevention In The Long-Term Acute Care Setting, Mary Lisbeth Dougherty Msn Rn Aocna

Doctoral Dissertations

Sustained reduction of central line-associated bloodstream infections remains elusive in many institutions, including the long-term acute care hospital (LTACH), despite a focus on improving patient outcomes. A clinical practice survey was distributed electronically to nurses working in the LTACH setting. The survey provided for an anonymous assessment of knowledge related to policy/procedure, fidelity to practice as well as site-specific barriers to adherence to clinical practice guidelines. Results revealed opportunities for education related to clinical practice guidelines and basic central line-associated bloodstream infection strategies as well as perceived barriers to adherence to policy/procedure. Strategies aimed at mitigating gaps and barriers are …

Expectations And Experiences Of Fathers Who Have Parented Children With And Without Intellectual Disabilities, Jane Christina Kusmik Walker

Electronic Theses and Dissertations

The parenting experience is as diverse as the children parented. Each child has diverse personality traits requiring flexibility and specificity in parenting strategy. This need for flexibility and specificity is more complex when one or more children within a family has an intellectual disability. Although research in this area is abundant, investigators have historically focused on mothers' attitudes, beliefs, and behaviors to represent the entire family (Essex, Seltzer, & Krauss, 2001; Greenberg, 2002) rather than focusing on fathers and their caregiving relationships with their children in need of malleable but consistent parenting. Using a qualitative descriptive design, this qualitative study …

Nurses’ Perceptions Of The Support Needs Of Women Experiencing A Crisis Pregnancy, Kristyn Dyson

Boise State University Theses and Dissertations

Background: In the United States, one half of all pregnancies are unintended. Research suggests that many women make a decision about their pregnancy immediately, taking action very quickly without any form of options counseling. Women oftentimes do not conceptualize their pregnancy as a scenario involving three alternative outcomes. Research has shown that when in a state of crisis, the decision-making process is diminished and the individual becomes vulnerable. Additionally, when making decisions in the absence of adequate social support, negative health outcomes can result.

Objectives: To explore nurses’ perceptions of the social support needs of women experiencing a crisis …

Successful Aging In Hispanic Elders: A Narrative Inquiry, Julie Kay Carr

Boise State University Theses and Dissertations

Purpose: The purpose of this narrative study was to describe and provide an understanding of the unique cultural factors that are associated with successful aging in the elder Hispanic population.

Background: The number of aging Hispanic in Americans is on the rise. The Center for Disease Control recently released data showing the life expectancy for the Hispanic population is 80.6 years — a 2.5 year advantage over the non-Hispanic white population and 7.7 years over the non-Hispanic black population. With longer life spans resulting in an increased number of Hispanic older adults, we are presented with a difference that – …

Living In Harmony: Health Perspectives Of Hispanics In Rural East Tennessee., Erin E. Bailey

Undergraduate Honors Theses

The purpose is to promote culturally competent care among healthcare providers by identifying and describing how Hispanics in East Tennessee view health and what they do to prevent illness. A focus group of six to ten Hispanics of mixed genders over age eighteen moderated by a native Spanish-speaking interpreter. Questions explored how Hispanics define health and sickness, health maintenance practices, and alternative medicines and practices. Results were interpreted from Spanish to English to be analyzed. The Circle in Which You Live was described by members as consisting of relationships, physical health, and peace of the mind and soul. In Shutting …

Exploring Healthcare Simulation As A Platform For Interprofessional Education, Janice Christine Palaganas

Loma Linda University Electronic Theses, Dissertations & Projects

Interprofessional education (IPE) is gradually recognized as essential to patient safety and implemented as a standard for healthcare education through professional organization recommendations and accrediting bodies. Given the increasing adoption of experiential and team-based learning, healthcare simulation (HCS) has become a preferred vehicle for IPE. As healthcare professional educators explore simulation as a platform for IPE, a need to better understand the state of the science has become apparent. This descriptive comparative study examines how the most commonly used simulation modalities and IPE teaching methods (low-technology versus high-technology; multiprofessional versus collaborative team-based activities; observational versus active methods; standardized patients versus …

Identification And Prevention Of Secondary Traumatic Stress In Mental Health Professionals Who Work With Child Sexual Abuse Victims, Abby Duckworth Mcneil

Doctoral Projects

Secondary traumatic stress (STS) is an issue that may be experienced by mental health professionals who are exposed to clients' trauma materials and become and become at risk of becoming traumatized themselves. Mental health professionals working with sexually abused children are more vulnerable to STS due to their empathic engagement and level of exposure to trauma. The impact of STS can result in poor productivity, increase in illness, and turnover rates for mental health professionals. Cumulative effects of STS make awareness and early intervention imperative. Research has shown that members of the helping profession suffer emotional and physical illness more …

Continuing Professional Development Program On Second-Generation Antipsychotics For Psychiatric-Mental Health Staff Nurses, Brenda Lee Phillips

Doctoral Projects

The lack of continuous professional development education regarding second-generation antipsychotics (SGAs) at a regional state acute care psychiatric hospital limits the ability of psychiatric-mental health (PMH) staff nurses to provide care for patients with or at risk for metabolic syndrome and other medical problems. The goals of the evidence-based program were to (1) examine PMH staff nurses’ knowledge of treatment guidelines for schizophrenia and SGAs; (2) provide education on schizophrenia, SGAs, and metabolic syndrome; and (3) provide continuous professional development training modules on schizophrenia and SGAs electronically for PMH staff nurses in an acute care mental health hospital. The effectiveness …

Value Based Purchasing: Positioning A Healthcare Organization For The Future, James Dale Heard

Doctoral Projects

In 2005, the Deficit Reduction Act introduced Value Based Purchasing (VBP) into the healthcare system as a means of hospital reimbursement for acute care hospitals receiving reimbursements from the Centers of Medicare and Medicaid (CMS). The purpose of this Capstone Project was to increase the knowledge of healthcare executives concerning Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and VBP and the effect it will place on the organization though the utilization of a consultant program. The role of the consultant in this project is to provide expert advice to healthcare executives about the impacts of HCAHPS and provide …

Exploration Of Self-Care Following Distribution Of Acute Management Tool For Elder Heart Failure Patients In Clinic Setting, Sharon Elaine Vincent

Doctoral Projects

The aim of this study was to develop a broad understanding of heart failure patients’ perceptions about their lived experiences. An acute symptom management tool, Red Flags I Need to Know: Heart Failure Action Plan (Health Net Federal Services, 2011), was distributed to the patients prior to initiation of the project.

The problem of heart failure rehospitalization is significant. Cost of treatment for heart disease in the United States exceeds all other conditions. The national excessive 30-day readmission rate in elders post-discharge is 24.8%. Pay-for-performance initiatives will reduce reimbursement for excessive readmissions beginning FY 2013.

The project was a mixed …

Impact Of Social Marketing On Nurse Practitioners' Acceptance Of Clinical Video Telehealth For Elderly Patients In Rural Mississippi, Teresa Lynn Langley

Doctoral Projects

Elderly patients 65 years and older who have chronic illness and disabilities living in rural Mississippi have increased difficulty in obtaining timely cost-effective healthcare services from nurse practitioners. The purpose of the capstone project was to utilize social marketing strategies for promoting nurse practitioners’ acceptance of clinical video telehealth (CVT) in improving healthcare access for rural elderly patients in Mississippi. Clinical video telehealth is an innovative way to provide healthcare services to populations in need by reducing barriers to healthcare, such as distances, time, and transportation, and financial resources. However, providing healthcare through the use of technology has not always …

Vertical Violence And The Student Nurse: Is This Toxic For Professional Identity Development?, Sherri Williams Cantey

Dissertations

This narrative inquiry centers on student nurses’ stories of vertical violence perpetuated by clinical registered nursing staff and the meaning that students associate with this phenomenon. Student nurses are the very young and potentially impressionable members of our profession; therefore, a concern of this study was if vertical violence affects professional identity development for the student nurse. Additionally through stories revealed by these participants, this study attempted to explore whether perceptions of violence are believed to be a rite of passage into the profession. Students are the future of our profession, and it is important that this phenomenon be understood …

Predictors Of Drug Court Client Graduation, Marie E. Gill

Theses and Dissertations (ETD)

Background: Substance use disorder in the United States adversely effects society by burdening the justice system with offender incarceration for drug-related crimes, it also strains in the healthcare system with costs in excess of $216 billion dollars for treatment of drug-related mental and physical illnesses. Many offenders of nonviolent crimes with substance use disorder have been diverted to Drug Court (DC) for year-long supervised community-based drug addiction treatment as an alternative to incarceration for non-violent drug-related crimes. Drug Court program outcomes, however, have been studied as a criminal justice intervention, rather than a primary care mental health intervention. The majority …

The Meaning Of The Lived Experience Of Nursing Faculty On A Dedicated Education Unit, Deborah Ann Demeester

UNLV Theses, Dissertations, Professional Papers, and Capstones

In 2011, 58,327 qualified applicants were denied admission to U.S. baccalaureate programs due to an inadequate number of qualified faculty, insufficient clinical placement sites, and resource constraints. Nursing faculty leaders are being challenged to increase enrollment to address a projected worsening nursing shortage and to transform prelicensure nursing education to ensure that program graduates have the nursing skills and competencies to meet the health care needs of the population.

Collaborative educational partnerships offer promising strategies to diminish the nursing faculty shortage, educate more students, and provide stable, rich learning environments. The Dedicated Education Unit (DEU) model is one of these …

The Associations Of The Level Of School Wellness Policy Implementation And School Nurse Activities To Weight Status Of School Children In Massachusetts, Mary Jane F. O'Brien

Graduate Doctoral Dissertations

The increase in prevalence of childhood obesity has prompted child health authorities to propose mandates focusing on population health efforts that may be implemented in public schools. In 2010, the federal government passed the Healthy, Hunger-Free Kids Act, reinforcing the 2004 regulations to guide school districts in development and implementation of school wellness policies.

The purpose of this secondary data analysis was an examination of the association between implementation of the school wellness policy and school nurse activities to the absolute change in percent of students with body mass index in the obese weight category between the school years 2005-2006 …

Perceived Stress And Surgical Wound Cytokine Patterns, Valentina Lucas

Theses and Dissertations

Normal wound healing is a complex process that occurs in overlapping phases and depends upon interactions of the patient, environment and a large number of cells, growth factors, cytokines, chemokines, and other biochemical mediators. Psychological stress has been shown to adversely affect the normal wound healing process through its impact on cellular immunity. Cellular immunity impacts wound healing through the production and regulation of many of the above biochemical mediators of wound healing. The purpose of this pilot study was to examine the relationships among pre- and post-operative psychological stress experienced by women who were undergoing either immediate or delayed …

"Being Certain": Moral Distress In Critical Care Nurses, Marian Baxter

Theses and Dissertations

Published literature has focused on understanding moral distress from a descriptive standpoint. Missing from the literature is an exploration of the role a nurse can play in his/her/own moral distress.A qualitative study with an interpretive design incorporated Clandinin and Connelly' narrative methodology. Results highlighted assumptions were made by participants in the absence of resources, which led them to" know the right action to take" from their own perspective.

Heart Failure Symptom Clusters And Functional Status, Janet Herr

Theses and Dissertations

Abstract HEART FAILURE SYMPTOM CLUSTERS AND FUNCTIONAL STATUS Janet Kay Herr Ph.D A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University Virginia Commonwealth University 2012 Major Director: Dr. Jeanne Salyer, Ph.D., R.N., F.N.A.P Associate Professor, Adult Health & Nursing Systems Clinical assessment of heart failure includes symptom identification and the evaluation of the relationship of symptoms to functional status. Symptom clusters are groups of at least 2 or 3 co-occurring symptoms that are related but are independent of other groups of symptoms. The objectives of this study are to: …

Evaluating The Impact Of Two Different Methods Of Diabetes Self-Management Education On Knowledge, Attitude, And Behaviours Of Patients With Type 2 Diabetes Mellitus, Laura B. Briden

Electronic Thesis and Dissertation Repository

This study compared the effectiveness of diabetes self-management education (DSME) methods by examining changes in knowledge, attitude, and behaviour (KAB) after receiving education. Participants from a convenience sample were randomized into two groups, one receiving education through conversation maps and the other through traditional group education. Participants’ knowledge and attitude changes were measured by using a repeated measures pre-test/post-test design and changes in Hb A1c were observed. Focus groups were conducted after education was received to obtain perceptions and self-reported behaviour changes. Significant knowledge and attitude score changes were observed in the conversation map group after education. When comparing the …

The Nature And Meaning Of Insulin Pump Use In Emerging Adults With Type 1 Diabetes, Donna G. Hood

Nursing Theses and Dissertations

Emerging adults (ages 18-25) with type 1 diabetes are a vulnerable population as they transition from the family home and their pediatric healthcare providers and deal with multiple competing demands. There is very little literature addressing those in this developmental group who use insulin pump technology for diabetes self-management. Listening to the voices of emerging adults who use insulin pump technology will increase our understanding of their experience and will give health care providers the opportunity to develop evidence based practice based on their lived experiences. The qualitative research, using the hermeneutic phenomenological approach described by Max van Manen, provides …

Nurse Practitioner Home-Based Care, Nicole Peters Kroll

Nursing Theses and Dissertations

The United States is currently faced with the challenge of how and where to care for its aging population. Nurse practitioner (NP) home-based care is a potential solution to meet this challenge. Current research indicates that care provision by advanced practice nurses reduces cost, decreases length of stay and readmission to hospitals, and improves patient quality of life. The purpose of this research was to examine the state of the science regarding home-based geriatric care by NPs and to determine the current status and potential expansion of NPs in home-based care for elderly patients. Advanced practice nurses are able to …

Linking Psychological Capital, Structural Empowerment And Perceived Staffing Adequacy To New Graduate Nurses' Job Satisfaction, Lisa Stam

Electronic Thesis and Dissertation Repository

Reports indicate that new graduate nurses (NGNs) are experiencing stressful work environments, affecting job satisfaction and retention in current positions. New nurses are a health human resource that must be retained in order to ensure the replacement of retiring nurses, and to address impending shortages. As a result, creating supportive work environments that promote NGNs’ job satisfaction may play an important role in the retention and recruitment of skilled, satisfied nursing staff. The purpose of this study was to test the relationships between new graduates’ self-reported psychological capital (PsyCap), access to empowerment structures, perceptions of staffing adequacy and job satisfaction. …

Health Literacy, Cognitive Impairment, And Medication Adherence In Veterans With Heart Failure, Lee Ann Hawkins Phd

Dissertations

Background: Heart failure (HF) affects 5.8 million people in the United States, costly in terms of patient mortality and morbidity as well as healthcare dollars. One important manifestation of poor HF outcomes is the excessive admission-readmission cycle. Non-adherence to medication is responsible for the majority of HF readmissions. Identification and intervention for key factors contributing to poor medication adherence is critical to improving outcomes. Two such factors prevalent in persons with HF are cognitive impairment (CI) and poor health literacy (HL). There is a paucity of tested interventions designed to improve medication adherence by addressing underlying CI or HL. A …

Using Grounded Theory To Reveal Tacit Knowledge For Nurse Educators In An Unfamiliar African Setting, Ramona B. Patterson

Theses and Dissertations (ETD)

There is a gap in evidence to guide individuals as they prepare for a nursing education partnership in an unfamiliar setting. Much of the existing knowledge base is contained within institutional or organizational confines. Individuals new to the field need access to existing expertise and tacit knowledge. The purpose of this research was to generate a grounded theory to guide aspiring nursing faculty in developing the necessary knowledge base to fulfill the nurse educator role in an unfamiliar setting. Ghana, Africa, was specified as the unfamiliar setting and context for this study.

Purposive sampling identified individuals from North America and …

Public Health Nurse Decisions Regarding At-Risk Postpartum Case Closure, Denise K. Thompson Phd

Dissertations

During the late 19th century, public health nursing emerged in the United States as an autonomous nursing specialty providing maternal-child health (MCH) home visitation services. Present day MCH public health nurses (PHNs), guided by their predecessors, focus on health promotion and disease prevention in at-risk maternal-child populations. Health policies, funding streams, and local public health nursing protocols are examples of extrinsic factors that may affect length of home visitation services for at-risk women and their children. The purpose of this study was to better understand the factors related to variations in PHN decisions to terminate home visitation services for at-risk …

Academic Success Factors Influencing Linguistically Diverse And Native English Speaking Associate Degree Nursing Students, Josie Lynn Veal

Dissertations (1934 -)

To address the healthcare needs of vulnerable populations, nursing educators should evaluate educational preparedness and identify which factors influence a successive academic trajectory in nursing school. A prospective design was used to determine the relationships and differences among the anatomy and physiology course grade, self-efficacy, linguistic diversity, language acculturation, and components of the National League for Nursing pre-admission exam for registered nurses and first semester nursing course grades of linguistically diverse and native English speaking associate degree nursing students.

A relationship exists between the PAX-RN composite score, anatomy mean grade, language diversity, and general self-efficacy score, the Nursing Pharmacology and …

Evaluation Of The Clinical Integration Model For Hospital Care Delivery, Cheryl Mckay

Nursing Theses and Dissertations

Purpose: Two studies were used to evaluate whether introduction of the Clinical Integration Model (CIM) would decrease cost, length of stay (LOS), and mortality in two populations: a psychiatric in-patient population and congestive heart failure (CHF) patients. Objectives: 1. Evaluate reliability and validity of a process tool, the CareGraph, essential in the CIM. 2. Determine if there is a difference for LOS and cost between patients receiving care in the CIM and those receiving care in a traditional primary care delivery model in a psychiatric population; compare the same parameters as well as survival in the CHF population. Methods: Reliability …

It Transforms All Of You: Lived Experiences Of Partners Of Iraq Combat Veterans With Traumatic Brain Injuries, Laurel Sue Cassidy

Doctoral Dissertations

Just over two million service men and women have been deployed to the wars in Iraq and Afghanistan over the past ten years. Conservative estimates suggest that nearly one fifth of those deployed sustain a blast induced mild traumatic brain injury (TBI). Nearly half of those in the service are married, meaning a large number of spouses unexpectedly find themselves navigating a “new normal” after their partner returns from combat with ongoing sequelae from a TBI.

Ultimately, a sizeable number of spouses of Iraq combat veterans with TBIs have found themselves in the role of caregiver. The large majority of …

Effects Of A Home-Based Exercise Program On Perception Of Illness And Adaptation In Heart Failure Patients, Robin Faust Harris

Doctoral Dissertations

Patients experience decreased functional capacity from chronic symptoms associated with heart failure. Exercise increases activity tolerance and quality of life in heart failure patients. Physiologic responses to exercise in heart failure patients have been well-documented. In contrast, the effects of exercise on an individual’s perception of degree of disability due to chronic illness and their adaptive responses to heart failure have not been studied. The purpose of this randomized controlled trial was to examine the effects of a 12-week home-based combined aerobic and resistance training exercise intervention on an individual’s perception of degree of disability and adaptive responses to chronic …

End-Of-Life Culture Care Expressions, Meanings, Patterns, And Practices Among Yup'ik Eskimo, Pamela J. Embler

Doctoral Dissertations

The need for end-of-life care research is exemplified by the fact that the National Institutes of Health has made this topic a research priority. End-of-life care is multifaceted and concepts become complex when cultural perspectives are considered. The purpose of this qualitative ethnonursing study was to discover culture care expressions, meanings, patterns, and practices at end-of-life among Yup’ik Eskimo in community settings. Data was obtained from Yup’ik Eskimo of the Yukon-Kuskokwim Delta, Alaska. The Culture Care Diversity and Universality Theory and the ethnonursing research method directed this study. Key and general informants were interviewed. Interviews and observations were analyzed. The …