Medicine and Health Sciences Commons^™

Perception Of Pediatric Readiness Across A Health System's Emergency Departments, Rebekah L. Sabo

Doctoral Dissertations

The recent pandemic and pediatric respiratory syncytial virus surge have reinvigorated pediatric care readiness conversations. National strategies and associations exist to guide health systems in improving the quality of emergency care offered to pediatric populations by first assessing readiness for care. These research strategies center on survey implementation and staff engagement in general emergency departments with the goal to improve staff readiness to care for pediatric patients that may present for treatment. What impact would developing a consolidated pediatric readiness program that includes: pediatric emergency care coordinator designation for each emergency department, pediatric readiness education and committee engagement have on …

Improving Adherence To Annual Retinal Screening Among Adult Diabetics In Rural Midwest, Sarah Hunger

Doctoral Dissertations

Background: Diabetic retinopathy (DR) affects millions of people worldwide and is a main cause of preventable blindness. Experts recommend annual retinal screenings on all diabetic patients. Studies show continuing trends of non-adherence, as well as significant barriers to screenings. Recommendations to overcome barriers and methods to improve adherence among diabetics are topics of interest among healthcare providers. The purpose of this project was to increase annual retinal screening adherence among adult diabetics at a privately owned primary care practice in the rural Midwest.

Methods: Staff and 59 patients, chosen through convenience sampling were involved. Pre- and post- implementation surveys were …

Formalized Diabetes Education In A Safety-Net Clinic, Haley N. Wanic

Doctoral Dissertations

Uncontrolled diabetes mellitus in a Hispanic population can be helped through a quality improvement project focused on progressive verbal and written diabetes self-management education (DSME) Purpose of this article is to review the background, an organizational assessment, a literature review, results of the quality improvement project that took place at a safety-net clinic in the Midwest. This project included four patients and data was analyzed through descriptive statistics. Results include improved hemoglobin (Hg) A1c, minimal workflow adjustments for providers, completed microalbumins, and written education given to patients. In conclusion, the quality improvement project showed positive trends in outcome measures over …

Improving Patient Portal Enrollment Through Education And Technology At Rural Family Practice, Kelsey Crampton

Doctoral Dissertations

Background: Patient portals are available through many healthcare offices. They offer the opportunity to improve patient engagement and quality of patient care, but few patients enroll. At a small rural primary care office, less than 20% of the patients were enrolled in the patient portal.

Objective: The purpose of this quality improvement project was to address the barriers reported by patients at this clinic and determine whether changes in portal enrollment volume occurred. Reported barriers included a lack of knowledge about the portal and difficulties with the sign-up process.

Methods: Over three months, strategies included the development of a …

Reducing Delirium And Functional Decline In Hospitalized Older Adults: Pre-Implementation Of Cocare Help, Thomas D. Finn, Autumn Baldwin, Elizabeth Hill

Doctoral Dissertations

Background: Delirium is a change in consciousness characterized by rapid onset and fluctuating attention, causing impairment in the ability to process and recall information, occurring in 30% of hospitalized older adults. Delirium can increase falls, length-of-stay, mortality, and cost. The CoCare Hospital Elder Life Program® (HELP) is an evidence-based bundle of interventions targeting cognitive impairment, sleep deprivation, immobility, visual/hearing impairment, and dehydration, embedding geriatric principles in care to prevent delirium.

Objectives: To further analyze the pre-implementation of the HELP in order to optimize success of program administration.

Methods: Mixed methods were used to collect retrospective/prospective data (interviews (N=25], surveys [N=25], …

Extraction And Analysis Of Data For Fragility Fracture Patients To Help Determine The Likelihood Of Follow-Up With A West Michigan Fragility Fracture Service, Michael Joseph Lamphere

Doctoral Dissertations

Fragility fractures and secondary fractures are a large physical, financial, and emotional drain on the individuals and families affected. Improving post fragility fracture care and increasing follow-up rates with specialty services, such as a fracture liaison service, may promote post-fracture recovery and help prevent future fractures. The purpose of this doctoral project was to increase and improve post osteoporotic fracture care by increasing appropriate referrals and follow-up care. Patient data was retrieved and analyzed on 60 fragility fracture patients referred to a local fracture liaison service. The analysis found that patient gender, fracture site, and history of a previous fracture …

Perceived Barriers To The Pre-Transplant Evaluation: A Patient Perspective, Linda K. Buck

Doctoral Dissertations

Patients who are afforded the opportunity for a kidney transplant tend to have better short and long-term outcomes, including improved physical health, quality of life, and long-term survival over those who are treated with prolonged dialysis (Landreneau, Lee, & Landreneau, 2010; Organ Procurement and Transplantation Network and Scientific Registry of Transplant Recipients (OPTN/SRTR), 2014; Wolfe et al., 1999). At the end of 2012, 402,514 people were being treated with hemodialysis while 40,605 were receiving peritoneal dialysis (USRDS, 2014). At this same time, only 92,885 people were listed on the OPTN national waitlist for kidney transplantation. The aim of this project …

Physical Activity Assessment And Intervention Among Adult Patients At A Community Health Center, Michelle L. Vandentoorn

Doctoral Dissertations

Low levels of physical activity are associated with a number of serious health conditions in adults. These conditions include hypertension, diabetes, certain types of cancers, cardiovascular disease, and an increased risk of mortality. In spite of these serious health risks, few adults in the United States are achieving the recommended levels of physical activity. The diseases associated with low physical activity levels contribute to high healthcare costs.

Healthcare providers claim that they are not aware of available interventions and resources to increase physical activity levels in their patients. Through screening patients for physical activity levels during office visits, providers can …

A Process Improvement Project: Demonstrating A Patient Portal To Increase Enrollment And Use In An Underserved Population With Chronic Illness, Jonathan Gibson

Doctoral Dissertations

High risk, high cost chronic conditions such as diabetes, asthma, and congestive heart failure are prevalent in the United States. Nearly half of all Americans have at least one chronic condition (Centers for Disease Control and Prevention, 2009). Almost four-fifths of total health care spending in the U.S. is related to high risk, chronic conditions (Baker, Johnson, Macaulay, & Birnbaum, 2011). The use of patient portals in ambulatory care may be an avenue toward improving chronic disease management. Portals can be used by patients to schedule appointments, send secure messages to their providers, request medication refills, review lab and test …

Implementation Of The Evidence-Based Cope Intervention In An Elementary Classroom To Promote Mental Health, Maria Mccormick

Doctoral Dissertations

There is a growing incidence of suicide and suicide attempts in the adolescent population. This is largely impacted by the increasing rates of mental illnesses such as anxiety and depression as well as instigating factors such as negative behaviors and stressful life events. In order to prevent these rates from continuing to rise, it is imperative that mental health promotion interventions be implemented in young children in order to facilitate positive behaviors and coping skills that can be used when stressors occur. The purpose of this scholarly project was to implement the cognitive-behavioral therapy intervention, the Creating Opportunities for Personal …

Designing, Implementing, And Evaluating A Community-Based Antenatal Education Program, Jennifer L. Zachary

Doctoral Dissertations

The United States has higher fetal and infant mortality than the majority of developed countries around the world. As of 2008, the United States was ranked 27th internationally for infant mortality among all developed countries (MacDorman, Hoyert, & Mathews, 2013). Infant morbidity and mortality is associated with numerous factors within a country; including access and quality of health care, maternal health status, public health, and socioeconomic status.

Despite recent declines in infant mortality across the country, the infant mortality rates for both Michigan and the project county remain alarmingly higher than the national averages. It is clear that innovative measures …

Acceptability Of The Interpersonal Needs Questionnaire As A Suicide Risk Screening Tool For Veterans In A Non Veterans Health Administration Primary Care Clinic, Jeffrey M. Bird

Doctoral Dissertations

Suicide among veterans is a growing concern. The Department of Veterans Affairs (VA) estimates that a veteran dies by suicide once every 60-80 minutes with 18 to 22 veterans killing themselves every day. Many veterans receive healthcare in the community (outside of the VA), but are typically not identified in these settings. Veteran-centric policies are typically absent in settings outside of the VA. Screening for suicide risk at the primary care level has been largely ineffective with some patients dying from suicide within a week of a negative screen. The Interpersonal Needs Questionnaire (INQ), which measures thwarted belongingness and perceived …

A Cyberbullying Needs Assessment In A Middle School Population: Identifying A Direction For Nurses, Ashley M. Eggleston

Doctoral Dissertations

Cyberbullying is a fairly new phenomenon that most adolescents will experience or be exposed to during their lifetime. It produces devastating outcomes on those who are victims and perpetrators of cyberbullying. There is a limited amount of research regarding the prevention of cyberbullying. The evidence that is available is mostly exploratory in nature. Currently, the literature recommends conducting a needs assessment to validate the problem, raise awareness, and identify potential solutions that are specific to a population and/or setting. Therefore, the purpose of this scholarly project was to administer a cyberbullying needs assessment at a local west Michigan middle school. …

A Process Improvement Toolkit To Guide The Attainment Of Meaningful Use Stage 2 Requirements, Katie M. Alfredson

Doctoral Dissertations

Healthcare is evolving. Reimbursement is transitioning to a model based on quality and patient outcomes. To remain relevant and survive this transition, providers of care must adapt and implement new models of care delivery that account for these changes. This toolkit was created as a deliverable of a Doctor of Nursing Practice dissertation that explored a successful primary care delivery model of a Patient-Centered Medical Home that utilized an interdisciplinary team approach that included nurses. Through this model high quality care was delivered to achieve desired outcomes, specifically, successful attestation for Stage 2 of the Meaningful Use Incentive Program during …

The Evaluation Of Select Lifestyle Behavior Modification Following Participation In A Comprehensive Weight Management Clinic, Jennifer L. Bowling

Doctoral Dissertations

Over the last decades, obesity in the United States has reached epidemic proportion. Obesity rates have nearly doubled since 1960 when 43% of the United States population was overweight or obese and 1% was extremely obese. In 2012, approximately 69% of the US population was overweight or obese while 6.3% were extremely obese. Obesity rates are expected to progressively increase; therefore, interventions and guidelines are imperative in order to reduce the long term health risks of the Nation and to reduce overall health care costs (National Institute of Health [NIH], 2012).

Obesity increases morbidity resulting from associated hypertension, cardiovascular disease, …

An Interdisciplinary Team Approach To The Patient-Centered Medical Home As A Means Of Meeting Meaningful Use Stage 2 Requirements, Katie M. Alfredson

Doctoral Dissertations

In an attempt to address the shortcomings of the current U.S. healthcare system, reimbursement structure is changing from fee-for-service to a value-based model. This requires drastic change in how care is delivered. Therefore, care delivery models and reimbursement incentive programs are evolving to promote advancements in care delivery. This project examined an interdisciplinary team model utilized at a rural, privately owned practice that is a Patient Centered Medical Home (PCMH). This practice has incorporated unique structures and processes to attain Stage 2 Meaningful Use requirements in the first year attesting for this stage became available as a means of addressing …

The Development Of An Evidence-Based Ebola Virus Disease Preparedness Plan For A College Health Center, Julie Cooper

Doctoral Dissertations

Ebola Virus Disease (EVD) represents a new and previously unexplored threat to college campuses across the United States. In the fall of 2014, thousands of international students arrived on college campuses across the nation, but there were few resources for officials in higher education to reference as they sought to manage the threat of an unfamiliar hemorrhagic disease. Preparing for viral outbreaks is an essential task for campus emergency response committees. Colleges and universities are at risk for disease outbreaks because of extensive travel programs and close living quarters. At the same time, colleges must also promote hospitality and avoid …

The Effectiveness Of A Multi-Component Community Program For The Prevention Of Childhood Obesity, Katelyn Bailey

Doctoral Dissertations

Trends in childhood obesity have increased in the past several decades at an alarming rate. According to the CDC, there are 12.5 million children ages 2-19 years affected by the condition. There are many associated comorbidities to childhood obesity and they are negatively affecting our nation’s youth. Research supports childhood obesity prevention programs that are familybased, take place in the community, and include education about nutrition, physical activity, and behavior change. B.Healthy Families is a program designed to address the issue of childhood obesity in a rural county in the Midwest. It was a six week community-based program that involved …

Implementation Of Motivational Interviewing In A Multidisciplinary Hiv Clinic In An Academic Medical Setting, Lucy Ledesma

Doctoral Dissertations

Purpose: People living with HIV (PLWH) struggle with medication adherence. Antiretroviral therapy (ART) requires greater than 95% adherence to prevent HIV drug resistance and treatment failure. Motivational interviewing (MI) is an effective counseling method designed to enhance health behavior change. This project determined the effectiveness of a two-day introductory MI training course on participant MI knowledge, perception of MI effectiveness, perception of client behavior change, and likelihood of MI use in a Midwest outpatient HIV clinic.

Participants: Seven clinical and non-clinical members of the multidisciplinary care team completed the two-day MI training course. Approximately 82% of the participants had never …

Implementation Of A Treatment Plan In A Rural Health Clinic For Patients With A Diagnosis Of Migraine Headache, Darleen C. Hoffert

Doctoral Dissertations

The purpose of this practice dissertation was to improve the quality of care and outcomes for patients in a small, rural health clinic with a diagnosis of migraine headache. The Institute for Clinical Systems Improvement (ICSI) prepared a health care guideline for the diagnosis and treatment of headaches (Beithon et al., 2013). As part of this guideline, aims and measures were provided for the purpose of quality improvement in migraine headache management (Beithon et al., 2013). The guidelines state the purpose of Aim #5 is to, “increase the percentage of patients with migraine headache who have a treatment plan” (Beithon …

Exploration Of Chemotherapy Safe-Handling Practices And Identification Of Knowledge Deficits Among Oncology Nurses In The Ambulatory Care Setting, Cheryl A. Verstrate

Doctoral Dissertations

The purpose of this project was to explore nursing practice perceptions regarding the safe-administration of outpatient chemotherapy and establish whether a knowledge deficit existed in an ambulatory care setting. Although recommendations for chemotherapy administration exist they are not mandatory and data suggests that contamination may still be occurring, due in part to inconsistent nursing compliance. To provide a foundation for instituting safety improvements in the administration of chemotherapy, a mailed survey was distributed to a population of 68 oncology nurses in an outpatient setting to explore the disparity between evidence-based recommendations and actual implementation.

The Chemotherapy Handling Questionnaire previously developed …

Protecting The Skin Of Older Adults Through Surveillance And Pressure Ulcer Prevention Beginning In Emergency Services, Jennifer L. Zoeteman

Doctoral Dissertations

ED (emergency department) personnel are admitting to inpatient services increasing numbers of elderly clients who are at risk for skin breakdown. The ED environment is designed for short term care in response to emergent situations. Pressure related injuries originating in the ED lead to both physical suffering and financial burdens. Pressure relief strategies have been actively employed on an inpatient basis without translation to the ED environment. Evidence for best practice in PUP (pressure ulcer prevention) in the ED is not widely embraced. Prevention of PUs is primarily within the scope of nursing practice and amenable to improvements in the …

Perceptions Of Residential Elders Following Facilitated Advance Care Planning, Teresa M. Boersma

Doctoral Dissertations

The purpose of this project was to explore the perceptions of residential elders following a facilitated advance care planning (ACP) conversation. While literature is available regarding ACP and advance directives (ADs), there is minimal knowledge of first hand experiences from those who complete ACP and live in a residential or retirement community. Five residents of a retirement community who participated in facilitated ACP conversations also participated in a focus group interview to explore their perceptions of facilitators of and barriers to ACP and completing an AD. The interview was audio recorded and transcribed verbatim. Then the transcript was reviewed for …

An Evidence-Based Evaluation Of Medication Barcode Scanning Acceptance In A Community Hospital, Marie M. Vanderkooi

Doctoral Dissertations

Barcode scanning during medication administration is a powerful tool to prevent errors and support patient safety. In spite of the significant patient safety benefits, there is a lack of adoption and acceptance of barcode scanning. The purpose of this project was to implement an evidence-based assessment, utilizing a survey instrument based on the technology acceptance model, to understand adoption and acceptance of barcode scanning at a community hospital. Forty-four people, 38 nurses and 8 respiratory therapists, participated in the survey. Data analyses were performed using descriptive statistics, Kruskal-Wallis, Mann-Whitney U, and Spearman's rho tests. The subscales for the intention to …

The Effectiveness Of A Psychoeducational Intervention On Health Promoting Behaviors And Physical Health Of Adult Patients (18 And Over) On Antipsychotic Medications, Alice O. Mwanda

Doctoral Dissertations

Individuals on antipsychotic medications have been found to be disproportionately affected by overweight and obesity which increases their cardiometabolic risk. Psychoeducation has been found to be an effective strategy for risk reduction of cardiometabolic risks. This intervention examined the effectiveness of a psychoeducational intervention in adults (aged 18 and above) with severe mental illness. The four session, 8 week intervention encouraged an increase in fruit and vegetable intake and engagement in physical activity. The conceptual frameworks included the Health Promotion Model and Chronic Care Model. Outcome measures included nutrition, physical activity and health promoting behaviors. Biological outcomes included weight, BMI, …

The Influence Of Supportive Nursing Leadership In Staff Nurse Retention, Theresa L. Dawson

Doctoral Dissertations

Based on the increasing need to retain healthcare’s greatest assets, work environments must provide positive relationships and RN empowerment in an effort to improve staff nurse retention. A variety of factors can influence a registered nurse’s intent to stay, however supportive nursing leadership is thought to have the greatest impact on improving work environments resulting in greater job satisfaction. The purpose of this organizational assessment was to determine the current culture of supportive nursing leadership, RN perceptions of supervisory support, and themes that appeared to require nursing leadership development intervention. Based on these findings a series of leadership development workshops …

Primary Care Assessment And Interventions To Improve Physical Activity Among Insufficiently Active Adults Ages 18 Through 64 Years Old, Thomas A. Sanchez

Doctoral Dissertations

A number of chronic and debilitating conditions such as cardiovascular disease, stroke, hypertension, anxiety, depression, pain, osteoporosis, and falls are known to be delayed, improved, or prevented by increasing physical activity (PA) levels. The numbers of those affected form a substantial portion of the US population. As of 2011, for example, 26 million adults in the U.S. were diagnosed with diabetes mellitus (DM) alone. Another 79 million people had elevated blood glucose measurements putting them at risk for DM. Despite knowledge of the connection with chronic disease, PA levels are not consistently and quantitatively assessed during primary care office visits. …

Enhancing Communication, Satisfaction, And Self Efficacy In High-Risk Prenatal Women Using ‘Ask Me 3’, Cynthia A. Betterly

Doctoral Dissertations

Despite the recent advances in health care related to the patient-centered medical home, meaningful use, and the Affordable Care Act, the health care system has failed the vast number of patients who do not understand basic health information providers or educational materials designed to communicate to them. For the purpose of this project, low health literacy is framed as a barrier to patient and provider communication. Unfortunately, low health literacy often leads to adverse outcomes. These poor outcomes make improving health literacy a priority by acknowledging and evaluating health literacy interventions. The purpose of this project is to evaluate the …

Use Of The Cope Intervention For Depressed Adolescents, Lindsey R. Jelsma

Doctoral Dissertations

Depression disorders often present during adolescence. Depression can lead to difficulties with relationships, problems in school, and associated high risk behaviors. The goal is to identify and treat depression as soon as possible. The purpose of this project is to implement a cognitive– behavioral based intervention called Creating Opportunities for Personal Empowerment (COPE) to depressed adolescents. Previously, the COPE program has been implemented in outpatient and school settings. This intervention was implemented to adolescents in an inpatient psychiatric hospital. Effectiveness, acceptability, and feasibility were evaluated.

Twenty-five adolescents, majority female, ages 12-18 participated in this project. The participants completed all seven …

School-Based Nurse Managed Health Centers, Sylvia J. Simons

Doctoral Dissertations

School-based health centers (SBHCs) are a directed approach for providing health services to students who may otherwise lack them. Over the past 40 years, the number of SBHCs has olved from targeting public health concerns to the development of a specific collaborative model of care that is responsive to the unique needs of children. The purpose of this project was to develop a sustainable model for the creation and implementation of a school-based nurse-managed health center (SB-NMHC) with the capacity to improve health access and quality, and to reduce cost, while also mitigating present and future health disparities within a …