Medicine and Health Sciences Commons^™

Substance Use Disorder Treatment Among African American Men Living In The Rural South Of The United States, Serge Raoul Wandji

Theses and Dissertations

Substance use disorders (SUD) affect more than 40 million Americans. African American (AA) men are disproportionally affected by the negative health and social consequences of SUD, and men in rural areas may be particularly at risk due to disadvantaged socioeconomic conditions and persistent race-related stressors such as perceived discrimination. The overall purpose of this study is to advance the understanding of factors associated with SUD treatment acceptance and relapse potential among Southern rural AA men.

This purpose was achieved by determining differences in treatment acceptance and relapse potential by race and gender among rural residents admitted in a SUD treatment …

Nurse Perceptions Of Caring And Professional Governance, Lan Angela Nguyen

Theses and Dissertations

Background: Caring, a characteristic of an effective work environment, and clinical nurse control over the professional governance of nursing practice results in higher nursing retention and better patient outcomes. Although the concepts of caring and professional governance of nursing practice, and their discrete associations with patient outcomes, are widely studied, little to no research is published on the nature of the relationship between caring and professional governance of nursing practice. Without understanding this relationship, it is challenging to explore the impact of this relationship on nursing practice and patient outcomes.

Aims: The purpose of this study was to describe nurse …

Advancing Knowledge Of Exercise As A Therapeutic Management Strategy For Women With Polycystic Ovary Syndrome, Pamela J. Wright

Theses and Dissertations

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among premenopausal women with a prevalence that ranges 15-21%. The estimated financial burden in the United States for evaluating and treating premenopausal women with PCOS was over $8 billion in 2020. PCOS etiology is complex and poorly understood, as is the optimal treatment and management. Endocrine Society Clinical Practice Guidelines recommend exercise as first-line treatment. Yet, the optimal exercise type and “dosing” are not defined. As last reported for women with PCOS, less than 60% are regularly physically active and more than 25% are sedentary. Additionally, little to no published data …

Nurses’ And Patients’ Perceptions Of The Availability Of Post-Hospital Instrumental Support As A Predictor Of 30- And 60-Day Acute Care Utilization, Beth E. Schultz

Theses and Dissertations

Social support is now part of the social determinants of health objective in Healthy People 2030. Positive social support improves health and well-being. Social support is concerned with people having the support they need within the community, including interacting and communicating with others on a regular basis. Instrumental support is a type of social support that is action oriented, involving one person directly assisting another person. A concept analysis of instrumental support was completed and revealed that the concept is well defined, but the terms used to describe it vary. Other terms in the research literature, most commonly “tangible support”, …

Race Is Not A Risk Factor: Examining The Influence Of Models Of Care, Race, And Discrimination On Racial Disparities In Maternal Outcomes, Curisa Mae Tucker

Theses and Dissertations

Maternal health outcomes are worst for racial and ethnic minority patients in the United States. There are disparities in pregnancy-related death and severe maternal morbidities where Black women suffer the most disparate outcomes. However, much of the previous scholarly work in this arena has charged that race is a risk factor for adverse maternal outcomes in which this dissertation refutes.

To better understand this phenomenon, we first conducted a scoping review of literature. Our aim was to examine the current state of literature on group prenatal care and its impact on maternal outcomes and racial disparities in adverse maternal outcomes. …

Examining The Relationship Of Blood Transfusions And Acute Morbidity In Preterm Infants, Kayla Chavis Everhart

Theses and Dissertations

Preterm infants, those that are born less than 37 weeks gestational age, often suffer major morbidity and mortality during hospitalization in the neonatal intensive care unit due to their prematurity; one of the major morbidities is Necrotizing Enterocolitis, a devastating gastrointestinal disease. The exact aspects that cause preterm infants to develop Necrotizing Enterocolitis are unknown; however, our hypothesis is preterm infant thermal stability and/or preterm infant stress around packed red blood cell transfusions are etiological factors in the relationship between these necessary transfusions and morbid outcomes such as Necrotizing Enterocolitis.This dissertation includes an in-depth background and introduction of various morbid …

Early Premature Infant Physiologic And Behavioral Indicators Of Ans Instability, Karen Popp Becker

Theses and Dissertations

The advanced survival of the early premature infant (EPI) since the post-surfactant era has not improved many comorbidities. EPI comorbidities influence their lifelong health, social, and cognitive outcomes. EPIs often have immature and disorganized responses to stimuli during the neonatal period. EPIs respond to stressors from the Neonatal Intensive Care Unit’s (NICU) environment, stimulation, or disease states based on physiologic system changes, often resulting in observable behavioral changes. Both physiologic and behavioral changes reflect autonomic nervous system (ANS) disruption, thus instability. Instability of the ANS due to chronic stressors, can lead to chronic physiologic dysregulation and lead to lifelong health …

An Evaluation Of The Healthfulness Of The Hospital Food Environment, Cynthia Elaine Horton Dias

Theses and Dissertations

Though nurses may have knowledge about the health promoting benefits of a healthy diet, many do not consume enough fruits or vegetables. For hospital shift nurses to achieve healthy eating while at work, environmental barriers were reportedly the most challenging to overcome. To better understand the hospital food environment from the nurses’ perspective, two mechanisms for workplace food acquisition were studied: 1.) hospital consumer food environment, which includes cafeterias, vending machines, and gift shops; and 2.) free food at work.

Through observations of 31 South Carolina hospitals using the Hospital Nutrition Environment Scan (HNES), descriptive data was collected to illuminate …

Examining Caregiver Vigilance For Child Sexual Abuse, Kate K. Chappell

Theses and Dissertations

Child sexual abuse (CSA) affects approximately one in four US children through adolescence. As an adverse childhood experience (ACE) implicated in long-term health and wellbeing, CSA is a pervasive safety concern. The influence of caregivers and healthcare providers is under-realized in CSA prevention. Examining the thinking processes preceding CSA vigilance response has been limited in research. Understanding the complexities in healthcare related to addressing CSA will facilitate caregiver-focused intervention in primary care. Guided by social ecology and protection motivation theories (PMT), the goals of this two-phase study were to explore caregiver cognitive processes towards vigilance for CSA and the challenges …

Exploring Turnover Among Nurse Managers, Directors, And Executives In Acute Care Hospitals, Deborah Hughes Warden

Theses and Dissertations

Background: The strength and quality of the nursing leader workforce is associated with staff nurse retention and patient outcomes. While leadership turnover is not always negative, there is still uncertainty, loss of program continuity, power shifts within an organization, and significant expense for the organization in recruiting and integrating a new leader.

Purpose: The purpose of this study is to explore intent to leave and turnover experiences of acute care nurse managers, directors, and executives.

Methods: For this nationwide survey, recruitment was done via snowball sampling through state hospital associations and professional organizations across the US with a resulting sample …

Psychometric Evaluation Of Lung Cancer Stigma Among Lung Cancer Survivors In South Carolina, Lisa A. Webb

Theses and Dissertations

Background: Despite the improved screening and treatment modalities, lung cancer is the second leading cause of cancer and accounts for 27% of all cancer deaths in the United States. Survivors of lung cancer experience physical, social, and particularly psychological challenges. Lung cancer stigma is a formidable challenge for survivors of lung cancer that complicates their physical, psychological and social well-being.

The Cataldo Lung Cancer Stigma Scale is the first instrument adapted to measure lung cancer stigma. This instrument was adapted from Berger’s HIV Stigma Scale. HIV stigma and lung cancer stigma share similarities. These health-related stigmas reflect behaviors that …

Chemotherapy Knowledge And Health Literacy Among Women With Breast Cancer, Pearman Detreville Parker

Theses and Dissertations

Chemotherapy education is imperative for patients to gain the knowledge to manage side effects, adhere to prescribed cycles, and recognize the severity of symptoms that require immediate provider contact. Two vital factors – the readability of teaching materials and the patient’s health literacy – must be considered during chemotherapy education. However, materials are often not assessed for readability. Further, the influence of a patient’s health literacy level and demographic factors on chemotherapy knowledge has not yet been investigated. The specific aims are to: (1) critique the readability and format of chemotherapy education materials; (2) explore how women with breast cancer …

Implementing A Surgical Pathway To Reduce Operating Room Cancellation Rates, Demerise Ott Minor

Theses and Dissertations

Improving operating room efficiency is a high priority as health care cost become more challenging. In order to reduce surgical cancellation rates, a process improvement plan was implemented using a preoperative surgical pathway to optimize a patient’s health prior to scheduling the surgical procedure. The surgical risk assessment tool risk stratifies the patient based on the urgency of the procedure, the type of procedure, and the patients overall medical disease state. The Surgical Risk Tool determines patients with surgical risk scores of 9 or greater require medical and/or cardiac clearance in addition to hemoglobin A1C of 8 or less and …

Initiating A Peer Support Program For Parents Of Children With Autism Spectrum Disorder In Richland And Lexington Counties, Danielle P. Simmons

Theses and Dissertations

Objective: To initiate a parenting support program for parents of children with Autism Spectrum Disorder (ASD) in Richland and Lexington Counties. Background: Parents of children with ASD have increased stress and a poorer sense of well-being relative to parents of children with typical development. This parent population in Richland and Lexington Counties identified lack of support as a major stressor. The parenting support model initiated (e.g. Parent to Parent program) is an evidence-based intervention used to provide peer support to parents of children with ASD. The training of veteran parents is essential in the development and initiation of a Parent …

Implementation Of Provider And Workflow Strategies To Increase Adherence To Tqip Guidelines In Traumatic Brain Injury, Regina Thompson

Theses and Dissertations

Traumatic brain injury (TBI) is a leading cause of death and permanent disability worldwide. The American College of Surgeon’s Trauma Quality Improvement Program (TQIP) has developed a set of recommendations for the management of trauma-related injuries, including TBI. The objective of this evidenced-based practice project was to implement provider- and workflow-based strategies to improve adherence to TQIP recommended guidelines for the placement of intracranial pressure (ICP) monitors. The primary outcome measured was number of ICP monitors placed post-intervention.

The author reviewed available literature and found six articles pertaining to guideline implementations. Analysis of the literature was performed utilizing Melynk and …

Initiating The Loeb Criteria In Long-Term Care, Janice Khauslender

Theses and Dissertations

Urinary tract infections are one of the most commonly reported infections in long-term care. Current practices often rely on non-specific symptoms, rather than specific genitourinary symptoms, to aid in the decision to obtain a urine culture. The literature does not support this practice due to the high prevalence of asymptomatic bacteriuria among long-term care patients, which does not have adverse outcomes when untreated. Antibiotics do not eradicate asymptomatic bacteriuria and place patients at risk of adverse reactions and increased risk of multi-drug resistant organisms. This clinical improvement project applied the Loeb criteria in two long-term care facilities to reduce the …

Online Risks, Sexual Behaviors, And Mobile Technology Use In Early Adolescent Children: Parental Awareness, Protective Practices, And Mediation, Kendra Allison

Theses and Dissertations

Mobile technologies (e.g., smartphones and associated social media accessed through downloadable mobile applications) have changed the social landscape of adolescent communication. Intertwined with this communication are risks, many of which are sexual. Evidence suggests online risks associated with mobile technology use can be mitigated by (a) parental awareness of online activities; (b) protective practices regarding content and contacts; and (c) mediation aimed at regulating access and use. Prior research on mobile technology use and associated risks in adolescent children focused on exposure to pornography, sexting, online victimization, and associated negative health outcomes. Parental awareness, protective practices, and mediation have also …

Forensic Patient Flow: An Imbalance Between Capacity And Demand, Versie J. Bellamy

Theses and Dissertations

Background: The United States (U.S.) has an ever-growing incarcerated population. The sheer volume of this population coupled with inefficient patient flow through the judicial and health care systems, create a large imbalance between the high demand for services and the capacity to deliver them. The delay in criminal defendants accessing mental health services is impacted by the lack of patient flow, which creates barriers to entering and exiting the forensic hospital system. The increasing demand for inpatient forensic services, coupled with a static supply of resources, warrants further intervention by treatment and service providers. Identifying and removing barriers to patient …

High Fidelity Simulation Experience And Development Of Clinical Judgment: Recent Graduate Nurses’ Reflections, Martha Kay Lawrence

Theses and Dissertations

Introduction: Nurse faculty endeavor to educate future nurses who are able to effectively transition to competent practice after graduation. Shrinking clinical resources and shortages of qualified clinical faculty have contributed to the increasing utilization of high fidelity simulation (HFS) as a substitute for and enhancement of clinical practice in nursing education. The growing body of HFS research documents both student and faculty satisfaction and increased student self-confidence and self-efficacy. A significant gap in the literature is the lack of research on the translation of knowledge gained in HFS to practice. The aim of this research was to investigate recently graduated …

An Evidence-Based Evaluation Tool To Assist Healthcare Providers In Their Assessment Of Effective Mhealth Applications For The Management Of Chronic Health Conditions, Sara Belle Donevant

Theses and Dissertations

Mobile health (mHealth) apps are considered a viable option to improve chronic disease management. Healthcare providers are now recommending mHealth apps for patient use to assist in managing chronic diseases. However, healthcare providers may have difficulty locating effective, evidence-based mHealth apps for patients as there are currently over 325,000 available health apps (Research2Guidance, 2017). Limited evaluation tools are available to assist healthcare providers in this process. Therefore, our goal was to develop an online mHealth evaluation tool to assist healthcare providers in the selection of evidence-based mHealth apps.

After creating a comprehensive pool of mHealth features, healthcare providers provided feedback …

Utilization Of The Usda Supertracker System In High Schools: A Quality Improvement Project, Twanda D. Addison

Theses and Dissertations

Obesity is a major chronic care condition proven to affect more than 12 million children and adolescents, age 2 to 19; categorizing approximately 17% of America’s youth as obese or overweight. As a result, Congress established federal mandates targeting obesity by enforcing nutritional policies for cafeteria and competitive foods to enhance learning environments. Establishing federal nutritional guidelines in education allows more than 31 million children to receive meals at a free or low cost in more than 96,000 public and nonprofit private schools. As such, the purpose of this quality improvement project is to compare individual food choices with the …

Assessment Of An Educational Intervention To Increase Knowledge And Intention To Take Hpv Vaccine And Cervical Cancer Screening In Nigeria, Chigozie Anastacia Nkwonta

Theses and Dissertations

Nigeria has some of the highest rates of cervical cancer morbidity and mortality in sub-Saharan Africa. Both the human papillomavirus vaccine (HPV) and cervical screening are effective prevention strategies against both HPV infection and cervical cancer. Lack of awareness, limited knowledge, limited decision-making agency, lack of spousal support and stigma are barriers to uptake of these preventive measures. Given patriarchal structures and norms through which men control family resources and dominate decisions, male involvement in initiatives aimed at improving sexual and reproductive health is necessary. Community-based health education is an effective intervention to improve knowledge and reduce stigma. The aim …

Efficiency Of Ambulatory Blood Pressure Monitoring Vs. 5-Day Serial Monitoring In A Military Treatment Facility, Kadijatu Kakay

Theses and Dissertations

The purpose of this process improvement project is to determine efficiency of ambulatory blood pressure monitoring (ABPM) vs. 5-day blood pressure checks in a military treatment facility. The sample consists of male and female active duty soldiers ages 18 to 54 years without a previous diagnosis of hypertension (HTN). The soldiers were assigned to a unit that is physically and mentally challenging, has demanding training opportunities and duty requirements, and are rapidly deployable in support of peacekeeping, humanitarian and combat missions.

The data collection method included a retrospective chart review of 128 charts randomly selected between June 2016 and May …

Implementation Of A Depression Screening Tool For Cardiovascular Patients In The Primary Care Setting, Amber Nicole Ballentine

Theses and Dissertations

Background: Patients with cardiovascular disease (CVD) have a two-fold increased risk of depression as compared to patients without CVD. According to the American Heart Association (AHA, 2016), there is no gold-standard procedure for screening for depression in cardiovascular patients. Screening for depression varies greatly across specialties and practices, often leaving a gap for detection and treatment of depression in cardiac patients. There are many depression screening tools available; however, the AHA recommends use of the patient health questionnaire (PHQ) screening tool. The PHQ-2 and PHQ-9 questionnaires are the most brief, sensitive, and specific depression screening tool for patients with …

Environmental Links To Ectopic Kidney Diseases, Firas Alhasson

Theses and Dissertations

Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in the western culture and worldwide. Its morbidity has been raising and it has become a burden on the public health. NAFLD is associated with other metabolic diseases such as Diabetic Mellitus and hypertension. NAFLD is a wide spectrum of symptoms, from an accumulation of fat in the liver (cirrhosis) to production of scar tissue (Fibrosis). The liver along with other distal organs such as the kidney and cardiovascular system can be damaged as ectopic manifestations of NAFLD. Contamination of drinking water with Cyanobacterium toxin (Microcystin) and water disinfection …

Home Exercise Therapy For The Treatment Of Knee Osteoarthritis, Kezia Nixon

Theses and Dissertations

Knee pain is the chief complaint of most osteoarthritis patients, and encourages them to seek medical attention. Unfortunately, pharmacological approaches to the treatment of knee osteoarthritis have been found to be inadequate. Given the prevalence and chronicity of osteoarthritic knee pain, there is an obvious need for treatments that can be provided for the course of the disease, with minimal adverse side effects. Exercise therapy has been found to significantly improve both pain and function among individuals with knee osteoarthritis. The primary objective of this quality improvement project was to investigate the effectiveness of a home-based therapeutic exercise program on …

Using Ultrasound Guided Peripheral Intravenous Catheters In Difficult Access Patients, Courtney Prince

Theses and Dissertations

The purpose of this quality improvement project is to compare the use of ultrasound to guide placement of peripheral intravenous (USGPIV) catheters versus standard techniques in difficult access patients, as measured by the number of attempts required to obtain venous access and total cost related to means of obtaining peripheral venous access between a nurse driven USGPIV and VAT team consults or physician assistance. The appraised evidence indicates USGPIV increases the number of successful PIV placements, prevents non-essential central lines and excessive needle sticks, and reduces patients and healthcare professionals frustrations (An et al., 2016, Au et al., 2012, Dargin, …

The Effect Of A Compassion Fatigue Awareness And Self-Care Skills Educational Program On Retention Among Certified Nursing Assistants Working In A Veterans Nursing Home, Michele M. Dreher

Theses and Dissertations

Background: Compassion fatigue is defined as the emotional and physical exhaustion that can affect helping professionals and caregivers over time. Certified nursing assistants (CNAs) are at high-risk for compassion fatigue due to their daily exposure to those who are suffering from a myriad of chronic medical and behavioral illnesses along with repeated workplace stressors. If not addressed early, compassion fatigue can adversely impact a CNA’s wellbeing and quality of resident care. Compassion fatigue is associated with high absenteeism, high turnover, and low retention rates. Despite these challenges, there is no published research on the effects of a workplace compassion …

Losing Weight With Five A’S (5 A’S): Assess, Advise, Agree, Assist, Arrange Framework And Motivational Interviewing (Mi) For Health Behavior Change Counseling, Jacqueline Baer

Theses and Dissertations

According to the Centers for Disease Control and Prevention (CDC), obesity has reached epidemic levels and has associated with increased risk of morbidity and mortality rates. The increasing prevalence of obesity is a major public health concern. Researchers calculate that health care costs are 44% higher among moderately and severely obese older persons than for persons at normal weights. Seventy-five percent of African American (AA) women are overweight and obese according to data from the CDC and The State of Obesity: Better Policies for a Healthier America. Compared to any other racial ethnic group, AA women are more likely to …

Evaluation, Treatment, And Education In The Hospice Setting By Initiating A Formalized Pain Card, Alyssa M. Soprano

Theses and Dissertations

The purpose of this DNP quality improvement project was to evaluate the use of a formalized pain card that Nurse Practitioners could use to assist clients and caregivers in making the decisions necessary for safe and effective pain management with improving outcomes by using the Brief Pain Inventory Form for measuring: 1) decreased pain, 2) increased pain, 3) pain relief. The appraised evidence suggested that there was a need for a policy standard for patients to notify when pain is unrelieved despite exhausting all other efforts to control pain (Glowacki, 2015). Forty-one (n=41) hospice patients were surveyed pre and post …