Medicine and Health Sciences Commons^™

Crna Decision-Making Within The Anesthesia Care Team, Cindi L. Dabney

Theses and Dissertations (ETD)

This research focused on Certified Registered Nurse Anesthesiologists’ (CRNAs’) perspectives on the value placed on their decision-making skills within the Anesthesia Care Team (ACT). The emphasis of the study was to examine CRNA’s perspectives on the strengths, challenges, conflict resolutions, and any other information they were willing to divulge when working with physician anesthesiologists in the ACT model. An electronic survey questionnaire was sent to practicing CRNAs, primarily in the southeast region of the United States, with 171 informants completing the questionnaire. Data analysis included demographic information of the convenience sample that included age, gender, initial educational preparation as a …

The Uncertainty And Psychological Health Of Family Caregivers Of Patients With Delirium In Intensive Care Units, Amal Shokri Haji Assa

Theses and Dissertations (ETD)

Each year, more than 5 million patients are admitted to an intensive care unit (ICU) in the United States, and up to 80 % of these patients develop delirium. Delirium is a common indicator of acute brain dysfunction in the ICU and a predictor of mortality, longer ICU/hospital stay, and long-term cognitive impairment. Family caregivers are a valuable resource in preventing, detecting, and managing delirium in the ICU. However, witnessing delirium episodes can generate adverse psychological symptoms in family caregivers that may compromise their health and well-being. Research in this area has demonstrated a gap in the literature regarding how …

Associations Between Postpartum Depression And Child Overweight And Obesity: Mediating Effect Of Maternal Feeding Behaviors And Beliefs, Michelle Harrison

Theses and Dissertations (ETD)

Purpose. Postpartum depression (PPD) is a mental condition that significantly affects 10% to 25% of women within the first year after the birth of their child. The mother-infant relationship is key to child growth. Previous studies have shown that PPD has a detrimental effect on children’s physical and psychological well-being as it affects the child through the mother’s parenting behavior. Depressed mothers show a lack of engagement with their children, which could extend to feeding practices influencing weight gain. The prevalence and severity of childhood overweight and obesity is a global public health problem. An increase in weight gain in …

Nursing Perspectives And Opinions On Early Or Delayed Sepsis Treatment: A Mixed Methods Approach, Pamela L. Harris

Theses and Dissertations (ETD)

Purpose. Each year at least 1.7 million adults in America develop sepsis. Sepsis can lead to life threatening organ dysfunction, severe hypotension, and death when severe sepsis or septic shock is involved. Sepsis is responsible for 50% of acute kidney injury (AKI), which is the most common form of organ dysfunction seen in critical care. Sepsis associated AKI results in loss of, or decreased renal function, is associated with adverse long-term outcomes, and carries a higher mortality rate than non-septic AKI, sepsis without AKI, or septic shock without AKI. Surviving sepsis guidelines suggests a 1-hour window from the time of …

The Relationship Of Child Health And Parenting Stress To Child Neurocognitive Development, Nancy Alise Farrell

Theses and Dissertations (ETD)

Problem. Although the United States rates high in economic resources, the neurocognitive development (NCD) of children falls behind many other developed nations. Levels of parenting stress may be linked to sociodemographic factors such as the high incidence of poverty in children or health disparities in children, which in turn may affect NCD in children. Using the data from an observational, longitudinal cohort study of a diverse population could provide information related to parenting stress, child health, and related factors to guide and support interventions with families and policies to improve child NCD. Aims. The overall aim of this study was …

Evaluation And Feasibility Of A Head Positioning Intervention In Patients With Intraparenchymal Hemorrhage, Wendy L. Dusenbury

Theses and Dissertations (ETD)

Stroke caused by intraparenchymal hemorrhage (IPH) is most commonly the result of hypertension-induced blood vessel rupture in the brain and is associated with devastating disability and high rates of death. To date, no intervention has improved outcomes in IPH stroke patients; however, head elevation may be one of the most important first steps to promote clinical stability in the hyperacute stage of IPH stroke because of the risk of increased intracranial pressure (ICP) in these patients. Nursing research completed in the late 1970s and early 1980s in patients with increased ICP due to traumatic brain injury showed that elevating the …

Development And Implementation Of Computer-Based Learning Modules On Alternative Communication For Pediatric Nurses And Nursing Students, Amanda Kaye Simmons

Theses and Dissertations (ETD)

Purpose and Rationale. To develop, implement, and assess computer-based learning modules (CBLs) on augmentative and alternative communication (AAC) with pediatric nurses and nursing students for knowledge outcomes, self-efficacy, and perceived relevance and effectiveness. Effective communication ensures all parties can understand and express themselves clearly, through any means necessary, often including AAC tools, supports, and strategies. Communication is essential in healthcare but there is limited research with pediatric nurses. Previous research with a single hospital indicated a need for nurse education on AAC. This research used focus groups and interviews to understand pediatric nurse and nursing student knowledge about AAC. The …

Early Diagnosis Of Alzheimer’S Disease In The Primary Care Setting, Raymond R. Romano

Theses and Dissertations (ETD)

The burden of Alzheimer’s disease (AD) affects not just the individual but also families, providers, and society. Early recognition and diagnosis of AD may reduce cost by reducing interaction with the health care system, earlier initiation of treatment, and prolonging time to long- term care. Primary care providers, the first contact for diagnosis of patients with AD, are not fulfilling the potential of early diagnosis for a variety of reasons. Biomarkers of AD emerge on average 15 to 20 years before clinical diagnosis, yet currently established biomarkers are not easily available in the primary care setting. A growing body of …

Mean Arterial Pressure In Acute Ischemic Stroke Study, Mary Angela Grove

Theses and Dissertations (ETD)

Background. There is little, if any, evidence available on the validation of blood pressure (BP) measurements obtained in the acute care setting. Despite this, acute stroke practitioners trust and rely on non-invasive blood pressure (NIBP) devices to guide acute ischemic stroke (AIS) patients’ treatment. Although systolic blood pressure (SBP) has been found to be the most unreliable measurement displayed on NIBP devices, treatment decisions for AIS are based on them. Today, 25 years after the FDA’s approval of alteplase, practitioners continue to use BP parameters of 185/110 and 180/105 to guide the initiation of alteplase bolus and infusion, although the …

Forecasting The Essential Chemotherapy Needed For Treatment Of Children With Acute Lymphoblastic Leukemia In Low- And Middle-Income Countries, Brian T. Lewis

Theses and Dissertations (ETD)

Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer, with contemporary therapy resulting in a 90% survival in high-income countries (HIC). However, an estimated 89% of the world’s children live in low- and middle-income countries (LMIC) where survival is much lower. Lack of access to essential chemotherapy contributes significantly to the decreased survival rates for LMIC, and inaccurate forecasting of chemotherapy needed may lead to stockouts or oversupply. This chapter describes a simple forecasting system with population and patient-based multipliers for each drug used in the treatment of pediatric ALL, thus estimating the essential chemotherapy quantities needed for a …

A Mixed Methods Evaluation Of Patient And Provider Perspectives Of Chronic Illness Management Following Kidney Transplantation, Catherine Kelley Pantik

Theses and Dissertations (ETD)

Introduction: Inconsistent, fragmented care coordination in kidney transplant recipients (KTRs)—whose management requires long-term, complex care, and multiple handoffs among providers—has been shown to result in suboptimal care and higher costs. In order to move forward in improving long-term outcomes, it is necessary to fully assess current practice patterns with appropriate measures. With a full and accurate picture of how elements of the management plan influence both KTR and the health care provider (HCP), it will be possible to implement changes that improve long-term outcomes.Methods: The Chronic Care Model (CCM) was the framework for the study. A mixed method research approach …

Effective Measures Of Weight Gain Five Years Post-Kidney Transplantation, Tara Calico Cherry

Theses and Dissertations (ETD)

BACKGROUND: Weight gain is commonly observed post-kidney transplantation and is associated with unfavorable health outcomes, such as graft loss, new onset diabetes, and cardiovascular disease. The purpose of this study was to determine the most effective measure for assessing body composition after kidney transplantation.

DESIGN: The study was a descriptive correlational follow-up study from a single kidney transplant site.

SUBJECTS: A total of 45 eligible patients from a 2007-2011 parent study were selected, ages of 37 to 78.

MEASUREMENTS: Body composition was obtained 5–8 years posttransplant via anthropometric measures (waist circumference, body mass index, and dual energy X-ray …

Health-Related Quality Of Life In Female Children With Congenital Adrenal Hyperplasia: A Mixed Methods Study, Lacretia Carroll

Theses and Dissertations (ETD)

Introduction. Health-related quality of life (HRQOL) has become a meaningful area in research, medical management, and in the evaluation of health outcomes. However, in children with congenital adrenal hyperplasia (CAH), HRQOL is a long-neglected subject. Previous research in individuals with CAH typically focused on medical treatment and outcomes, which suggested that HRQOL is influenced by personal factors such as genital ambiguity, impaired growth, higher incidence of obesity, metabolic syndrome, hypertension, acute adrenal crisis, as well as losses in psychosexual milestones and psychological functioning. Social contexts, such as family, were identified as factors that contribute to an individual’s perceived HRQOL. Today, …

Psychometric Evaluation Of The Nursing Child Assessment Teaching (Ncat) Scale In Two Samples Of Mothers And Children, Samantha H. Ransone

Theses and Dissertations (ETD)

The mother-child relationship (MCR) has received an increasing amount of attention over the last several decades regarding its effect on long-term child development. Because the quality and quantity of interactions in the MCR have been established as important predictors of the child’s development, early identification of areas in the relationship requiring support and intervention is essential for promoting positive child outcomes. Observational assessment of the mother and child is considered best practice in evaluating maternal-child interaction (MCI). The Nursing Child Assessment Teaching (NCAT) scale is an instrument that has been used to quantify the quality of interaction in the MCR …

Examining The Associations Between Depressive Symptoms, Body Mass Index, And Physical Activity Self-Efficacy In African American Mother-Child Dyads, Y'Esha Vonyae Williams

Theses and Dissertations (ETD)

In recent decades the prevalence of childhood and adult depression and obesity has increased worldwide. Multiple factors influence the onset of both depression and obesity. Individual manifestations of depressive symptomatology and health-related problems associated with obesity vary; however, genetics and environmental and psychological factors have been implicated as correlates. Consequently, both disorders can ultimately interfere with individuals’ activities of daily living and decrease their quality of life. African American women are known to have a higher prevalence of obesity and more severe depressive symptoms in comparison to Caucasian women. Likewise, African American children are more obese and experience many factors …

Modulation Of The Magnetic Properties Of Aqueous Metal Ions And The Bioelectrodynamic Effects On Cancerous And Noncancerous Cells, Marcy C. Purnell

Theses and Dissertations (ETD)

Bioelectrodynamics is the study of how electromagnetism affects the biophysical functions of living organisms by examining the effects on biochemical processing at the cellular level. The Cellular Energy Transfer Science (CETS) system modulates the magnetic behavior of aqueous metal ions by applying direct current (DC) with a Lorenz force to a hypotonic saline solution. This treated solution was then used to make growth media for cancerous and noncancerous cell lines in vitro. Exposure of cancerous and noncancerous cells to this media showed significant growth inhibition, cell cycle arrest, hyperpolarization of transmembrane potential and apoptosis of cancerous cells while not causing …

Burden, Depressive Symptoms, And Perceived Health In Male Caregivers Of Persons With End Stage Renal Disease, Loretta Alexia Williams

Theses and Dissertations (ETD)

Introduction: Men are increasingly assuming the role of caregiver to individuals with chronic illnesses. The debilitating effects of ESRD cause many of those diagnosed with the disease to require assistance from family caregivers. Caregiver literature well reports that caregivers experience mental and physical health effects related to this role. However, research involving the experiences of male caregivers of individuals with ESRD is understudied. These studies use the background and contextual as well as primary and secondary domains of the Stress Process Model to determine the levels of and explore the experiences associated with caregiver burden, depressive symptoms, and perceived health …

Health-Related Quality Of Life In Children With Cancer, Tha'er Ghandi Almomani

Theses and Dissertations (ETD)

Health-related quality of life is an important phenomenon to measure in children undergoing treatment for cancer. However, the effects of different treatment modalities and cancer related factors over the duration of treatment have not been explored. To assess the effects of different child-, cancer-, and treatment-related factors, we analyzed a large sample of children undergoing curative treatment for 5 different childhood cancer diagnoses. These diagnostic groups were Hodgkin Lymphoma (HL), Acute Lymphoblastic Leukemia (ALL), Acute Myeloid Leukemia (AML), Osteosarcoma (OS), and Melanoma. We analyzed a sample of 710 patients across the five diagnostic groups over four time-points in treatment. These …

Hemoglobin A1c And The Diagnosis Of Diabetes And Prediabetes In Children And Adolescents, Jennifer Mcguire Hitt

Theses and Dissertations (ETD)

Although the American Diabetes Association (ADA) adopted the use of the glycated hemoglobin (A1C) test as a method of diabetes and prediabetes diagnosis, the ADA has not developed firm guidelines concerning the use of the A1C test in children and adolescents, as research has not validated thresholds in this group. Diabetes and prediabetes are diseases influenced by multiple factors, including race and ethnicity, age, vitamin D deficiency, and body mass index (BMI). The purpose of this study was to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the A1C test compared to the gold …

Dopaminergic Genetic Contributions To Obesity In Kidney Transplant Recipients, Ashley Grimes Stanfill

Theses and Dissertations (ETD)

Background: Kidney transplant recipients are a population who experience a high likelihood of gaining a significant amount of weight (between 6 and 13 kilograms) during the first year after transplantation. However, not all kidney transplant recipients gain weight. Studies have found little difference in physical activity and nutritional intake among those who do and do not gain weight. Immunosuppressant medications have also not been shown to play a substantive role in post-transplant weight gain. Additionally, although some studies have shown that age, gender, and race can influence weight gain, this information does not fully capture the observed variance. These observations …

The Health-Related Quality Of Life Of Adults With Down Syndrome, Rebecca Jermyn Graves

Theses and Dissertations (ETD)

Purpose. The purpose of this study was to examine the health-related quality of life (HRQOL) and factors associated with the HRQOL of adults with Down syndrome (DS) as reported by adults with DS and their caregivers. The study was designed to compare measures of HRQOL, health problems, health risks, and health-care utilization of adults with DS based on self-report with those from caregiver-report and to explore associations between HRQOL and health problems, health risks, health-care utilization, adaptive behavior, and demographic characteristics. Background. The life expectancy of individuals with DS has lengthened from approximately 30 years around 1960 to over 50 …

Analysis Of Community-Based Accumulation Of Home Medications (Caches) Found At Death Scenes In Davidson County, Tennessee, Carrie E. Plummer

Theses and Dissertations (ETD)

Introduction: Stockpiling of unused medications by community-dwelling individuals results in Community-based ACcumulation of Home mEdicationS (CACHES). CACHES place the individual, health care and justice system, and ecosystem at risk for adverse outcomes including: a) diversion of prescription medications by friends and family, b) pediatric poisonings, c) adverse drug events, d) increased criminal justice system costs related to prescription drug abuse, e) increased health care costs, and f) pollution of local water supplies via improper medication disposal. This study explores the relationship among individual risk factors (gender, race, age, comorbid conditions), geographical location, health care risk factors (number of prescribers and …

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 …

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 …

Military Sexual Trauma Exposure And Heart Rate Variability Outcomes In Female Veterans, Elizabeth Ann Davis Lee

Theses and Dissertations (ETD)

Area of Investigation and Hypothesis: Decreased heart rate variability (HRV) has been used as a predictor of cardiac and all-cause mortality. Studies have documented decreased HRV in a variety of conditions, including posttraumatic stress disorder (PTSD), depression, age, coronary artery disease (CAD), diabetes mellitus (DM), and tobacco use but improvement with beta blocker (BB) treatment. No prior study evaluated the relationship between military sexual trauma (MST) exposure and HRV outcomes. The hypothesis of this study was that female veterans exposed to MST would have lower time domain HRV measures than a reference cohort reporting non-exposure. Methods and Procedures: Electronic medical …

Nurses Information Appraisal Within The Clinical Setting, Heather D. Carter-Templeton

Theses and Dissertations (ETD)

Information appraisal is foundational to information literacy, a necessary skill to support evidence-based practice. Little discussion in nursing literature exists regarding how nurses appraise information. If nurses lack information appraisal skills they cannot safely and effectively apply evidence in practice. Furthermore, if nurses at all levels are to engage in evidence-based practice, information appraisal in the clinical setting must be understood. The research study used an interpretive description design to define and describe the process of information appraisal in the clinical setting. Participants of this study represented a stratified purposeful sample of 44 registered nurses employed at a regional medical …

The Relationship Between Lower Extremity Bone Mass And Body Mass Index In A Nhanes Adolescent Population, James Randall Post

Theses and Dissertations (ETD)

The effect of body mass index (BMI) on bone mineral content (BMC) among adolescents has been researched yielding mixed results. This study explored the relationship of left lower extremity (LLE) BMC on BMI across the spectrum of weight in a large nationally representative group of adolescents. This descriptive study used secondary data from the publically accessible, cross-sectional survey files of the 1999-2004 Continuous National Health Assessment and Nutritional Examination Survey (NHANES) that contained whole body dual energy X‑ray absorptiometry (DXA) data as well as BMI calculations looking at the adolescent population 12- to19-year-olds at the time of the exam. The …

Characterizing Dietary Intake And Physical Activity Affecting Weight Gain In Kidney Transplant Recipients, Connie Klopfenstein Cupples

Theses and Dissertations (ETD)

Weight gain following kidney transplant is a significant problem with 50 to 90% of kidney transplant recipients gaining weight. Potential factors leading to weight gain following kidney transplantation have been thought to include a change in lifestyle such asdietary intake and physical activity, along with the use of immunosuppressant medications to preserve the newly implanted organ. Other influences affecting weight gain include genetic determinates such as age, gender and race. There is little data to confirm which of these factors may indeed lead to weight gain and obesity. The purpose of this study was to examine dietary intake and physical …

Evaluating The Impact Of The Guatemalan Nursing Program On Staff, Organizational, And Clinical Outcomes, Sara Williamson Day

Theses and Dissertations (ETD)

There is great disparity between the outcome of childhood cancer in developed and developing countries. Nurses, who comprise the largest group of health care professionals globally, are essential to successful treatment. Pediatric oncology education is generally unavailable for nurses in developing countries. This lack of education is likely to contribute to the disparity in survival rates, as undereducated nurses are unable to meet the demands of pediatric cancer care. A second critical problem in developing countries is the workload of the nurse, with a patient nurse ratio reported as high as 30 patients per one nurse.

In 2006, the quality …

Function And Pain In Community-Dwelling, Adult Mid-Southerners With Limb Loss, Cecile B. Evans

Theses and Dissertations (ETD)

Background: Limb loss affects about 1 in 190 people in the US. Risk factors for limb loss include diabetes, obesity, smoking, minority race, and poverty, which are all common in the Mid-South population. Function is impaired by limb loss, and pain associated with limb loss may further impair function.

Purpose: Describe the function, pain, health status, and demographics of community-dwelling, adult Mid-Southerners with limb loss. Estimate the relationship between function and pain, health status, and demographics of community-dwelling, adult Mid-Southerners with limb loss. Estimate the joint influences on function by pain, health status, and demographics of community-dwelling, adult Mid-Southerners with …