Medicine and Health Sciences Commons^™

The Role Of The Nurse Practitioner In The Patient-Centered Medical Home, Patricia M. Sohn

Dissertations

The Patient Centered Medical Home (PCMH) was established to improve patient access to high quality, cost-effective primary care. Critical to this new model of care is the optimal utilization of nurse practitioners (NPs) in performing services traditionally offered by physicians. This study compared the roles of NPs and physicians in providing primary care in two PCMHs in a local health care system. During the calendar year 2011, a total of 50,471 patient visits occurred in the two PCMHs. Each PCMH consisted of a Traditional Clinic that saw patients on a scheduled basis and a Convenient Care Clinic that accepted walk-in …

The Feasibility Of An Advanced Practice Registered Nurse-Managed Adhd Resource Center In Missouri, Kara Janelle Stackley

Dissertations

The primary objective of this project was to develop a survey to determine provider receptiveness to referring patients to an advanced practice registered nurse-(APRN) managed center for the diagnosis and management of Attention Deficit/Hyperactivity Disorder (ADHD). A secondary aim of this project was to develop a business plan for the center, provided feedback from the survey was determined to be supportive. Physicians were more likely to use ADHD clinical guidelines (65%) in their practice and expressed greater comfort managing ADHD. Only 50% of APRNs use the clinical practice guidelines and 50% reported they were uncomfortable diagnosing and managing ADHD. Almost …

Identification And Management Of Vertebral Column Fractures In Primary Care, Christopher Richard Hemmer

Dissertations

The purpose of this project is to perform a program evaluation of current treatment patterns of primary care providers for osteoporotic vertebral compression fractures (VCF). VCF’s result in significant morbidity and long term sequelae following a VCF is not uncommon. Additionally, there is controversy regarding the diagnosis and management of this disorder, especially as these relate to the clinical practice guidelines. This practice evaluation project included a pre and post-test survey and a continuing education offering. Thirty-nine physicians and nurse practitioners completed the survey instruments and attended the continuing education sessions. The educational session resulted in improvement of the provider’s …

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 …

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 …

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 …

Obstructive Sleep Apnea And The Effects Of Co-Existing Factors On Pacu Stay Time, Shari F. Jones Phd, Crna

Dissertations

Significance/Background: Obstructive Sleep Apnea (OSA) is the most common disturbance during sleep affecting 30% of the population. The occurrence of moderate/severe OSA is 11.4% in men and 4.7% in women. OSA is caused by repetitive partial or complete obstruction of the upper airway with apnea episodes. OSA is prevalent in western society, yet is frequently undiagnosed due to lack of knowledge of the disorder. This population presents a challenge during the peri-operative period due to increased risk for several complications. Of particular interest to Nurse Anesthetists, are respiratory complications that result in delayed emergence from anesthesia, delayed post-operative recovery, increased …

Case Study Of Parents Caring For A Child Having Type-1 Diabetes With Optimal Hga1c, Elizabeth Ciaccio Phd

Dissertations

Type 1 diabetes in school age children is a complex condition requiring continuous physical, nutritional, and therapeutic monitoring to prevent lifelong complications and maintain quality of life. In 2011, one in 400 children in the United States were affected by it. The purpose of this research study was to understand how parents achieve optimal HgA1c for their school age children with type-1 diabetes. Currently, there is very little research documenting how parents achieve this goal. Understanding this phenomenon more clearly can be used to inform future research, improve practice and provide information for development of effective health policy. Management of …

Assessing The Feasibility And Perceptions Of Health Services For Refugees Of Resettlement Organizations, Heidi Jean Worabo

Dissertations

Background: Since 1975 the U.S. has resettled 2.6 million refugees who had to flee from their home countries. Many refugee resettlement organizations have developed different models of innovation to promote a smooth transition between previous foreign refugee camps to U.S. communities so that refugees swiftly become economically and socially self-sufficient. Providing refugees with health benefits and resources has been foremost priority upon arrival as they try to overcome health care barriers. Yet there is a lack of literature examining the impact of these health services and how they are perceived by the program recipients. Purpose: This scholarly project aimed to …

A Qualitative Descriptive Study Of The Work Of Nurses In Interventional Radiology, Brenda Naef Boone Phd

Dissertations

This dissertation study explored the work of nurses in interventional radiology. Interventional radiology (IR) is an emerging field of practice in health care. More and more procedures that were historically done in the operating room are being performed in IR. This has led to higher acuity patients and an increased need for specialized nursing care. The work of nurses in this area of practice is not well described and as such can lead to a lack of understanding of nursing involved in high tech low touch areas. This qualitative descriptive research study was conducted to shed light on this under …

Pain Management In Triage And Reducing Percentage Of Left Without Being Seen In An Overcrowded Ed, Christina Ballejos-Campos Phd

Dissertations

Although in most emergency rooms, the patient is seen first by a highly trained triage nurse, the ED physician is trained to determine if the patient can safely leave the ED prior to in-depth exam, treatment and diagnosis. The goal is to keep the left without being seen by a physician percentage low, since a high number would indicate poor quality, additionally patients who present with pain, and then leave the ED prior to being seen can pose a greater risk. This study examined the association of nurse-initiated triage pain protocol on the LWOBS percentage rate of patients who present …

Inpatient Glycemic Management: Glucose Control Relationship With Hospital Variables, Discharge Planning And Education, Crisamar Javellana-Anunciado Phd, Fnp-Bc, Rn

Dissertations

This dissertation study examined the relationship of glucose control with clinical outcomes, costs, discharge planning and education. Extant studies showed that hyperglycemia, in the presence or absence of a diabetes diagnosis, is prevalent in hospitalized patients. Hyperglycemia is found in one-third of all hospital admissions and is linked to poor clinical outcomes and increased healthcare costs. Furthermore, clinical evidence suggests that lack of discharge coordination associated with medical errors and readmission. This entire body of work contains three distinct sections: Two manuscripts and a grant proposal. The two manuscripts in this study were based on more current retrospective data at …

Tobacco-Use Promotional Environment And Intrapersonal Environment: Predictors Of Smoking Intention Among Young Southern California Thai-American Adolescents, Arpakorn Magkunthod Phd, Msn, Rn

Dissertations

This study explores tobacco-use related environment, intrapersonal factors, and smoking initiation in Thai-American adolescents aged 10 to 16 living in Southern California. A purposive sample of 217 youth was recruited from seven Thai-community centers located in four counties of Southern California: The sample was fairly evenly distributed by gender with female (54.5%) and almost three quarters (70.9%) were born in the United States (70.9%). Age ranged from 10 to 16 years, with the mean age 12.71 years old (SD =1.835); 27% reported age of 11. Data were collected using the 97 item Teen Tobacco-Use Questionnaire. Findings indicated 12 participants (6.3%) …

Relationship Between Delirium And Night-Time Interruptions In Icu, Amy R. Stuck Phd, Rn

Dissertations

Background: This dissertation examined the phenomenon of delirium in the intensive care unit (ICU) setting. Delirium is a form of cognitive disturbance with a physiologic etiology and complex, multifactorial mechanisms of causation and risk. Delirium in the ICU patient presents a significant risk for adverse outcomes including increased mortality, length of stay, falls, and restraint use. ICU delirium can lead to persistent cognitive impairment beyond discharge and frequent skilled nursing placement. Identifying delirium requires accurate diagnosis that is optimized when validated instruments are used. Sleep deprivation has been linked to adverse health consequences including delirium. Previous studies investigating the relationship …

Breast Health And Mammography Screening In Older Women, Martha A. Ibarra Phd, Msn, Anp, Rn

Dissertations

Age-related health disparities in breast cancer screening are a public health concern. From 2002 to 2006, the median age for newly diagnosed cases of breast cancer was 61 years and the median age for breast cancer mortality was 68 years of age (Surveillance Epidemiology and End Results [SEER], 2009). Mammography is the best available screening tool for breast cancer detection (Susan G. Komen Foundation, 2008). The Centers for Medicare and Medicaid Services (CMS, 2006) reported that only about half of older women who are eligible for mammograms through Medicare obtain a mammogram every two years. The literature identifies psychosocial barriers, …

Nurse Manager Transformational Leadership Practices And Patient Outcomes Among Magnet And Non-Magnet Hospitals, Bridgett Byrd Sellars Phd, Msn, Ma, Rn

Dissertations

In 2004 the Institute Of Medicine called for healthcare leaders to embrace and adopt transformational leadership practices to promote quality of care and favorable patient outcomes. Nurse managers are accountable for 24-hour operations of their departments and influence patient outcomes. The purpose of this research was to examine the relationships among nurse manager transformational leadership practices, patient outcomes and hospital types (Magnet, On The Journey, and Non-Magnet). A correlational study examined relationships between self-reported transformational leadership practices of nurse managers and patient outcomes by hospital types. The study was conducted using a purposive sample of Association of California Nurse Leader …

Documentation: Delirium In The Hospitalized Older Adult, Jacqueline Fitzgerald Close Phd

Dissertations

Background: Delirium is a common, life threatening and preventable geriatric syndrome. Because this condition is frequently addressed by administering dangerous antipsychotic drugs, it is imperative that accurate systematic assessments are charted to determine the actual need for these medications. The purpose of the study was to describe medical record documentation of a systematic assessment of delirium in older adults who had been administered an antipsychotic medication. Methods: A descriptive correlational retrospective design was used for this medical record data based study. The setting was a 107 bed acute care community hospital located in southern California. Inclusion criteria were medical records …

Development Of An Advanced Practice Registered Nurse Primary Care Telephone Clinic, Linda G. Kaiser

Dissertations

Abstract Development of an Advanced Practice Registered Nurse Primary Care Telephone Clinic This pilot project developed and implemented a telephone clinic based on established Veterans Affairs telephone policy and procedures and determined patient acceptability of this new visit type as an alternative to face to face visits. The review of the literature produced research that indicates telephone clinics are a viable visit option for patients. Telephone visits provide access to the primary care provider while being convenient and economical for patients. Research studies demonstrate that patients are satisfied with this visit option. The pilot project was successfully implemented in a …

Instituting An Oral Health Preventive Service Program, Including Fluoride Varnish, For Preschool Children Birth To Five Years In A Rural Health Clinic: A Clinical Scholarship Project, Carol Ann Berger

Dissertations

Abstract This project was designed to institute an oral health preventive program in a rural health clinic, in a dental provider shortage area, promoting oral health in preschool children birth to five years by: (a) instituting a program that supports the Missouri preventive service program in oral health, (b) promoting oral screenings and fluoride varnish twice yearly, (c) assessing the risk of caries, (d) referring to appropriate dental services and (e) educating parents or guardian about the importance of oral health and how to maintain oral health at home with children birth to five years. This project sought to answer …

Oncology Nurses' Cultural Competence, Knowledge, And Attitudes Toward Cancer Pain, Ayman Alnems Phd, Msn, Rn

Dissertations

Effective pain management requires appropriate knowledge, attitudes, and assessment skills. The purposes of this study were to obtain information about the knowledge and attitudes of oncology nurses related to cancer pain and its management, to evaluate oncology nurses' cultural competence, and to investigate relationships between oncology nurses' cultural competence and their pain management knowledge and attitudes. Ferrell and McCaffery's (2008) Nurses' Knowledge and Attitude Survey Regarding Pain (NKASRP), the Cultural Competence Assessment Survey (CCA) (Doorenbos, Schim, Benkert, & Borse, 2005; Schim, Doorenbos, Miller, & Benkert, 2003), and a demographic questionnaire were used to measure oncology registered nurses' cultural competence and …

California School Nurses' Knowledge, Attitude, And Intention To Participate In Sexuality Education, Maria G. Matza Phd, Msn, Rnc

Dissertations

A critical need exists to provide adolescents with sexual health education as demonstrated by our nation's position in having the highest adolescent pregnancy rates among all the developed nations. The critical need is further pronounced by California's changing demographic profile of young Latinos who are projected to be the majority in 2042 and continue to demonstrate higher pregnancy and birth rates than other racial and ethnic groups. Currently, there is limited evidence to confirm if California's students are receiving sexual and reproductive health as required by law, nor is there evidence to link school nurses as teachers or consultants in …

Factors And Health Promoting Behaviors That Influence Maternal And Infant Outcomes In Older Pregnant Thai Women, Supawadee Thaewpia Phd, Msn, Rn

Dissertations

This dissertation summarizes research conducted in partial fulfillment of the program requirements for the Doctor of Philosophy in Nursing degree from the Hahn school of Nursing and Health Sciences, University of San Diego. The results of the dissertation research are organized as three discrete papers. Article one is entitled; "Reliability and Validity of Thai Translations of Instruments Measuring Psychosocial Factors and Health Promoting Behaviors among Older Pregnant Thai Women." This article describes the dissertation research study in which the selected instruments were piloted at an antenatal clinic in Thailand. The article determines the instruments' ability to examine perceived benefits, perceived …

The Impact Of Guided Imagery On Sleep Quality In Mothers Of Preterm Infants, Linda M. Schaffer Phd, Mn, Rn

Dissertations

Background: Mothers who have given birth to preterm infants are at an increased risk for impaired sleep. Evidence based interventions are needed to assist mothers in improving their sleep quality as few are available. Purpose: Guided by the transactional framework of Lazarus and Folkman (1984), the purpose of this study was to: describe maternal and infant factors which influence sleep quality, examine the relationships between depression, anxiety, stress, social support, to sleep quality, and describe the influence of a R-GI intervention on sleep quality among a sample of mothers whose preterm babies were admitted to NICU. Methods: This prospective, descriptive, …

Enzyme Therapy In Oncology Care: A Clinical Scholarship Project, Julie Penick

Dissertations

Studies worldwide indicate that oral enzyme therapy (OET) can prevent or reduce the side effects associated with standard oncology care. Yet use of OET is not common in the United States. The ultimate aim of the proposed project is to improve the quality of life of women with breast cancer who are on standard chemotherapy protocols. Achieving this goal can be facilitated by implementation of the proposed feasibility project designed to: (a) enhance the knowledge of oncology care providers and women with breast cancer on use of OET in conjunction with standard oncology care, (b) assess the attitudes of oncology …

Acute-To-Home Care Nursing Handoffs: Distributed Cognition Across Patterns Of Knowledge, Rosemary Kennedy

Dissertations

Timely, explicit, and effective communication of patient information during care transitions is fundamental to safe care. Studies show that handoffs or transfers of patient care from one provider to another are susceptible to communication failures (Riesenberg et al., 2009a). Most studies on communication failures focus on communication between providers within the same setting of care. Few studies, if any, focus on communication between care settings in different locations. However, research has identified gaps in care during critical transitions and identified poor communication and incomplete transfer of information as the root cause (Naylor et al., 2004). This qualitative dissertation consists of …

In Search Of Resilience And Positive Health Outcomes In Low-Income Adolescents With Asthma, Darla Kim Dewolff

Dissertations

Asthma is a chronic lung disease of epidemic proportions affecting 24.6 million Americans, including 7.0 million children. In particular, 22% of high school students indicated a doctor or a nurse had told them that they had asthma, with 10.8% with current asthma. The disease disproportionately afflicts minority children from low-income areas. Adolescents with asthma, who live in such areas, are at particular risk for increased morbidity and mortality. The purpose of this study was to examine the degree to which the phenomenon of resilience, observed in other physical health and psycho-social contexts, may be found in adolescents with asthma exposed …

Coping Mechanisms Among Lebanese First-Time College Students, Rita Doumit

Dissertations

No abstract provided.

The Development Of Trust In The Nurse-Patient Relationship With Hospitalized Mexican American Patients, Sharon M. Jones

Dissertations

The Hispanic population in the United States is growing and this population experiences health care disparities compared to non-Hispanic Whites. Mexican Americans are the largest sub-group of Hispanics and providing nursing care that is patient-centered and culturally competent is important when caring for this population. Trust is an important component of patient-centered care and culturally competent care as well as a major element , (confianza) in the Hispanic culture. Although nursing researchers have identified the need for trust in culturally competent care with Mexican American patients, none have explored how trust develops between the nurse and the Mexican American patient. …

Risk Perception, Psychological Well-Being, And Health-Promoting Behaviors In Persons Informed Of A Coronary Artery Calcium Score, Jennie Elizabeth Johnson

Dissertations

Background: Cardiovascular disease (CVD) remains the leading cause of adult deaths because individuals continue to engage in behaviors that exacerbate CVD. New technologies such as coronary artery calcium (CAC) screening detect atherosclerosis before clinical disease is manifested. Awareness of an abnormal finding should enhance motivation for change.

Objective: To examine how awareness of a CAC score affects risk perception and health-promoting behaviors in persons at high risk for CVD.

Methods: This study used a descriptive prospective design with 174 high risk adults (3 or more major risk factors) recruited at a radiology center offering CAC scans in a Chicago suburb. …

The Emotional Intelligence Profiles And Cognitive Measures Of Nurse Anesthesia Students In The Southeastern United States, Shawn Bryant Collins

Dissertations

Problem. The purpose of this cross-sectional correlational study was to explore the relationship between emotional intelligence and personal and academic factors of nurse anesthesia students at three points in a program: matriculation, at one year of study, and in the last semester of study and the relationship of these to clinical scores and national certification examination (NCE) scores.

Method. An ex-post-facto cross-sectional study design was used to gather data at three critical times in nurse anesthesia (NA) programs to explore the relationships between emotional intelligence scores, preadmission demographics, clinical scores, and NCE scores.

Results. Data from 216 nurse anesthesia students …