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Full-Text Articles in Medicine and Health Sciences
Transitioning Adolescents With Type I Diabetes To Adult Care, Kathyann Kenny Marsh Phd
Transitioning Adolescents With Type I Diabetes To Adult Care, Kathyann Kenny Marsh Phd
Dissertations
Background: Care transitions, defined as hospital discharge or movement from one healthcare setting to another, are currently a major concern for healthcare providers and policy makers alike. These care transitions are occurring in the context of increasingly fragmented care and have been known to result in hospital readmissions, adverse events, and medication errors. The adolescents' transition between pediatric and the adult care system is not only fragmented but occurs at a time when they are most vulnerable and ill equipped for change. Objectives: The purpose of this research was to conduct a feasibility study to examine if the use of …
Nutritional Status Of Patients With End Stage Liver Disease: An Outpatient Assessment, Anna Marie Cumming-Browne Hefner Phd, Msn, Cpnp, Rn
Nutritional Status Of Patients With End Stage Liver Disease: An Outpatient Assessment, Anna Marie Cumming-Browne Hefner Phd, Msn, Cpnp, Rn
Dissertations
Cirrhosis is the 12th leading cause of death in the United States. It is well documented end stage liver disease drives a patient to a catabolic state thus depleting them of essential nutrients. Malnutrition is often unrecognized and untreated in outpatients. Though BMI, nutritional intake, anthropometric measurements have been used in clinical trials, there still remains no standard nutritional assessment. The purpose of this dissertation was to (1) identify the incidence of malnutrition in patients with compensated and decompensated liver disease utilizing defined nutritional parameters (Subjective Global Assessment, anthropometric measurements, hand grip strength, and laboratory values) and (2) correlate with …
Description Of Medical-Surgical Nurses Care Of Patients At Risk For Pressure Ulcers, Barbara Jean Mayer Phd
Description Of Medical-Surgical Nurses Care Of Patients At Risk For Pressure Ulcers, Barbara Jean Mayer Phd
Dissertations
Aim: The purpose of this qualitative study was to explore and describe the level of understanding of PU development and prevention and perceptions of implementing PU prevention measures in nurses caring for patients in medical-surgical units. Method: The study was conducted in three (3) community hospitals within the same healthcare system using an Interpretive Description approach. Six (6) focus groups were conducted including thirty (30) participants. Findings: Participants described their knowledge of PU development and prevention as good and perceived continuing education as important in maintaining knowledge levels. Two (2) methods of identifying patients at risk for PU development were …
Determinants Of Health-Related Quality Of Life In Arab American Patients With Type 2 Diabetes, Yousef Zakarni Phd
Determinants Of Health-Related Quality Of Life In Arab American Patients With Type 2 Diabetes, Yousef Zakarni Phd
Dissertations
HRQL is an important aspect of chronic illnesses such as diabetes and needs to be considered by healthcare providers. It is one of the most important outcomes of healthcare interventions, representing an integral public health goal in Healthy People 2000, 2010, and 2020. Arab Americans (AAs), one of the most rapidly growing minorities in United States, tend to have a high prevalence of type 2 diabetes. The purpose of this study was to describe determinants of HRQL, including social support attitude, religiosity, and select demographics for AA patients with type 2 diabetes. A descriptive correlational study using a cross sectional …
Pain Management In Triage And Reducing Percentage Of Left Without Being Seen In An Overcrowded Ed, Christina Ballejos-Campos Phd
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 …
Relationship Between Delirium And Night-Time Interruptions In Icu, Amy R. Stuck Phd, Rn
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 …
Examining Nursing Presence In The Acute Care Setting As An Indicator Of Patient Satisfaction With Nursing Care, Wendy Hansbrough Phd, Msn, Rn
Examining Nursing Presence In The Acute Care Setting As An Indicator Of Patient Satisfaction With Nursing Care, Wendy Hansbrough Phd, Msn, Rn
Dissertations
Nursing presence is conceptualized as occurring within the nurse-patient relationship when the nurse acknowledges the uniqueness of the patient, within his or her context of being and chooses to intervene on the patient's behalf with a patient who allows the nurse into a reciprocal relationship. Nursing presence is described as occurring in varying levels and nurse expertise is suggested as one antecedent. Quantification of nursing presence would be useful in examination of nursing care outcomes, quality management and research. The Presence of Nursing Scale, PONS (Kostovich, 2002) was used in this study to test its reliability and determine its validity …
Compassionate Care, The Patient Perspective, Lori Burnell Phd
Compassionate Care, The Patient Perspective, Lori Burnell Phd
Dissertations
Professional mandates call for nurses to respond with compassion (e.g., American Nurses Association [ANA] Code of Ethics, International Council of Nurses [ICN]) and countless hospital mission and vision statements prominently display compassion as their fundamental purpose. As a component of healthcare and nursing models, however, defining characteristics and standards are inconsistent. Compassion as a means of establishing a connection on a spiritual level abounds in the literature (Buck, 2006; Grant, 2004; O'Brien, 2008; Schultz et al., 2007) and is documented as a nursing requirement (e.g., ANA, ICN); however, it remains virtually uncharted from the lens of the patient. Through interpretive …
Quality Of Life, Religious/Spiritual Coping, Demoralization And Depression In Heart Failure Patients, Terry Larsen Phd, Rn, Cns
Quality Of Life, Religious/Spiritual Coping, Demoralization And Depression In Heart Failure Patients, Terry Larsen Phd, Rn, Cns
Dissertations
Background: Research suggests that the heart failure (HF) population is particularly vulnerable to depression. Other factors may also affect quality of life such as religious/spiritual coping, and demoralization. Purpose: The purpose of this descriptive correlational study was to examine factors that predict health-related quality of life (HRQoL) in adults with heart failure. Specific Aims: (1) to examine level of religious/spiritual coping, spiritual distress, demoralization, depression and HRQoL among adults with heart failure; (2) to examine the relationships of religious/spiritual coping, spiritual distress demoralization, depression and selected demographic variables (age, gender, race/ethnicity and length of living with HF) with HRQoL. Methods: …
An Educational Initiative To Promote Evidence-Based Practice, Laurel Ann Ecoff Phd, Ms, Rn, Nea-Bc
An Educational Initiative To Promote Evidence-Based Practice, Laurel Ann Ecoff Phd, Ms, Rn, Nea-Bc
Dissertations
Evidence-based practice (EBP), recognized as essential in providing quality patient care and achieving optimal outcomes, is the integration of the best research evidence, patient preference, and clinician expertise. Healthcare providers must attain expertise in integrating EBP into the clinical setting. Fellowships are one strategy reported in the literature to assist nurses in acquiring needed knowledge and skills for evidence-based care. The purpose of the study was to evaluate the effectiveness of an educational intervention, the Evidence-Based Practice Institute (EPBI), to teach nurses the process of EBP for project implementation to improve nursing and patient outcomes. This descriptive study used a …
Predictors Of Re-Hospitalization For Home Healthcare Patients, Brenda Fischer Phd, Msn, Mba, Rn, Cphq
Predictors Of Re-Hospitalization For Home Healthcare Patients, Brenda Fischer Phd, Msn, Mba, Rn, Cphq
Dissertations
The overall purpose of this study was to examine the predictive capability of OASIS admission data for acute care re-hospitalization of home healthcare patients. Secondary data analysis using logistic regression was conducted on retrospective data from OASIS collected during the time period of July 1, 2006 to June 30, 2007. This study was conducted in a Medicare certified Home Health organization that is part of the largest public health system in California. The sample of 1802 patients with complete episodes of care was derived from a data set of 5,523 patients. All patients were included in the analysis and logistic …
Dyspnea: Effect Of Auricular Acupressure In End Stage Lung Cancer Patients, A Pilot Feasibility Study, Roger Alan Strong Phd
Dyspnea: Effect Of Auricular Acupressure In End Stage Lung Cancer Patients, A Pilot Feasibility Study, Roger Alan Strong Phd
Dissertations
Introduction: Dyspnea is a debilitating symptom, common in advanced lung cancer patients, and poorly controlled. The National Institutes of Health has promoted the need for research regarding end of life care symptom control. Purpose: Conduct a feasibility study evaluating auricular acupressure effects on dyspnea in hospice lung cancer patients. Theoretical framework: The UCSF School of Nursing Symptom Management Faculty Group's Model for Symptom Management was used for the conceptual framework. The model includes three dimensions: symptom experience, symptom management strategies, and symptom outcomes. The Human Energy Field Theory provided context for using auricular acupressure. Aim: Conduct a pilot study evaluating …
Nurse Practitioner Adoption Of Clinical Innovations, Rhoberta Jones Haley Phd
Nurse Practitioner Adoption Of Clinical Innovations, Rhoberta Jones Haley Phd
Dissertations
Adoption of clinical innovations by Nurse Practitioners (NP) is a complex phenomenon, rooted in personal values and influenced by challenges within health care environments. When clinical innovations are adopted or rejected by NPs, this decision has meaning for patients, NPs, health care agencies, and society. The decision controls the opportunity for patients to access a clinical innovation that could reduce morbidity and mortality, save money, and provide satisfaction related to the health care encounter. The purpose of the study was to increase knowledge about NP adoption of clinical innovations, particularly emotionally-laden clinical innovations. The lines of inquiry focused on what …
Healthcare Encounters Of Formerly Incarcerated Women: A Grounded Theory Study, Karen Sue Hoyt Phd
Healthcare Encounters Of Formerly Incarcerated Women: A Grounded Theory Study, Karen Sue Hoyt Phd
Dissertations
The adult correctional population in the United States soared to nearly 7 million people (Bureau of Justice Statistics [BJS], 2005). Over 2 million individuals were housed in prisons or jails in the United States. Nearly 7 percent (6.9%) were women (BJS, 2005). Recent trends in the adult correctional population suggest that there has been a stark increase in the number of formerly incarcerated women in the United States. The purpose of this research was to explore how formerly incarcerated women perceived their healthcare encounters. The aims of this study were to answer the following questions. How did formerly incarcerated women …
Changes In Functional Status Of Home Health Cardiac Patients From Admission To Discharge, Mary Rita Mcgoldrick Phd, Mph, Msn, Rn, Anp-Bc
Changes In Functional Status Of Home Health Cardiac Patients From Admission To Discharge, Mary Rita Mcgoldrick Phd, Mph, Msn, Rn, Anp-Bc
Dissertations
The purpose of this research is to examine the functional status (ADLs and IADLs) in patients with a primary/secondary diagnosis of cardiac disease in the home health setting. The independent variables of dyspnea and service were examined for the effect on discharge functional status while controlling for the effects of age, gender, race, admission functional status, primary and secondary diagnosis. A descriptive correlational, non-experimental study of cardiac patients in an urban home health agency from January 2003 to December 2004 was conducted using data collected through a retrospective chart review. Seventeen areas of OASIS (ADL and IADL) were assessed for …
Clients' Expectations Of Public Health Nurses' Home Visits, Eva G. Miller Dnsc, Ms, Rn, Phn
Clients' Expectations Of Public Health Nurses' Home Visits, Eva G. Miller Dnsc, Ms, Rn, Phn
Dissertations
Although there is considerable research on the relationship between client expectations and outcomes of care in acute care settings, less is known about clients' expectations for public health nurses' home visits. The aim of this study was to understand clients' expectations of public health nurses' home visits as a first step in making explicit how expectations affect client responses to, and ultimately, outcomes of public health nurses' care. Interviews were conducted with a convenience sample of 19 primary caretakers of high-risk infants admitted to a Neonatal Intensive Care Unit (NICU) and voluntarily enrolled in a High-Risk Infant (HRI) Program in …
Nursing Students' Knowledge And Attitudes Regarding Pain And Pain Management, Ruth L. Schaffler Phd
Nursing Students' Knowledge And Attitudes Regarding Pain And Pain Management, Ruth L. Schaffler Phd
Dissertations
Pain is a universal human experience and is a primary reason people seek health care; however, undertreatment of pain has been reported in the literature as a significant clinical problem for more than three decades. Researchers have concluded that nurses have inadequate knowledge of pain assessment, are misinformed about opioids, and have inappropriate attitudes about pain and pain management that lead to the undertreatment of pain. One question is whether those misconceptions are acquired in nursing school or whether they are present when students enroll in nursing programs. The purpose of this quasi-experimental study was to examine the attitudes regarding …
Reconciling Temporalities: A Substantive Explanation Of The Origins Of Difficulty In The Nurse Patient Encounter, Marilyn Theresa Macdonald Phd
Reconciling Temporalities: A Substantive Explanation Of The Origins Of Difficulty In The Nurse Patient Encounter, Marilyn Theresa Macdonald Phd
Dissertations
Nurses describe patients as difficult on a regular basis. Nursing research to date has assumed the existence of this phenomenon. Most studies have listed descriptors of the difficult patient and offered interventions for nurses to use to alter patient behavior. Locating of difficulty within the individual and failure to consider the context of the nurse patient encounter is problematic. The practice of locating difficulty in the individual absolves organizations and society of responsibility to work to change factors that contribute to the construction of difficulty. The purpose of this research was to move beyond a focus on the patient as …
Therapeutic Alliance: Development, Evaluation, And Application Of The Kim Alliance Scale, Son Chae Kim Phd, Msn, Fnp, Rn
Therapeutic Alliance: Development, Evaluation, And Application Of The Kim Alliance Scale, Son Chae Kim Phd, Msn, Fnp, Rn
Dissertations
The quality of therapeutic alliance between the patient and healthcare provider is a pivotal contributing factor toward optimal healthcare in the current context of rising healthcare costs, shorter hospital stays, and patient's rights. The availability of a well-designed and sound therapeutic alliance instrument can provide understanding and insight into improving the quality of healthcare. The purpose of this study was to develop a reliable and valid therapeutic alliance instrument, to evaluate its psychometric properties, and to explore its usefulness in predicting patient satisfaction. The retroductive triangulation method provided a framework for the development of the instrument, the Kim Alliance Scale …
Conceptual Metaphor In The Health Care Culture, Cheryl D. Glennon Dnsc, Ms, Rn
Conceptual Metaphor In The Health Care Culture, Cheryl D. Glennon Dnsc, Ms, Rn
Dissertations
The conceptual metaphor has meaning only when understood within the cultural framework which gives rise to the conceptualization. The purpose of this study was to investigate the interaction of cognition (conceptual metaphor) and culture as manifest during intercultural communication in teaching-learning sessions between health care providers and patients. An ethnography of communication (Hymes, 1974; Saville-Troike, 1989) was the method employed to investigate the use of metaphor by patients, nurses and other health care professionals. Patients were viewed as a sojourner group in the health care culture; nurses and their health care partners were seen as a host group. Data were …
Cultural Discovery In Nursing Practice: The Experience Of Nurses' Who Work With Vietnamese, Evelyn Labun Dnsc, Mscn, Rn
Cultural Discovery In Nursing Practice: The Experience Of Nurses' Who Work With Vietnamese, Evelyn Labun Dnsc, Mscn, Rn
Dissertations
The purpose of this investigation was to generate a substantive theory of cultural discovery among nurses who work with Vietnamese. A grounded theory approach involving dimensional analysis was employed. A purposive sample of 27 registered nurses with experiences working with Vietnamese in acute care, community, and clinic settings was interviewed using a semi-structured format. Data were analyzed for dimensions as well as conditions, context, action strategies, and consequences. The theory of cultural discovery described how nurses learn to see their Vietnamese clients, how they saw a common humanity with others, and how they learn to see health. Nurses who made …
The Effect Of Written Information And Reassurance On Patient Satisfaction, Anxiety, And Intent To Return For Emergency Care, June Andrea Dnsc
The Effect Of Written Information And Reassurance On Patient Satisfaction, Anxiety, And Intent To Return For Emergency Care, June Andrea Dnsc
Dissertations
Patients' satisfaction is one of the primary goals of emergency department (ED) providers today. As emergency departments are overcrowded, stressful environments, anxious patients want to be kept informed. Nurses have the opportunity to meet these needs and possibly influence the patients' perception of the experience and intent to return for future care. This study examined the effects of providing written information and reassurance on patient satisfaction, anxiety, and intent to return for emergency care. The design was a posttest design involving a comparison between the control and three experimental groups. Two hundred and forty patients participated in the study, approximately …
A Model Of Patient Satisfaction And Behavioral Intention In Managed Care, Diane Sturdy Greeneich Dnsc, Ms, Rn
A Model Of Patient Satisfaction And Behavioral Intention In Managed Care, Diane Sturdy Greeneich Dnsc, Ms, Rn
Dissertations
Determination of patient outcomes associated with new and return business is a primary objective of the managed care marketplace. Identification of variables which contribute to both positive and negative patient experience in managed care systems is crucial to their effectiveness. The purpose of this study was to test the functional relationships between the variables of nurse practitioner attributes and behaviors, patient perceptions of the managed care system, and outcomes of patient satisfaction and intention to return to and recommend the managed care system. Functional relationships were measured with the Patient Satisfaction Semantic Differential (Greeneich and Long, 1992), and the Service …
Sociolinguistic Dimensions Of Nurse Practitioner Practice: A Question Of Power, Merrily J. Allen Dnsc, Mn, Rn
Sociolinguistic Dimensions Of Nurse Practitioner Practice: A Question Of Power, Merrily J. Allen Dnsc, Mn, Rn
Dissertations
Ethnographic methods were used to examine the sociolinguistic dimensions of female nurse practitioner interactions with female patients. The purpose was to provide a contextual account of the discursive practices used by the nurse practitioners during routine office visits with female patients. Direction for this research was provided by my concern about power inherent in professional-client dyadic relationships. Data collection methods included formal and informal interviews, participant observation and audio taping nurse-patient encounters. Nine nurse practitioners and 26 patients participated in the study in both private and public ambulatory care settings. Data analysis yielded two concurrent story lines which I labeled …
Nursing Care Through The Eyes Of The Patient, Donna May Fosbinder Dnsc, Msn, Rn
Nursing Care Through The Eyes Of The Patient, Donna May Fosbinder Dnsc, Msn, Rn
Dissertations
Ethnographic methods were used to examine the nurse-patient interaction for the purpose of developing descriptive and explanatory theory of patient satisfaction based on patients' perceptions regarding their nurses' interpersonal skills. A private acute care hospital was the setting for 40 patients and 12 nurses who were study participants. Four processes provided the framework for the themes that emerged: "translating," "getting to know you," "establishing trust," and "going the extra mile." I labeled the action of nurses informing, explaining, instructing, and teaching patients the translation process. Informing and explaining were described by both patients and nurses as very important to the …
The Essential Characteristics Of Advocacy Associated With The Nurse-Client Relationship: The Client's Perspective, Victoria Louise Cole Schonlau Dnsc, Mpa, Bsn, Rn
The Essential Characteristics Of Advocacy Associated With The Nurse-Client Relationship: The Client's Perspective, Victoria Louise Cole Schonlau Dnsc, Mpa, Bsn, Rn
Dissertations
The purpose of this phenomenological study was to describe clients' lived experiences of advocacy associated with the nurse-client relationship. The sample consisted of ten non-hospitalized adults, 19 to 72 years of age, who had a hospitalization or ambulatory relationship with a registered nurse within the previous six months. Data were gathered via interviews initiated with the same open-ended question. Georgi's five step method was used for data analysis. Four essential characteristics of advocacy associated with the nurse-client relationship were identified. Described by clients as nurse attributes, behaviors, and actions, they were labelled: Competent Knower, Competent Doer, Humanizer, and Communicator. Clients …