Medicine and Health Sciences Commons^™

From War To Home: The Systematic Issues Operation Enduring And Iraqi Freedom Veterans Face Transitioning With Ptsd, Tiffany D. Ware

Dissertations

Purpose: The purpose of this phenomenological study was to describe the perceptions of Operation Enduring and Iraqi Freedom veterans with PTSD, who are transitioning from active duty to civilian life, regarding their participation in the Disabled Transition Assistance Program.

Methodology: The methodology for this research study will be qualitative from a phenomenological perspective. When thinking of research as it pertains to qualitative methods, it is appropriate to use when a researcher is trying to study the lived experiences of individuals (Flipp, 2014; Patton, 2015). This method will describe perceptions of Operation Enduring and Iraqi Freedom veterans with PTSD, who are …

A Mixed-Methods Study: An Examination Of The Relationship Between Private Social Media Participation And Accountability, Adherence, And Social Connectedness In, Diana A. Cabori

Dissertations

Purpose: The purpose of this mixed-methods sequential explanatory study was to examine the influence of private social media usage on accountability, adherence, and social connectedness in weight loss and fitness program participants.

Methodology: This study utilized a mixed-methods sequential explanatory research design comprised of a multi-state quantitative survey of weight loss and fitness participants and subsequent qualitative interviews to elucidate the influence of private social media on weight loss and fitness program participants regarding program accountability and adherence, and social connectedness to others. The population included 3,000 participants of The Camp Transformation Center and 1,000 participants of Warrior Fitness and …

Peri-Operative Regional Nerve Blocks (Pnb) In The Treatment Of Pain In Patients Undergoing Operative Fixation Of Lower Extremity Fractures, Joshua K. Radi

Dissertations

This research explores current approaches to managing pain control in patients undergoing operative fixation of lower extremity fractures. As opioid use in the U.S. and abroad increases, alternative methods of treating and preventing opioid requirements are being examined. Patients with lower extremity fractures are susceptible to nonunion when anti-inflammatories are consumed, so alternative approaches are warranted. One such alternative, a peri-operative regional nerve block (PNB), is accomplished by injecting local anesthetic adjacent to one or more peripheral nerves supplying the area of the fracture to decrease pain (Fowler, Symons, Sabato, & Myles, 2008). The goal of this research was to …

Evaluation Instruction In Council On Education For Public Health Accredited Master Of Public Health Schools And Programs, Kristin Ann Hobson

Dissertations

Despite the increasing role of evaluation in public health practice and research (Association of Schools and Programs of Public Health [ASPH], 2006; Institute of Medicine [IOM], 1998; Public Health Functions Steering Committee, 2008; United States Government Accountability Office [GAO], 2012), as well as Henry and Mark’s (2003) assertion of a need for systematic evidence on evaluation training and education, the literature continues to lack studies on evaluation instruction in Council on Education for Public Health (CEPH)-accredited Master of Public Health (MPH) schools and programs. As such, this study explored evaluation instruction in CEPH-accredited MPH schools and programs in the following …

High School Seniors' Educational Experience Lnfluencing The Decision To Pursue A Career In Nursing, Ryan L. Rowe

Dissertations

Many high school students interested in nursing as an occupation choose to engage in a Career and Technical Education (CTE) program and subsequently progress through the exploration stage of Super’s Career Development Theory in a succinct, deliberate, and intentional manner. While CTE continues to serve as an educational option for many high school students interested in nursing, its value as a means for students to crystallize, specify, and implement the choice to pursue the high-wage, high-skill, and high-demand career of nursing is not understood to the extent possible. CTE is regularly overlooked as a viable educational option by high school …

Predictors Of Cognitive Function Among Cognitively Impaired Older African Americans Living In Congregate Residential Settings, Zyra Daffodil Apugan

Dissertations

The purpose of this secondary data analysis was to identify potential psychosocial predictors of cognition, including social support, depression, and functional activity, among older African Americans, ≥ 65 years, with a diagnosis of Alzheimer’s disease and living in congregate residential settings. Guided by the main effect model of social support, this study used existing data from the National Alzheimer’s Coordinating Center Uniform Data Set, an NIH-funded multicenter study. Results showed that on average, the participants (n=56) were 81.7 years of age with 13.8 years of education. All, but six, were married. Bivariate Pearson correlations indicate a moderately strong negative relationship …

Testing The Double-Deficit Hypothesis In Arabic Language Among Emirati Students In Grade-3, Mahmoud Fahid Mohammad Gharaibeh

Dissertations

The purpose of this dissertation was to test the validity of the double-deficit hypothesis as applied to a sample of third-grade Arabic-speaking students in the United Arab Emirates. The double-deficit hypothesis postulates that individuals with a combination of Rapid Automatized Naming (RAN) and Phonological Awareness (PA) deficits will tend to have worse reading ability than individuals with either a RAN deficit, a PA deficit, or no deficit. Thus, the double-deficit hypothesis has been advanced as an explanation of dyslexia. Descriptive statistics were used to describe the essential feature of data in the study, and a correlational study design was applied …

Monitoring Patient Safety In The Recovery Room, Gail Davis

Dissertations

Respiratory depression is a serious complication after surgery. Early detection is a major patient safety concern for recovery room personnel as patients recover from anesthesia and experience pain. The opioids used for pain management may contribute to over-sedation effects and respiratory depression. Vital signs and pulse oximetry are standard postoperative monitoring procedures. End-tidal capnography and arterial blood gases may augment the standard-of-care procedures but may not be effective at detecting early respiratory depression. The purpose of this study was to generate baseline data trending patient safety variables and outcomes for postoperative patients using standard monitoring with standard-of-care plus transcutaneous capnography …

Finding Common Ground: Learning From Leaders Who Have Utilized Conflict Transformation Behaviors In The Mental Health Field In The United States, Tamarah E. Tilos

Dissertations

Purpose: The purpose of this study was to discover and describe how exemplary leaders establish common ground and produce breakthrough results in the mental health field by utilizing the 6 domains of conflict transformation: collaboration, communication, problem solving, process, emotional intelligence, and ethics.

Methodology: This thematic, phenomenological study was accomplished through examination of the lived experiences of exemplary leaders with firsthand experience transforming conflict and finding common ground. The target population for this study included executive-level leaders of nonprofit organizations, governmental institutions, state and national associations, and private businesses serving adults and children with mental illness, developmental or behavioral disabilities, …

Implementation Of The National Asthma Guidelines In A Residential Pediatric Clinic, Patricia A. Foster-Staples

Dissertations

Abstract

Purpose: Foster care children admitted to residential facilities are a unique and vulnerable group, many presenting with undiagnosed or poorly managed asthma. The alarming rate of residents admitted to a particular residential primary care clinic with a diagnosis of asthma led to the project question: “Based on record reviews, does staff education about the importance of utilizing the national guidelines for asthma education influence the implementation of such guidelines in a residential pediatric clinic?” The purpose of this quality improvement project was to implement a systematic process to influence practice change. The project was conducted over a period …

A Healthcare Provider Needs Assessment Regarding Transgender Patient Health For A Student Health Services Center, Dorothy J. Cochran

Dissertations

Objective: This study sought to identify education and training needs of university health service providers regarding transgender patient care. Transgender patients are a vulnerable population who tend to have negative health outcomes. Limited information exists regarding transgender patients and their providers at student university health services nationally.

Methods: The researcher conducted a one hour semi-structured focus group with the professional staff at a Midwestern state university health service. The focus group conversation was guided by a list of prepared questions but other issues were allowed to arise. Two readers qualitatively analyzed the focus group transcripts for predominant themes.

Participants: The …

A Functional Algorithm For Weight Loss And Obesity Practice: Guide For Clinical Decision-Making For Treating Women, Jennifer A. Tice Williams

Dissertations

ABSTRACT

Background

Overweight and obesity have significant impact and consequences on women leading to reduced quality of life, comorbid conditions and premature mortality. Many healthcare providers lack adequate training and the time to properly treat overweight and obesity. Algorithms have been shown to improve clinical knowledge and save time.

Objectives

To develop an algorithm for weight loss assessment and treatment to aid in the clinical decision-making process while improving the quality of care for overweight and obese clients in an efficient manner that can be replicated.

Methods

After an extensive literature review to identify best-practice guidelines for weight loss a …

Birth Record Analysis Of Gestational Diabetes: Applications For Intervention Planning, Elizabeth L. Macquillan

Dissertations

Gestational diabetes (GDM) rates in the U.S. and in Michigan have increased over the past several decades, along with the increases in Type 2 Diabetes Mellitus and obesity. GDM is associated with adverse health outcomes for mothers and their offspring. Many current maternal-infant health (MIH) programs in Michigan do not target women with GDM. This study aims to assess state-level rates of GDM in pregnancy with a combination of statistical and spatial analyses using Geographic Information Systems (GIS) for the purpose of informing content and location of public health interventions.

Existing data from 2013 Michigan birth records (107,743 births) were …

Discriminative And Reinforcing Effects Of Cocaine-Levamisole Combinations, Zachary J. Zimmermann

Dissertations

The behavioral and neurochemical effects of cocaine are well established, and it is one of the most widely abused illicit drugs. Illicit cocaine is often adulterated with levamisole, which is an anthelmintic that was withdrawn from the U. S. market in 2000. It has been hypothesized that levamisole, unlike other common adulterants which are added as simple bulking agents, has effects of its own which may be responsible for its use as an adulterant. Although these effects are speculative, the addition of levamisole to cocaine has become an increasing public health concern, as serious adverse effects (e.g., vasculitis, neutropenia) of …

A Novel Role For Osteopontin In Facilitating West Nile Virus Neuroinvasion, Amber M. Paul

Dissertations

West Nile virus (WNV) is a positive-sensed, single-stranded RNA flavivirus that can cause human neuroinvasive diseases, including encephalitis, meningitis, and flaccid paralysis. The mechanisms by which WNV enters the central nervous system and the host-factors that are involved in WNV-neuroinvasiveness are not completely understood. Osteopontin (OPN), a multifunctional glycoprotein, has been implicated as a bio-marker for a number of neuroinflammatory diseases. In particular, secreted (s)OPN has been implicated to participate in recruitment of polymorphonuclear neutrophils (PMN) to sites of its expression, while PMNs have been suggested to act as WNV reservoirs. Therefore, sOPN recruitment of PMNs may contribute to neuroinvasive …

Defining Deliberate Practice In Supervised Dietetics Education, Kevin D. Haubrick

Dissertations

Deliberate practice serves as a potential framework to understand what activities, attributes, and characteristics make an individual an expert in their chosen field or profession. Historically, deliberate practice activities included those that were highly structured with purposeful goals, frequent repetition, and active feedback with immediate remediation. Deliberate practice has never been defined within the context of supervised dietetics education; therefore, the purpose of this research was to develop a valid and reliable instrument to define deliberate practice in supervised dietetics practice, based on the opinions of practitioners and educators in dietetics and allied health professions. Segment one of the research …

An Exploratory Study Of The Utilization Of Evidence-Based Pharmacological Treatment On Heart Failure Patients In Mississippi And Its Impact On Readmission, Keri A. Barron

Dissertations

The purpose of this study was to explore the relationship of adherence to evidence-based guidelines for pharmacologic management by select Mississippi hospitals and their hospital readmission rates. This was an exploratory study with a retrospective design. This design offered insight into the relationship between readmissions of heart failure patients and adherence to the national guidelines for the pharmacologic treatment of heart failure. The study took place in a hospital in the southeastern section of the United States. Data were collected from a database of patients with heart failure seen between January 2011 and June 2014.

The unit of analysis for …

The Design Of An Instrument To Assess Clinical Laboratories Efficacy Post Implementation Of The Patient Protection Affordable Care Act, Harry Mcdonald Jr.

Dissertations

The healthcare system in the United States has undergone substantial changes in support of the Patient Protection and Affordable Care Act (PPACA). On March 23, 2010, the implementation of the new healthcare law brought universal healthcare access to all Americans, while attempting to increase quality and decrease medical costs. The new law promotes more of a quality-focused, outcome-based model rather than a pay-for-fee service model; thus, moving the paradigm from infrequent to preemptive healthcare. The PPACA postulates as the only way to achieve cost savings while increasing quality and access. Never before has there been such an extensive change to …

Study Of Rickettsia Parkeri Colonization And Proliferation In The Tick Host Amblyomma Maculatum (Acari: Ixodidae), Khemraj Budachetri

Dissertations

Amblyomma maculatum (Gulf coast tick) ticks are prevalent across the Atlantic to Gulf Coast region of United States. These ticks are recognized vectors of Rickettsia parkeri, a spotted fever group of Rickettsia (SFGR) known to cause American boutonneuse fever associated with fever and eschar rashes localized to the site of bites. We hypothesized that Rickettsia parkeri colonization and proliferation in the tick vector involve pathogen-symbiont dynamics and tick-pathogen interactions, which influence rickettsial transmission to the victims after tick bites. The rickettsial infection is maintained across the tick life cycle for many generations due to transovarial and transstadial transmission of …

William Walker And The Seeds Of Progressive Imperialism: The War In Nicaragua And The Message Of Regeneration, 1855-1860, John J. Mangipano

Dissertations

For a brief period of time, between 1855 and 1857, William Walker successfully portrayed himself to American audiences as the regenerator of Nicaragua. Though he arrived in Nicaragua in June 1855, with only fifty-eight men, his image as a regenerator attracted several-thousand men and women to join him in his mission to stabilize the region. Walker relied on both his medical studies as well as his experience in journalism to craft a message of regeneration that placated the anxieties that many Americans felt about the instability of the Caribbean. People supported Walker because he provided a strategy of regeneration that …

An Analysis Of Ed Nurse Opinion Of Their Ed Nurse Manager Leadership Characteristics And Outcomes, Charlotte Ann Gore

Dissertations

The purpose of this cross-sectional, descriptive, correlational study was to examine ED staff nurses’ opinions of their ED nurse managers’ full range of leadership characteristics , the degree to which the characteristics correlate with specific outcomes of leadership behavior, and how the results of the measure and subscale compare to other nursing groups in literature. The Multifactor Leadership Questionnaire 5X Rater Form (MLQ 5X Rater Form) was used to measure ED staff nurses’ opinions of their ED nurse managers, along with an ED Staff Nurse Demographics Questionnaire to gather information about the characteristics of the population. The population for this …

A Motivational Profile Of Nurses Who Pursue Doctoral Education, Tomekia Yvette Luckett

Dissertations

The need for nurses to pursue doctoral education is imperative to the professionalization of the discipline of nursing in light of the changing healthcare environment. Presently, < 1% of the nursing workforce possesses a doctoral degree (“Transforming Nursing Education,” 2016), albeit recommendations from the Institute of Medicine (IOM) (2010) admonish the need to increase the number of doctoral-prepared nurses. The need to understand characteristics of nurses who seek doctoral education is critical in planning long-term strategies for nursing education in the United States (US) (Kovner, Brewer, Katigbak, Djukic, & Fatehi, 2012). In conjunction with describing characteristics of nurses pursuing doctoral education, this research describes the motivational orientation and factors of registered nurses (RNs) pursuing doctoral education.

A descriptive correlational design was utilized to examine concepts relating to motivational orientation of RNs pursuing doctoral education. Participants were divided into two categories: (a) RNs seeking the Doctor of Philosophy (Ph.D.) degree and (b) RNs pursuing the Doctor of Nursing Practice (DNP) degree. A total of 173 RNs enrolled in either a Ph.D. or DNP program in the Gulf South region of the US comprised the final sample. Binary logistic regression was utilized …

A Mixed-Methods Study: Self-Efficacy And Barriers To Participation In Workplace Wellness Programs, Massiel Perez-Calhoon

Dissertations

America needs a healthy workforce to sustain the country. The scourge of obesity continues to plague Americans despite government initiatives such as the Affordable Care Act and wellness programs in the workplace to combat this epidemic. However, despite initiatives to make America healthy, barriers continued to impede the nation’s health. Lack of awareness and sensitivity to what motivates individual participants versus group participants built formidable barriers to accessing all workplace employees equitably. The purpose of this study was twofold. First, the intent of this study was to explore the relationship between self-efficacy and the impact on participation and engagement when …

Post-Intensive Care Syndrome: Comparison Of Educational Interventions To Educate Parents Of Children Hospitalized In The Pediatric Intensive Care Unit At St. Louis Children’S Hospital, Stephanie A. Esses

Dissertations

Background: Family members of children hospitalized in the pediatric intensive care unit (PICU) can develop cognitive, psychological, and physical manifestations of post-intensive care syndrome (PICS). Targeted education to help parents/caregivers recognize the signs and symptoms of PICS may result in better awareness of the syndrome and greater willingness to seek and receive support during their child’s PICU admission.

Objective: to evaluate three targeted PICS educational interventions to increase PICS awareness among parents/caregivers in the St. Louis Children’s Hospital (SLCH) PICU.

Results: A total of 62 parents/caregivers received one of three educational interventions: informational brochures (n=22), scripted informational conversation (n=20), or …

Improving New Graduate Critical Care Nurse Practitioner Knowledge And Retention Using A Dedicated Orientation And Mentoring Program, Katherine Huffer

Dissertations

Abstract

Background: There has been a significant amount of research into the many challenges that nurse practitioners (NPs) face as they transition from school to practice, however, there is limited research on how to improve this transition. Regardless of the setting in which the NPs are working, novices NPs alike report feelings of being unprepared and experiencing high levels of stress, anxiety, fear, and frustration. New research suggests that a comprehensive NP orientation and residency programs may provide a way to integrate the new NPs into their practice environment successfully.

Method: Kern’s Six Step Approach to Curriculum Development for Medical …

The Acute Care Pediatric Nurse Practitioner In Missouri: An Analysis Of Needs Assessment, Jessica L. Mann

Dissertations

Introduction: Due to an increasing number of acutely ill pediatric patients and changing healthcare demands, there is an even greater need for nurse practitioners (NPs) to work in the area of pediatric acute care (AC). There is a lack of alignment of education and certification with the scope of practice of the AC Pediatric Nurse Practitioner (PNP). The development and implementation of a graduate level AC PNP program in Missouri will support the alignment of education, clinical training, and certification with the scope of practice of the AC PNP and improve access to a quality program for nurses that currently …

Implementation Of A Daily Checklist To Improve Patient Safety And Quality Of Care In A Pediatric Intensive Care Unit, Catherine Reese

Dissertations

Background

Multiple industries have demonstrated checklists to be of great value in reducing errors of omission and improving communication. In healthcare, checklists have been shown to ensure patients receive evidence-based, safe care. In a fast paced environment of a critical care unit, adverse events are common and can have significant consequences on patient outcome. Safety guardrails are necessary to minimize naturally occurring human error. Safety checklists help support best practices to standardize care and support processes to improve outcome.

Objectives

To develop and implement a daily safety checklist in a pediatric intensive care unit (PICU) to enhance clinical care and …

Right Hemisphere Capacities For Word-Finding: Bilateral Modulation Of Event-Related Potentials In Healthy Adults And Adults With Aphasia, Amanda C. Alton

Dissertations

Language tasks are typically lateralized to the language dominant left hemisphere in healthy right-handed adults. Additionally, lesions in left frontotemporal areas typically result in a variety of language impairments called aphasia. Interestingly, increased activation in right cerebral regions homologous to left side lesions has been observed in patients with aphasia during word-finding tasks. The neural mechanism and the impact on word-finding remain unclear. There are two competing theories concerning compensatory right hemisphere activation. One view is that the right hemisphere plays a supportive role, taking over functions of the damaged left hemisphere. The other perspective is that rightward laterality is …

The Influence Of Culture On The Use Of Healthcare Services By Refugees In Southcentral Kentucky: A Mixed Study, Chika N. Ejike

Dissertations

The world as a global village has become a ubiquitous trope in the popular discourse, and Bowling Green, Kentucky, with its substantial immigrant population, may be considered an exemplar of this idealized community. It has become an ideal location for research regarding the challenges faced by immigrants. Due to the diverse cultural identities of the refugee/immigrant population, it is particularly well suited for studies into complex culturally dependent healthcare utilization patterns.

The central research question for the study was as follows: What are the healthcare-seeking behavioral patterns (as influenced by culture) among refugees at their nearest healthcare facilities? This mixed …

Factors That Influence Physicians To Assume Leadership Roles: A Focus On Clinical Integration, Jennifer Lynne Jackson

Dissertations

The Patient Protection and Affordable Care Act of 2010 (PPACA) drastically altered the healthcare industry in the United States. Along with multiple other directives, the PPACA mandated that physicians and hospitals work together in strategies known as clinical integration. For effective clinical integration to be achieved, interdependence among physicians and hospitals is required to provide the highest quality outcomes for patients at the best possible value. To this end, healthcare leaders have identified that the key to establishing successful clinical integration is the presence and commitment of physician leaders (Penlington & Marshall, 2016).

This study explores factors that influenced a …