Medicine and Health Sciences Commons^™

Bringing Hospital And Community Together: Interventions To Bridge The Transitional Care Gap, Jeremy Yates

Dissertations

Abstract

Problem

As healthcare spending continues to increase and overall quality lags in comparison to other developed countries, hospital readmission has been targeted to increase quality while decreasing cost. Components of the Affordable Care Act (ACA) have placed an emphasis on preventative and transitional care which has created programs aimed at reducing readmission, including the Community Health Access Programs (CHAP). One program in St. Louis, Missouri consisted of advanced practice paramedics and an occupational therapy assistant that performed discharge follow-up through in-home, in-office, and telephone visits. An in-depth program evaluation can create a foundation to build other programs in communities …

The Role Of Counseling Trainee Adversity, Attachment Style, And Trauma-Informed Principles In Clinical Supervision, Nicole Hurless

Dissertations

Current supervision literature suggests that supervisees with insecure attachment styles may perceive a poorer relationship with their supervisor and feel less satisfied with supervision. Studies across disciplines indicate a relationship between traumatic and/or adverse experiences and insecure attachment; however, this association has not been studied within the context of supervision. This dissertation explores a structural equation model assessing the associations between student’s adverse experiences, insecure attachment, and quality of the supervision relationship. It was hypothesized that greater prevalence of adverse experiences would negatively relate to supervision relationship quality, and this relationship would be mediated by insecure attachment. The results of …

Complexation Of Glycoalkaloid Α- Tomatine With Sterols And Its Potential Application As An Anti-Cancer Drug, Bishal Nepal

Dissertations

Glycoalkaloids (GAs) are secondary metabolites found mostly in higher plant species and some marine invertebrates. They are known to form complexes with 3β-hydroxy sterols such as cholesterol causing membrane disruption. So far the visual evidence showcasing the complexes formed between glycoalkaloids and sterols has been mainly restricted to some earlier studies using Brewster angle microscopy. This study aimed to develop a method for topographic and morphological analysis of sterol-glycoalkaloid complexes. Langmuir-Blodgett (LB) transfer of monolayers comprising of glycoalkaloid tomatine, sterols, and lipids in varying molar ratios onto mica followed by AFM examination was performed. The AFM method used required minimal …

Discovering Hidden Signs And Symptoms Of Heart Failure In The Electronic Health Record Using The Omaha System, Anita Reger

Dissertations

Purpose/Background/Significance: For the past 30 years, heart failure has been in the top 3 readmission diagnoses with patients discharged to community care. This is costly to the healthcare system and negatively impacts the patient’s quality of life. The purpose of this study is to evaluate a community care database to determine if previously under-considered latent variables exist that could provide early detection of heart failure signs and symptoms. Theoretical/Conceptual Framework: The theoretical and conceptual frameworks surrounding this work are the Omaha System and Donabedian’s structure, process, and outcomes theory for healthcare quality improvement supported by Neuman’s Systems Model. The Omaha …

Evaluation Of A Hypertension Bundle To Improve Maternal Outcomes, Jamie Jetton

Dissertations

Abstract

Problem: Hypertensive disorders of pregnancy continue to be on the rise in the United States, contributing to an increase in both maternal morbidity and mortality rates. These disorders not only have an effect on the pregnant women, but also the neonate. Early recognition and treatment of increased blood pressure findings can improve maternal and fetal outcomes.

Methods: This Quality Improvement (QI) project used a descriptive design and was comprised of a retrospective chart review, focused on the effectiveness of evaluating a hypertension bundle to improve maternal outcomes. The data collected for this project encompassed six months pre and post …

The Effect Of Pre-Procedural Opioid Video Education On Pediatric Patients Undergoing Orthopedic Surgery, Amy Pham

Dissertations

Problem The opioid epidemic is a continuing public health threat, growing amongst the pediatric population. Contributing to the issue are their accessibility within the community, and lack of education on safe storage and disposal of opioids.

Methods For this quality improvement (QI) project, a descriptive observational study design was used to identify the opioid storage and disposal habits of patients and their caregivers at home. The participant and caregiver dyads were shown a brief opioid educational video pre-operatively and were followed up with via emailed survey two weeks post-operatively. The survey contained questions pertaining to disposal and storage habits of …

Measuring Serum Lactate In Sepsis, Ouafae Bouziane

Dissertations

Problem: Sepsis is the leading cause of hospitalized deaths in the United States and the leading cause of hospital readmissions. Each year, approximately 1.7 million Americans develop sepsis, and nearly 270,000 die due to sepsis. The purpose of this quality improvement project was to evaluate the acquisition time of initial and repeat lactate levels once a sepsis bundle was activated.

Methods: This quality improvement project used an observational, descriptive design utilizing a retrospective medical record review and the Plan-Do-Study-Act (PDSA) to evaluate code sepsis activations in a Midwestern, suburban, Level II trauma ED from November 1^st, 2020, through …

Preventing Ocular Surface Disease In The Pediatric Intensive Care Unit, Emily Mallette

Dissertations

Preventing Ocular Surface Disease in the Pediatric Intensive Care Unit

Problem: Ocular surface disease in the Pediatric Intensive Care Unit is a significant problem in intubated patients due to altered eye protective mechanics, leading to exposure of the eye surface and dry eye. The purpose of this quality improvement project was to evaluate how an eye care protocol affected the frequency of artificial tear ointment administration.

Method: A descriptive, cohort design utilizing a retrospective chart review with convenience sampling of intubated children in the PICU from two cohorts was used. Comparisons were made between the preintervention cohort in 2020 and …

Primary Care Screening For Adverse Childhood Experiences (Aces) In The Adult Population, Carrie Plisco

Dissertations

Problem: Exposure to Adverse Childhood Experiences (ACEs) is associated with chronic diseases in adulthood. Several studies found over 60% of adults have had exposure to one or more ACEs. While guidelines for ACEs screening exist, most primary care practices do not perform screening at this time. This results in a lack of referrals for adults with history of ACEs for proper behavioral health (BH) intervention.

Methods: This quality improvement (QI) initiative utilized a descriptive observational design. The Centers for Disease Control and Prevention (CDC) ACEs screening tool was administered to a convenience sample of adult patients aged 18 years and …

Post-Cesarean Section Pain Management Using Pre-Built Computerized Order Entry Sets, Ashleigh Hunkins

Dissertations

Abstract

Problem

Electronic medical records (EMR) have helped decrease common medication errors. However, prescribing errors are still elevated. Creating pre-built order sets can decrease medication errors for post-cesarean section women.

Methods

This project used an evidence-based practice approach to create new order sets. Women undergoing a cesarean section between January 15, 2021 and April 14, 2021 received the new order sets. A retrospective data review was conducted pre and post-implementation between the dates of October 15, 2021 and April 14, 2021 to view medication errors.

Results

Before implementation of the order sets, there were 239 cesarean deliveries and eight errors …

Enhancing Communication Between Nurses And Physicians On Patients With Sepsis, Jayne Ehirim

Dissertations

Abstract

Problem: The condition of sepsis is life-threatening, and its severity increases when there are delays in interventions. Communication challenges exist on medical-surgical units and are major contributors to poor management of patients with sepsis. Ineffective communication among health care team members continues to threaten patients` health outcomes. The purpose of this project was to implement a standardized form of communication between nurses and physicians of patients with sepsis.

Methods: An observational descriptive design with a retrospective chart review. A quality improvement PDSA cycle was used to implement an SBAR communication instrument.

Results: A total of 16 …

Evaluation Of Depression, Anxiety And Stress In Graduate Nursing Students, Rachel Dunston

Dissertations

Mental health issues are growing in the United States. Postgraduate school is widely known to increase the level of psychological difficulties (Dyrbye et al., 2006) experienced by students. There is a need to address mental health care in graduate nursing students. This project was a descriptive observational comparison pre-post-intervention design used to see if online modes of delivery would aid in decreasing mental health issues for nursing graduate students. Participants were provided with access to three podcasts and encouraged to use the Sanvello mobile application provided to all students at this university. The first podcast focused on using the Sanvello …

County Youth Athletics Response To Covid-19 Pandemic, Elise Schaller

Dissertations

Problem: To ensure safe participation in youth athletics and prevent COVID-19 transmission during the COVID-19 pandemic, St. Louis County Department of Public Health (DPH) implemented Youth Sports Guidelines on October 14, 2020. This project aimed to identify level of adherence to precautions listed in the guidelines at six county public high school athletic events.

Methods: An observational descriptive study design was used to monitor guideline adherence at high school athletic events. Two observers tallied violations by participants and spectators to Youth Sports Guidelines at St. Louis County public high school athletic events. Six high-frequency contact (basketball and wrestling) events …

Impact Of Social Isolation In Hiv-Positive Individuals During A Pandemic, Corina Jane Bakoylis

Dissertations

Problem: The global pandemic of COVID-19 caused concern for immunocompromised individuals. The purpose of this quality improvement initiative was to assess the impact of social isolation on feelings of loneliness, depression, and social isolation experiences in HIV-positive individuals residing in a long-term care facility.

Methods: A mixed-method convergent design with a purposeful sample of HIV-positive adult residents residing in a long-term care facility was utilized. An evaluation of loneliness using the University of California Los Angeles (UCLA) Loneliness Scale (Version 3) and depression using the Patient Health Questionnaire-8 (PHQ-8) were completed. Personal experiences were also assessed with five predetermined open-ended …

Antibiotic Administration Time During A Code Sepsis, Shemekia Ford

Dissertations

Problem: Sepsis is the leading cause of morbidity and mortality and antibiotic administration within 60-minutes is a priority. The purpose of this quality improvement project was to improve sepsis patient’s outcomes by administering parenteral antibiotics within 60-minutes of a code sepsis (CS) activation.

Method: Observational descriptive design utilizing a retrospective medical record review over a three-month period in 2020 and 2021. A purposive sampling of adult patients from a Midwestern, metropolitan, Level II trauma and medical center emergency department (ED) were selected.

Results: The administration of parental antibiotics once a sepsis bundle was activated was essentially 28-minutes in 2020 …

Bladder Management Post Epidural Anesthesia: Impact On The Second Stage Of Labor, Megan Hedgcorth

Dissertations

Abstract

Problem

Currently, no national practice guidelines or organizations suggest the use of continuous bladder catheterization during labor for women receiving epidural anesthesia (DeSevo & Semeraro, 2010). Despite there being no national practice guidelines supporting the use of continuous bladder catheterization, many labor and delivery units still utilize this method for bladder drainage following epidural anesthesia in labor. The purpose of this project is to evaluate if the type of bladder management post-epidural anesthesia affects the length of the second stage of labor and the mode of delivery after implementation of new intermittent catheterization pilot.

Methods

This quality improvement project …

Implementation Of Pediatric Adverse Childhood Experiences Screening In Primary Care, Alexzandra Hillyer

Dissertations

Implementation of Pediatric Adverse Childhood Experiences Screening in Primary Care

Problem: Over half of children worldwide have experienced abuse in the past year. In 2012, The American Academy of Pediatrics released a policy statement emphasizing the importance of primary care providers implementing Adverse Childhood Experience (ACE) screening into all well-child examinations.

Methods: This quality improvement project was a descriptive, observational pilot study in which Center for Youth-Well ACE Questionnaire (CYW-ACE-Q) was implemented into a large, metropolitan pediatric primary care clinic. A convenience sample was utilized composed of pediatric patients between the ages of 5 and 18 being seen for a …

Intimate Partner Violence Education For High School Students, Morgan Foster

Dissertations

Problem Adolescents are at risk for experiencing intimate partner violence (IPV). As early as seventh grade, over half of adolescents have reported being in a romantic relationship. Adolescent screening for and education of IPV is minimal, and only the Healthy Relationships Quiz developed by the U.S. Department of Health and Human Services [HHS] screens young adolescents across all aspects of IPV, including psychological and sexual violence. The purpose of this project was to develop an IPV education plan for high school students in a health course.

Methods An educational lesson plan for IPV was created for high school teachers.

Results …

Effect Of Purposeful Nurse Rounding On Patient Satisfaction, Jayne Mangi

Dissertations

Problem Delayed nurse response times in an inpatient setting can have a negative impact on patient experience, and is reflected in patient satisfaction surveys such as The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The purpose of this project is to improve HCAHPS scores related to “responsiveness” in an antepartum unit.

Methods A prospective observational study designed to improve HCAHPS scores regarding nurse response time conducted as a retrospective and prospective review of data. Results of HCAHPS scores related to “responsiveness”, and actual nurse response times were examined before and after a nurse education tool was implemented. …

Standardizing Genomic Testing Of Pancreatic Cancer In A Community Oncology Practice, Julie Marie Scott

Dissertations

Problem. Ordering genomic testing for patients with pancreatic cancer can discover germline or somatic mutations that may allow for targeted therapy. There are some difficulties in obtaining genomic tests, such as which test to order, and optimal timing of ordering. In addition, interpreting results and maintaining easy access to the report in the electronic medical record can be difficult. Delays in ordering genomic testing can delay the discovery of an actionable mutation for treatment.

Methods. A descriptive comparison project was developed comparing rates and timing of ordering of genomic testing for patients with pancreatic cancer who established care with a …

Identification Of Veterans Experiencing Symptoms Of Mental Illness For The First Time After Covid-19 Diagnosis, Brittania Phillips

Dissertations

There has been a general increase in psychiatric symptoms since the COVID-19 pandemic began. Literature that has been published since the start of the pandemic has indicated there is an increased risk of depression, insomnia, altered mental status, new-onset psychosis, neurocognitive syndrome, and anxiety. The military veteran population is at higher risk for psychiatric illness than the general population, and should be screened accordingly. This quality improvement project was developed in collaboration with the mental health clinic at urban medical center in the Midwest to identify new symptoms of mental illness after COVID-19 diagnosis utilizing the PDSA model and descriptive …

Implementing A Depression Screening In A Pediatric Acute Care Setting For Adolescents With Type 1 Diabetes, Kelcie Marler

Dissertations

Problem: Depression among adolescents with Diabetes Mellitus type 1 (DM 1) is three times more prevalent than adolescents without chronic disease. Diagnosis of depression has been found to negatively affect the quality-of-care management, quality of life, and results in an increase in hospital admissions with hypoglycemia or hyperglycemia events.

Methods: A depression screening, the patient health questionnaire 9 (PHQ-9), a validated screening tool for use among adolescents was implemented in this quality improvement (QI) project. It was the first cycle of a plan-do-study-act (PDSA) cycle for in a pediatric ICU. Adolescents between the ages of 12 – 18, were …

A Standardized Approach To Awakening And Breathing Trials, Maureen Awuor Abongo

Dissertations

Abstract

Problem: Mechanical ventilation with sedation, are crucial co-therapies for the critically ill. Risks of both, known as Ventilator Associated Events( VAEs), can worsen outcomes. Performing Spontaneous Awakening Trials (SATs), with Spontaneous Breathing Trials(SBTs), is a targeted evidence-based strategy in reducing VAE rates. The Intensive Care Unit (ICU) lacked a coordinated approach to operationalizing SATs with SBTs.

Methods: An observational retrospective study involving a review of VAE and patient data for corresponding months in years before, and after an improvement strategy application, and making comparisons. The multimodal strategy includes filling out checklists outlining criteria for performing a SAT with …

Evaluation Of A Dirfloortime® Program For Autism Spectrum Disorder, Jennifer L. Pipitone

Dissertations

Problem. Parents with children who have neurodevelopmental disorders, such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) experience high levels of parenting stress. The prevalence of ASD is on the rise in the United States. As a result, there has been an increase in the use of treatment modalities, in effort to better understand which modalities have the most positive impact on children and their parents. DIRFloortime® is a developmental treatment modality used to help strengthen the parent-child bond and used to decrease parental-child stress. The Autism Parenting Stress Index (APSI) measures the impact of an intervention …

Mental Health Concerns Of Frontline Registered Nurses Associated With The Covid-19 Pandemic, Julie Ingle

Dissertations

Problem

COVID-19 caused local healthcare facilities to admit patients with COVID-19 at increasing rates, critically overloading healthcare system resources. Caregiver-related stress associated with the COVID-19 pandemic placed frontline registered nurses (RNs) at risk for mental health consequences (Havlioglu & Demir, 2020; Shechter et al.,2020).

Methods

This quality improvement project used a descriptive design to administer a collection of validated instruments assessing anxiety, depression, posttraumatic stress disorder (PTSD), and demographics. A purposive sample of RNs were recruited from the COVID-19 units in a local hospital, and the survey was distributed via email.

Results

During the implementation period (April 4, 2021-May 15, …

Proactive Text Messaging For Public Health Surveillance During The Covid-19 Pandemic, Daria Kester

Dissertations

Problem

The Department of Public Health (DPH) of a suburban Midwestern county considers surveillance and control of COVID-19 to be sub-optimal, resulting in part from difficulties with completing case and contact interviews.

Methods

To increase the success rate of case investigation, proactive messaging using short message media (SMS) alerts is used in a quality improvement initiative based on the PDSA framework. Participants are sent text message alerts prior to receiving a call from a DPH case investigator. Results are recorded in a statewide database.

Results

Individuals who received text messages prior to receiving a case investigation interview phone call were …

A Telehealth Palliative Care Objective Structured Clinical Examination, Lindsey Q. Mcintyre

Dissertations

Problem: Palliative care is a service focused on symptom management and improved quality of life for persons with serious or chronic illnesses and is widely underutilized. Although advanced practice registered nurses (APRNs) possess a unique skillset to contribute to palliative care, there is minimal reporting on palliative care training for this professional group. The purpose of this clinical scholarship project was to implement the End-of-Life Nursing Education Consortium (ELNEC) online training program for APRN students in the BSN-DNP program and evaluate its effect on student performance during a telehealth objective structured clinical examination (OSCE).

Methods: An observational, descriptive …

Attitudes Toward Sars-Cov-2 In Frontline Healthcare Workers And First Responders, Michelle Tiffany Arrington

Dissertations

Problem: To date, little evidence exists to understand attitudes of SARS-CoV-2 in frontline healthcare workers (HCW) and first responders (FR), related to best practices in mitigating virus spread. The purpose of this project was to assess attitudes toward COVID-19 in young adults, ages 18-44 years old, who are frontline workers related to their adherence to PPE guidelines, social distancing, hand hygiene, community exposures, and vaccinations.

Methods: A descriptive survey design using five-point Likert scale questions and 26 open-ended questions and was implemented one-year after onset of the pandemic. A purposive sample working in a large, urban, Midwest metropolitan area was …

Mental Health Effects Of The Covid-19 Pandemic On Older Adults, Elizabeth Kerr

Dissertations

Problem: Significant psychological effects such as anxiety, depression, stress, and loneliness are shown to affect the older adult population, aged 65 years and older. The social isolation and disconnectedness related to the COVID-19 pandemic potentially worsens anxious and depressive feelings, increasing the risk for adverse outcomes in the high-risk older adult population. This project aimed to identify older adults at risk for acute, situational mental health issues associated with the pandemic.

Methods: A descriptive study design was used. Telephone interviews were conducted to explore effects of the COVID-19 pandemic on mental health responses in older adults. A convenience sample …

Youth Sports In A Pandemic Age, Robert Bohnert

Dissertations

Abstract

Problem: Youth sporting events is a public health concern as infected youth with coronavirus disease 2019 may unknowingly spread the virus, as many show little to no symptoms (Zimmerman & Nigel, 2020). This project aimed to identify level of adherence to posted Youth Sports Guidelines, which were designed to mitigate the spread of virus at youth sporting events.

Methods: An observational descriptive design was utilized. Two observers tallied guideline violations by participants and spectators at six high-contact (basketball) and six low-contact (swimming) public high school youth sporting events.

Results: A total of 726 youth sport participants and 139 …