Medicine and Health Sciences Commons^™

Diversity In Pre-Nursing Majors And Nursing Program Applicants, Christel Fehr

Dissertations

Problem: The population of the US has become increasingly ethnically diverse. This diversity has not been reflected in the nursing workforce with approximately 70% being Caucasian and 85% being female, resulting in a disparity in healthcare delivery by minorities. The purpose of this project was to perform an analysis of race, ethnicity, and gender diversity in undergraduate nursing applicants at a rural midwestern university.

Method: A retrospective review of nursing applications, enrollment reports, and graduation rates were examined for three academic years.

Results: 326 students (N=326) applied to the nursing program from Fall 2016 through Spring 2019. Of …

Nurse Practitioner Student Confidence And Competence In Common Women's Health Diagnostic Procedures, Jessica Cowan

Dissertations

Problem: In areas with limited health resources, such as Guatemala, cost-effective and reliable methods for sexually transmitted infection and cervical cancer screenings are needed. The purpose of this Quality Improvement (QI) project was to develop standardized training in Vaginal Wet Mount (VWM) preparation and cervical cancer screening using Visual Inspection with Acetic Acid (VIA) for Nurse Practitioner students who traveled to Guatemala for a week-long global immersion experience.

Methods: This was a QI project with a prospective descriptive design utilizing a purposive sample of 10 University of Missouri-St. Louis Nurse Practitioner students who traveled to Guatemala on medical mission trip …

Screening For Delirium In The Emergency Department, Melissa Minks

Dissertations

Abstract

Delirium is a problem for many older adults who are acutely ill. Delirium often comes on suddenly, can be severe, and is often difficult to diagnose, especially in the presence of dementia. Missed delirium has a mortality rate of 30.8% and costs millions. What is the purpose of this study?

Methods The 4A’s Test screening instrument was implemented and evaluated in the Emergency Department of a rural Midwestern hospital from May 1, 2019 through August 31, 2019.

Results There were 122 participants in the study with 61 in each cohort. In 2018, three (5%) were diagnosed with delirium without …

Evaluation Of Mcgeer Criteria For Uti Determination In A Nursing Home, Julie Rehagen

Dissertations

Problem: Urinary tract infection (UTI) is one of the most complex and challenging medical diagnoses to make in the long-term care (LTC) population. The unnecessary treatment of a UTI can increase cost of care and the likelihood of multi-drug resistant organisms.

Methods: The McGeer criteria which focuses on UTI in the LTC population was utilized to complete a quality improvement initiative. A descriptive cohort project utilizing retrospective and prospective data was completed to determine if an implemented McGeer criteria protocol improved the avoidable treatment of asymptomatic bacteriuria (ASB).

Results: Before implementation of the protocol, 62.5% of residents were unnecessarily treated …

A Strategic Plan To Thread Genomics Competencies Into Undergraduate Curriculum, Holly Mathis

Dissertations

Problem: Genomics in undergraduate nursing education has experienced slow adoption in the United States. Various approaches have been proposed but do not address barriers to successful implementation.

Methods: A strategic plan was developed to increase the amount of genetics and genomic content in the curriculum of an undergraduate nursing program. A gap analysis was performed on the curriculum revealing a paucity of content. A SWOT analysis informed the strategic plan, which included a faculty education program using the ANA/ISONG’s Essentials of Genetic and Genomic Nursing: Competencies, Curricula Guidelines and Outcome Indicators (2^nd ed.) (2009) as a foundation.

Results: Faculty …

Utilizing Wellness Champions As A Faith-Based Initiative For Mental Health Promotion, Tracy M. Webster Cooley

Dissertations

Abstract

Purpose: This program evaluation project evaluated the effectiveness of mental health training and support provided to wellness champions affiliated with a behavioral health organization. This project sought to gain a better understanding of how clergy and laypersons acting as wellness champions in predominately African-American faith-based organizations perceive they create an atmosphere to decrease stigma and increase mental health promotion and wellness when receiving education and training on mental health.

Methods: A descriptive project using a program evaluation design to evaluate the effectiveness of the training of 122 wellness champions from faith-based organizations received from a behavioral health organization …

Evaluation Of Sleep Hygiene Checklist For Delirium In An Intensive Care Unit, Ying Wei

Dissertations

Abstract

Problem: Delirium is a severe complication brought on by sleep deprivation that could increase mortality and prolong intensive care unit (ICU) stays in critically ill patients. This project aimed to develop and implement a sleep hygiene checklist to decrease the incidence of delirium in a Medical Intensive Care Unit (MICU).

Methods: This study used a pre-post design to compare the incidence of delirium pre-and post-implementation of the sleep hygiene checklist. Forty-four patients and thirty-six patients were recruited for the pre-and post-intervention groups, respectively.

Results: The result of this study demonstrated use of a sleep hygiene checklist could decrease the …

The Effects Of High Dose Intravenous Vitamin C In Cancer Patients, Bankole Aluko

Dissertations

Problem: Currently used standard treatments (Chemotherapy, radiation) in cancer patients are generally accompanied with side effects, which may include pain, nausea, vomiting, fatigue, and chemotherapy-induced peripheral neuropathy (CIPN) during and after completion of treatments. High dose IV C may improve the anti-cancer action of chemotherapeutic agents by reducing side effects of fatigue, pain, nausea and vomiting and boosting immune cell functioning, and inhibiting angiogenesis (Mikirova, Casciari, & Hunninghake, 2019).The purpose of this quality improvement project was to explore whether high dose intravenous vitamin C (IV C) prevented major side effects that frequently occur with standard treatments in cancer patients and …

Impact Of The Hester Davis Fall Risk Scale On Inpatient Falls, Amelia Payne

Dissertations

Problem: During a three month period in 2018, a rural acute care facility experienced a fall rate of 3.4 falls per 1,000 patient days. The aim of this clinical scholarship project was to implement the Hester Davis Fall Risk Scale (HDFRS) for adult inpatients in a rural acute care facility.

Methods: Utilizing the Find, Organize, Clarify, Understand, Select- Plan, Do, Study, Act (FOCUS-PDSA) model, the HDFRS was implemented and evaluated using a pre and post design to determine its impact on falls per 1,000 patient days and falls with injury per 1,000 patient days. The method of evaluation was a …

Evaluation Of A Type 2 Diabetes Mellitus Care Coordination Program, Carrie Smith

Dissertations

Abstract

Purpose: This Quality Improvement (QI) project evaluated the impact of an existing Diabetes Care Coordination (DCC) program at an urban clinic for clients with no health insurance in the Midwest. Diabetes related indicators of those enrolled in the DCC program and client reported barriers were documented over a 19 month period.

Sample: Clients included were 18 years and older, with no insurance, having the diagnosis of Type 2 diabetes mellitus, and were enrolled in the DCC program within the first six months of the program's initiation.

Methods: A retrospective chart review of 24 clients recording diabetes related outcome indicators …

Utilizing High Flow Oxygen Therapy In Infants With Bronchiolitis, Sarah Ulses

Dissertations

Problem Bronchiolitis is the leading diagnosis of hospitalizations for children under one-year. The purpose of this study was to evaluate the effectiveness of supportive high-flow oxygen (HFO) therapy for infant patients requiring more than 2L/min nasal cannula (NC).

Methods An observational, descriptive design with convenience sampling of infants aged one-year or less, hospitalized with bronchiolitis and requiring HFO therapy. Comparisons were done between 2019 when no HFO was allowed on the general unit and in 2020 when HFO was allowed.

Results Of 28 patients (N = 28), 13 (n = 13) were in the 2019 cohort and 15 …

Increasing Cms Sepsis Core Measure Adherence Rates Through Virtual Consultation, Angela Cann

Dissertations

Problem: According to the Centers of Disease Control and Prevention (CDC, 2016), it is estimated that sepsis affects around 1.5 million individuals in the United States annually, causing the death of 250,000 individuals and being responsible for one out of three hospital deaths. One-fourth of patients who develop severe sepsis will die during their hospital stay. Delays in sepsis treatment contribute significantly to increased morbidity, mortality, and length of stay in the hospital. The Centers for Medicare and Medicaid (CMS) sepsis bundle guideline adherence rate in the Emergency Department of a Level III Trauma Center was stagnant at 55% through …

Multidisciplinary Team Approach Effect On Pediatric Severe Asthma, Lila Kertz

Dissertations

Problem. Children with severe asthma are more likely to be non-adherent with their prescribed medications, often related to barriers. A holistic assessment of these patients has been suggested, but is not typically performed in most pediatric asthma clinics. The purpose of this project was to evaluate the effects of severe pediatric asthma clinic services designed to perform holistic assessments and provide comprehensive care.

Methods. An observational, descriptive design was used to evaluate the Severe Asthma Clinic for Kids (SACK) created in 2013 using a retrospective database review. A convenience sample of data collected on all children treated in the clinic …

Intimate Partner Violence Screening In Adolescent And Young Adult Females, Emily Myers

Dissertations

Abstract

Problem Adolescents and young adult females are at risk for experiencing intimate partner violence (IPV). Females aged 16- to 24-years of age experience IPV three times more likely than males. Universal screening for adolescent IPV is considered a gold standard for adolescent anticipatory guidance. The purpose of this quality improvement initiative was to evaluate the impact of an adolescent IPV screening instrument in an urban, Midwestern shelter for pregnant adolescent and young adult females.

Methods An observational, descriptive design. All adolescent and young adult females presenting for intake evaluation were screened for IPV using the Healthy Relationship Quiz over …

Mitigating Suicide Risk Post-Discharge From Inpatient Crisis Stabilization: Safety Planning Intervention, Leighia M. Mcghee

Dissertations

Abstract

Purpose: The purpose of this program evaluation is to evaluate the effectiveness of a newly implemented safety planning intervention (SPI) tool, comparing patient outcomes relating to suicide attempt rates, emergency department (ED) encounter rates, and inpatient rehospitalizations rates pre and post its integration to care in a suburban behavioral health hospital.

Methods: A descriptive cohort design utilizing a retrospective chart review was completed over six months, three months pre, and three months post implementation of the SPI program. A convenience sample of inpatient charts was reviewed to assess the rate of suicide attempts, ED encounters frequencies, and hospitalization rates …

Optimizing The Effectiveness Of Peripheral Intravenous Catheters, Carrie Kollar

Dissertations

Problem Hospitalized adult patients require more than one short peripheral catheter (SPC) to complete the prescribed intravenous (IV) therapy due to catheter failure and the practice of resiting. The purpose of this quality improvement initiative was to increase the rate of SPCs remaining in situ for the entire duration of the IV therapy for hospitalized adult patients.

Methods Application of an engineered securement device (ESD), an educational program pertaining to modifiable risk factors, and changing the practice to removal upon clinical indication were methods utilized to reduce the number of SPC insertions and catheter failures. This study was conducted at …

Compassion Fatigue And The Emergency Department, Alexandra Myers

Dissertations

Problem The emergency department (ED) is a high-stress environment. Nurses exposed to this stress for prolonged periods are subject to compassion fatigue (CF). The purpose of this quality improvement project was to identify and reduce the level of CF in ED nurses by implementing Real Time Transformative Response^© (RTR). RTR^© is a technique that uses combinations of neurofeedback response awareness, biofield therapy intervention, and clearing of unwanted energy.

Method A purposeful sample of ED nurses working at a moderately-sized, suburban, Midwestern hospital ED who were scheduled to work 24-hours or more per week completed a Professional Quality of …

Psychometric Properties Of The College Athlete Psychological Screening Tool: Validation Of The Depression And Anxiety Subscales, Joseph C. Case

Dissertations

The aim of the present study was to gain a better understanding of the descriptive psychometric properties of the College Athlete Psychological Screening (CAPS) measure. The CAPS is a newly developed assessment screening measure designed to assess 14 common problem areas for college athletes. For the present investigation, 395 participants completed the 108-item CAPS measure. To establish criterion validity, participants also completed the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). The present study had three research questions. Question one discussed the descriptive psychodynamic properties (Cronbach’s alpha, means, and standard deviations) of the 14 CAPS subscales. Question two …

Exploring The Impact Of Insecure Attachment Styles In Couple Adjustment Through The Lens Of Cluster B Pathology, Laura Bonnemort

Dissertations

The current body of research literature appears to lack adequate studies focused on individuals who possess an insecure attachment, potential cluster B personality pathology, and who are engaged in couple discord. The following clinical research project explored how insecure attachments impact the trajectory of both cluster B pathology and adult couples’ relationship discord. Studies reviewed included adults diagnosed with mood disorders, personality pathology, and those engaged in couples therapy due to dissatisfaction and discord. Developing an insecure attachment in childhood appears to place adults at risk for higher rates of personality pathology and risky romantic relationships fraught with discord. Evidence-based …

Social-Ecological And Protective Factor Approach To Managing Parental Incarceration, Jacquelyn Harris

Dissertations

Mass imprisonment does not only impact the incarcerated individual; it also affects approximately five million children in the United States. Researchers identified and compare the impact of parental incarceration on child development. They acknowledged the protective factors across the lifecycle from a social-ecological perspective and specifically related to parental incarceration. The comprehensive literature review inspired an innovative model, the social-ecological and protective factor approach to managing parental incarceration. The primary goal of this model is to combat the detrimental effects of parental incarceration by identifying protective factors across the lifecycle and throughout the microsystem, mesosystem, and exosystem. This model is …

Bridging The Gap: Understanding Non-Offending Parental Responses To Their Children's Sexual Abuse., Jennifer Latreill, Psy.D.

Dissertations

The parental response to children's disclosure of childhood sexual abuse (CSA) is the most critical and important factor regarding the child's post trauma trajectory and overall trauma resolution. Understanding parental responses and the factors that prompt acceptance versus disbelief among the non-offending parent (NOP) is vital to children's success following disclosure given the weight of the NOPs response and its impact on long-term consequences of CSA. This literature review provides a comprehensive summary of what may deter the NOP from recognizing intrafamilial sexual abuse, factors that may contribute to the NOPs disbelief following disclosure, and possible clinical implications of such …

Exploration Of Physician Attitudes About Self-Care And Personal Mental Health: Possible Barriers To Physician Well Being, Candich Farrar

Dissertations

The present study was designed to examine physicians’ mental health, attitudes, and behaviors toward self-care and the utilization of mental health services. As the medical field can be very demanding and exhausting, it is believed that many physicians suffer from mental illnesses such as anxiety and depression. However, it was theorized that many physicians do not engage in adequate self-care regimes or seek support and suppress their symptoms, which may further exacerbate their illnesses. A thorough literature review was performed to explore the following: possible barriers to physicians seeking mental health services to address high rates of mental illnesses, physicians …

Anticonvulsant And Procognitive Effect Of Nonimidazole Histamine H3r Receptor Antagonists /Inverse Agonists In Experimental Animal Models, Alaa Imad Alachkar

Dissertations

Epilepsy is a common chronic neurological disorder accompanied by cognitive impairment. Available antiepileptic drugs (AEDs) have not been reported to have ameliorative effects on epilepsy-associated memory impairment. The potential of histamine H3 receptors (H3R) in several neuropsychiatric diseases, including epilepsy and Alzheimer’s disease, is well recognized. In this study, a series of H3R antagonists (1-16) were screened for their in vivo anticonvulsant effect in several acute-induced seizures in rats. Moreover, the procognitive effect of the most promising H3R antagonist was investigated in dizocilpine (DIZ)-induced amnesic effect applying several behavioral memory tests. Furthermore, the most promising H3R antagonist was assessed for …

Occupational Therapy As Part Of A Team-Based Approach In Primary Care Settings, Lydia Royeen

Dissertations

The purpose of this project was to study issues related to occupational therapists integrating into primary care settings, as part of a team-based approach and to best meet the needs of the clients.

This is a mixed methods study that examined quantitative and qualitative data for members of the primary care team and occupational therapists working in primary care clinics. The Team Climate Inventory-14 (Kivimaki & Elovainio, 1999) was selected as the quantitative measure because it examines themes related to team functioning, which include vision, participative safety, task orientation, and mutual support. Participants completed a semi-structured interview that examined themes …

Pinch Span And Force: Normative Data, Requirements For Functional Tasks And Life Roles, And The Influence Of Carpometacarpal Joint Osteoarthritis, Nancy Hock

Dissertations

The three studies that form this dissertation build knowledge related to functional pinch. Study 1 provides normative data for the Baseline® 5-Position Hydraulic Pinch Meter, which may be used in clinical practice. The data collected in this study demonstrate the relationship between lateral pinch strength and age and reveal that strength decreases with age in both males and females. Through examination of the lateral pinch force produced at the 5 different pinch spans, it was found that the strongest lateral pinch strength was produced at 4-5 cm of pinch span. This information can be used by clinicians as they modify …

Exploring Functional Health Literacy In Older Adults With Age-Related Macular Degeneration, Jennifer K. Fortuna

Dissertations

This three-paper dissertation explores functional health literacy (i.e., the ability to access, process and understand health information) in older adults with vision loss caused by age-related macular degeneration (AMD). This research builds scholarship that explores the unique patient education needs of older adults with AMD. The specific aims of this research are to: (1) explore associations between functional health literacy and severity of visual impairment; (2) determine the general readability, suitability and comprehensibility of online patient education materials (PEMs) designed for older adults with AMD; and, (3) assess the overall quality of one PEM that has been simplified based on …

Methods For Improving Quality Of Care Within Acute And Post-Acute Settings, Kelly L. Vankoevering

Dissertations

According to the Centers for Medicare and Medicaid (CMS), over the next 7 years, U.S. national healthcare spending is projected to grow at an average of 5.7% per year, up from 4.8% in 2019. Additionally, personal health care cost is expected to increase by 2.7% per year. As a result, there have been increased efforts among healthcare systems and hospital organizations to improve quality of care while decreasing healthcare cost. The research reported in this dissertation builds upon the existing literature regarding interventions to improve hospital performance and quality metrics. Two of the most researched and effective strategies for improving …

Training Practitioners On The Effects Of Psychotropic Medication Via A Web-Based Platform, Anita Li

Dissertations

Many individuals diagnosed with autism spectrum disorders (ASD) receive multiple therapeutic services in an attempt to supplement behavioral therapy. These services include pharmacological interventions. Two drugs, risperidone (Risperdal) and aripiprazole (Abilify), are FDA-approved to treat “irritability” in children with ASD. Research shows that the effects of risperidone and aripiprazole on irritability varies greatly across treated individuals. Therefore, individualized monitoring and evaluation must be conducted to provide the physician with data to determine if the medication is resulting in desired changes and effects. Certified behavior analysts are trained in data collection and experience high levels of contact with individuals diagnosed with …

Nanocarbon Modification Of Membranes For Enhanced Water Desalination And Water Treatment, Worawit Intrchom

Dissertations

Water scarcity is foreseen to be one of the great global issues in the coming decades. The challenges are not only in providing water supply to cope with the growing public demand, but recovering clean water to natural resources. Clean water supply, from brackish and seawater is attractive. Membrane distillation (MD) is an emerging thermal membrane-based process that has been used for desalination and other pollutant separations from water. MD can be operated at low temperature, so low-grade energy sources are a good alternative heat source for MD. High salt rejection and low membrane fouling also make MD interesting for …

Veteran Specific Risk Factors For Delirium, Allison Perkins

Dissertations

Purpose/Aims: This study explored the relationships between military characteristics such as combat experience, mental health issues such as post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), depression, anxiety and substance use disorder (SUD), physical comorbidities such as coronary artery disease (CAD), other risk factors, and delirium diagnosis among hospitalized veterans.

Background: Delirium is a common disorder experienced by 25% of all hospitalized adults 65 years and older. No published studies to date have examined whether combat, TBI and PTSD are associated with the incidence of delirium in the hospitalized veteran.

Methods: A retrospective cross-sectional cohort design with a sample size …