Barriers And Facilitators To Opioid Use Treatment And Recovery Services During Pregnancy, Loralie Woods

Dissertations

Purpose: To identify barriers and facilitators to opioid use treatment and recovery services among pregnant and nonpregnant women who misuse opioids.

Background: Over 130 Americans die daily after overdosing on opioids. Women have not been immune from opioid use disorders (OUDs), with a 4-fold increase from 1999-2010. The prevalence of opioid use among pregnant women increased from 1.5 per 1,000 hospital deliveries to 6.5. Although the annual National Surveys on Drug Use and Health (NSDUH) has provided information on risk factors for OUD related to socioeconomic and demographic factors, no studies using this data have identified barriers to opioid use …

Skin And Soft Tissue Infections In The Emergency Department, Nicole Martinez

Dissertations

Background/Purpose: Skin and soft tissue infections (SSTI) represent a diverse group of infections varying in clinical presentation and degree of severity. The International Classification of Diseases codes for patients presenting with cellulitis or abscess account for $5.5 billion in annual health care costs and 1.4% of all hospital admissions nationally. Data are needed to inform admission and management decisions. The purpose of this study is to examine relationships among sociodemographic, physical examination findings, and treatment modality and management in patients with SSTIs.

Theoretical/Conceptual Framework: Web of Causation Theoretical Framework explores multiple causative factors treated with equal prominence, thus …

Pain And Spiritual Distress At End Of Life, Kathryn Lee Robinson

Dissertations

Purpose: The purpose of this study is to examine the relationship between unmanaged pain and spiritual distress in adults newly admitted to hospice.

Background/Rationale: Current evidence supports the presence of a positive relationship between increased physical pain and spiritual distress for those with advanced cancer and/or receiving palliative care services. Nonetheless, spiritual distress remains a relatively understudied area; anecdotally, assessment and management of physical symptoms often take precedence over interventions for spiritual distress in patients at end of life (EOL) on hospice. Research is needed to examine the relationships between physical pain, spiritual distress, and other relevant variables specific to …

Frailty And Post-Operative Outcomes In Adult Hip Fracture Patients, Melissa Yager

Dissertations

Abstract

Background/ Purpose: The majority of adult hip fracture patients never return to their pre-fracture functional level and have a poor quality of life (Kistler, Nicholas, Kates, & Friedman, 2015; Pioli et al., 2016; Sheehan et al., 2018). The prevalence of frailty in adult hip fracture patients is estimated at 51%. Frail patients with hip fractures are twice as likely to have a complication (Kistler et al., 2015). Extant studies have examined frailty and hip fractures independently, nonetheless, a gap in the literature exists with few investigations of the connection between frailty and post-operative outcomes after hip fracture. The purpose …

La Maestra’S Circle Of Care: Studying The Impact Of An Integrated Service Model On The Health And Well-Being Of Vulnerable Populations, Zara Marselian

Dissertations

ABSTRACT

There is an urgent need to reform the health care delivery system in the United States, as recognized through current bipartisan efforts. Society’s vulnerable populations especially need health care reform as health care outcomes are the poorest among disadvantaged populations. Moreover, vulnerable populations are twice as likely to develop chronic diseases than the general population and they remain ill due to other contextual, societal factors affecting their ability to achieve health and well-being. This population is subjected to adverse life events that suggest a more comprehensive approach to health and well-being is called for.

The Circle of Care is …

The Relationship Between Race And Ethnicity And Serious Safety Events In Hospitalized Patients, Samantha Crandall

Dissertations

Purpose. This study explored the association between patient sociodemographic characteristics and the occurrence of serious safety events (SSE) in hospitalized patients. Specific aims were to describe among patients who have experienced an SSE: 1) patient sociodemographic variables (age, gender, race, ethnicity and language spoken), health insurance coverage, patient zip code, payer mix, site of care location, and severity of event; 2) the relationships between the select patient sociodemographic variables, health insurance coverage, patient zip code, payer mix, site of care location and SSE level of harm; and 3) what factors increase or decrease the odds of experiencing higher levels of …

Impulsivity As A Trait Predictor In Baccalaureate Nursing Students, Jennifer Bertucci

Dissertations

Impulsive personality traits have been linked to pathological decision making in individuals who possess the trait. Impulsive pathological decision making may include acts of aggression, divergence, risky behavior, lack of self-care, etc. The purpose of this study was to examine impulsive personality traits among nursing students. Traditional students are defined by the following characteristics: earns a high school diploma, enrolls full time immediately after finishing high school, are financially dependent on parents, and either do not work during the school year or works part-time (the exception to the rule) (Choy, 2002). A non-traditional nursing student is defined as students who …

Health Care Access And Utilization By U.S. Farmworkers, Genesis Bojorquez

Dissertations

Background: Agriculture industry has the highest fatality rate among all United States industries. Farmworkers experience high rates of occupational injury, illness, and mortality, yet have limited access to health care. Implementation of the Patient Protection and Affordable Care Act (ACA) of 2010 increased health care accessibility and broadened farmworker eligibility for health insurance, yet no study has measured the impact of the ACA upon U.S. farmworkers.

Purpose: The purpose of this research was to examine health care access and health care services utilization among U.S. farmworkers following the implementation of the ACA in 2010.

Specific Aims:

1. Apply the …

An Examination Of The Night Burn Clinic Transition To Nurse Practitioner Coverage, Kevin J. Maxwell Dnp, Fnp-Bc

Dissertations

Background/Significance: Burns are dynamic, evolving wounds requiring prompt attention and treatment (Morgan et al., 2018). Many studies have been conducted comparing physician outcomes to those of APNs showing no difference (McCleery, Christensen, Peterson, Humphrey, & Helfand, 2011; Naylor & Kurtzman, 2010; Pioro et al., 2001; Roche, Gardner, & Jack, 2017; Spetz, Skillman, & Andrilla, 2017). Time delays which allow for progression of the injury have a negative impact on patient outcomes. Any pathway allowing for quicker review of the burn by a burn specialist should be welcomed (Kelly et al., 2013). APNs can augment physician efforts and expand access to …

Establishment Of Organoids From Gastric Stem Cells And Their Use To Study The Role Of Aryl-Hydrocarbon Receptors, Shakila Afroz Taleb

Dissertations

Stem cells are powerful tools in different aspects of biomedical and translational research, including disease modelling, drug testing, and tissue engineering for regenerative medicine. However, isolation and culture of organ-specific stem cells are challenging tasks. Therefore, the biological features of many adult stem cells are not well studied and their involvement in the development of cancer is still controversial. Some immortal stem cell lines have been established and used as an alternative to studying features of organ-specific stem cells. The ability to grow cells in a scaffold-free, three-dimensional (3D) model system that mimics in vivo conditions would help in revealing …

Consumer Assessment Of Healthcare Providers And Systems In A Psychiatry Practice, Treacy Williams

Dissertations

Problem: Patient-centered care improves healthcare. Patient surveys are instruments used to assess the patient’s experience and is essential to providing patient-centered care. The aim of this quality improvement initiative was to assess patient perceptions of care delivered by nurse practitioner (NP) providers in a psychiatric mental health practice.

Methods: An observational, descriptive design with a customized Consumer Assessment of Health Care Providers and Systems (CAHPS) survey administered in an outpatient psychiatric mental health practice for six weeks. A structure, process, outcomes framework was used. The structure of study was care delivered by the NP, the process of interest was communication …

A Descriptive Phenomenological Study Of Body Art Patients And Their Health Care Experience, Lacee Kaufmann

Dissertations

This study aimed to update dated research by exploring the relationships between patients with body art (tattoos and body piercings) and their interaction with health care providers. This creates a current description of the body art patient’s health care experience. Previous research indicates that body art has been associated with risk taking and deviant behaviors and these behaviors have been used to justify why people with body art are negatively perceived. If the presence of body art and the associated behavior are viewed as a threat to normalcy, then Stangor and Crandall’s theory (2000) suggests that stigma may surround the …

Increasing Patient Adherence To Gestational Weight Gain Goals In Pregnancy, Annie Vining

Dissertations

Abstract

Problem: The inability to maintain healthy weight gain during pregnancy may contribute to multiple pregnancy-related complications. Nutritional education and support may improve nutrition and vitamin consumption, and recommendations for healthy gestational weight gains have been published. However, pregnant women have reported minimal advice regarding healthy weight gain during pregnancy. A personalized, nutritional counseling program was initiated in a Midwestern, suburban OB-GYN private practice.

Methods: A quality improvement descriptive, correlational design was used. A cohort of pregnant women first trimester through six-weeks postpartum received individual counseling and face-to-face interaction at an office visit each trimester.

Results: Twenty ( …

Emotional Intelligence Methods Utilized By Successful Major League Baseball Closers To Perform Successfully In High Pressure Situations, Joshua Rosenthal

Dissertations

Purpose: The purpose of this qualitative case study is to understand the similarities that exist in the descriptions of emotional intelligence methods utilized by retired successful Major League Baseball closers to appraise, express, regulate, and utilize their emotions to perform successfully in high pressure situations.

Methodology: The dissertation was a qualitative case study. Twelve of the top 50 retired save leaders in Major League Baseball were interviewed to understand the similarities in the descriptions of emotional intelligence methods used to perform successfully in high pressure situations. This study attempted to understand what exactly elite closers did to utilize emotional intelligence …

Impact Of Meaningful Recognition On Work Environment Perception Of Critical Care Nurses, Kristin Meinershagen

Dissertations

Problem: Absence of nursing staff recognition can lead to compassion fatigue, burnout, job dissatisfaction, and increased turnover rate resulting in high costs for hospitals. Meaningful recognition has been found to decrease compassion fatigue and reduce burnout. A meaningful recognition program was implemented over a 3-month period for staff nurses in an Intensive Care Unit (ICU) at a large midwestern, metropolitan hospital to determine its effect on nurse’s perception of work environment and turnover rate in the ICU.

Methods: This was an observational, descriptive, cohort design utilizing the AACN Healthy Work EnvironmentSurvey instrument for assessing results before and after implementation …

Team Creation Methods In Practice: Understanding The Potential Effects Of Nonverbal Communication In The Leadership Of Team Formation, Troy Allen Robertson

Dissertations

Teams require leadership, even if they are self-managed. The group of individuals who make up a team must be gathered in some form or another. For self managed teams to function successfully, the first step is the process of creating the team. Many aspects may factor into the creation process. Often time is of the essence and methods to quickly assess and form teams show merit. First impressions in general are based largely on nonverbal communication. The focus of this mixed-methods concurrent embedded study is to analyze the potential effects of nonverbal communication on influencing team creation. A group of …

Dominican Nursing Students’ Self-Reported Mastery Of International Nursing Competencies, Wady Ramirez

Dissertations

The Dominican health care system has many challenges to meet the legal and the population’s health care expectations (La Hoz, 2018; United States Agency for International Development, 2013). The purpose of this study was to evaluate how well Dominican nursing students, who have completed their internship but not yet defended their final career project, assessed themselves against a set of international nursing competencies. In addition, the purpose was to explore any differences in their self-assessments based on whether these students completed their internship at public health care centers or not. Finally, the goal was to determine to what extent do …

The Epidemiology And Burden Of Cardiometabolic Risk Factors In A Young Emirati Population, Fatima Abobakr Hussein Mezhal

Dissertations

The United Arab Emirates (UAE) has experienced rapid economic growth that was paralleled by a drastic rise in non-communicable diseases (NCDs); primarily cardiovascular diseases (CVDs), which account for 40% of mortality in UAE. CVDs have complex etiology, interplay, and accumulation of many risk factors. Understanding the clustering and interrelationships between common risk factors like obesity, deglycation, dyslipidemia, hypertension and central obesity, and the associations with social and lifestyle determinants are warranted. The study aimed to estimate the burden of cardiometabolic risk factors (CRFs), their interrelationship, and their associations with other social and lifestyle determinants in a young Emirati population. Data …

Anxiety, Attributions, And Marital Quality: A Mediation Model, Tara Vossenkemper

Dissertations

Marital quality plays a significant role in the physical and mental health of many people. The purpose of this study was to examine anxiety, attributions, and marital quality in a sample of females. The first two hypotheses aimed to assess the relationship between anxiety and marital quality, and the relationship between attributions and marital quality. The primary research question aimed to assess attributions as a mediator in the relationship between anxiety and marital quality. Participants (N = 358) completed a demographic questionnaire, the Quality Marriage Index (QMI; Norton, 1983), the Marital Adjustment Test (MAT; Locke & Wallace, 1959), the …

How Do Student Nurses Of English Language Learner Populations Experience Nclex-Rn Style Questions?, Shawne Manies

Dissertations

The purpose of this qualitative study was to explore how student nurses of English Language Learner (ELL) populations experienced National Council Licensure Examination for Registered Nurses (NCLEX-RN) style questions. Evidence has suggested difficulty in improving the nation’s diversified nursing workforce, resulting in concerns over minority nurse representation. Student nurses of ELL populations are more likely than non-English language learner student nurses to be out of sequence or released from a nursing program. The extant literature has shown that this population of students struggle with NCLEX-RN style questions and that they have significantly lower pass rates than their English-speaking counterparts. Literature …

A Meta-Synthesis Of The American And The European Standards For The Accreditation Of Counseling Training Programs, Natalia Zapolsky

Dissertations

The purpose of this qualitative study was to explore how the European Standards for the accreditation of counseling training programs compare to CACREP standards and to each other. The differences and commonalities between standards have been defined through a meta-synthesis of integrated findings from a large body of inter-related qualitative studies and reinterpretation of the synthesized data.

This qualitative meta-synthesis research was intended to contribute to the process of counseling globalization by exploring the unique cultural features and aspects of the European and the U.S. accrediting systems for counseling training programs. This research revealed 1) the commonly recognized areas that …

Treatments For Cancer Given Orally: Patients' Perceptions Of Distress Due To Financial Toxicity, Ellen Carr

Dissertations

Purpose/Aims: For adult participants who have received or are receiving treatment for hematologic and solid tumor malignancies given orally, this study describes the relationship between participants’ experience of financial toxicity (FT), the participants’ perception of distress associated with FT, and participants’ self-identified adherence to prescribed treatments in the context of FT.

Background: FT has emerged as an additional source of distress for cancer patients. The costs of treatments given orally can be prohibitively expensive for patients. Therefore, these patients may experience considerable distress and may not adhere to treatments as prescribed.

Method: Descriptive cross-sectional correlational design study of a sample …

A Correlational Model Of Burnout And Personality Among Clergy In The United States, Nathanael M. Stephens

Dissertations

Problem

This study explored the relationship between personality and burnout. The facets of personality detailed in the Factor Five Model served as the independent variables, with burnout as the dependent variable. Research exists on the relationship between personality and burnout for individuals in helping professions. However, there is little research on the interaction between burnout and personality factors among Protestant clergy members.

Method

A total of 602 participants who self-identified as living in the United States were recruited through an advertisement on Facebook. Participants all indicated they were Protestant members of the clergy and had been in the ministry for …

Ethnic Identity Salience, Socioeconomic Status, And Attitudes Toward Seeking Mental Health Treatment As Predictors Of Receptivity To Community-Based Psychoeducation Among African American Men, Hadiya Suzanne Dubose-Smith

Dissertations

Problem

Distrust and socioeconomic barriers are widely recognized as contributors to disparities in the healthcare system, particularly as it relates to mental health care (Lindinger-Sternart, 2015; National Alliance on Mental Illness, n.d.). African Americans continually experience societal pressures to disassociate with African American culture and to assimilate into mainstream culture. Perhaps accessing mental health services via a counselor is an extension of that pressure. In this way, the traditional counseling model for mental health intervention is a culturally counterintuitive approach for developing mental health among African American men. Men are a subset of the African American community that tends to …

Behavioral Symptoms, Inflammation And Cortisol: Relationship To Cardiac Health And Quality Of Life In Cardiac Rehabilitation Patients, Deborah Anne Sindewald

Dissertations

Background: The experience of a cardiac event is associated with psychological stress, which is often accompanied by depressive mood, fatigue and sleep disturbance (i.e., psycho-behavioral symptoms). To assist in recovery, cardiac patients can participate in a structured rehabilitation program, which provides monitored exercise and health education. There is limited knowledge, however, as to the extent to which cardiac rehabilitation reduces psycho-behavioral symptoms; nor is there knowledge of the association of these symptoms with stress-related biological mediators. Cortisol and inflammatory mediators (e.g., interleukin 6; IL-6) contribute to cardiovascular disease, and are also associated with greater stress perception, depressive mood, fatigue, and …

Patient-Specific Factors Associated With Surgical Delay In A Large Academic Hospital, Natalie Meyers

Dissertations

The high cost of healthcare is driving the search for more efficient practice, especially in high-stakes locations like the operating room. In addition to financial losses, patients suffer physical and emotional distress, including an increased risk of morbidity or mortality when surgical cases are delayed due to inefficiency. While patient-related causes of delay have been implicated, it is unclear which specific factors are most significant. This study aimed to identify specific patient factors correlated with surgical delay and develop a predictive risk algorithm that describes the relationship between patient-specific factors and surgical delay.

A retrospective review of 36,543 patients’ charts …

Choice Of God/Higher Power, Perceptions Of God/Higher Power, Religious Beliefs And Behaviors, And Social Support As Predictors Of Length Of Sobriety, Satisfaction With Life, And Quality Of Life Among People Recovering From Alcohol Addictions In Three Midwestern States, Carlton Martin

Dissertations

Problem

An estimated 12.7% of the US population meet the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) (American Psychiatric Association, 1994) criteria for Alcohol Use Disorder (AUD). The annual cost to the society, including emergency room visits, lost days at work, and accidents on the road is in the billions. The impact of this disorder on the family, the community, and the individual is immeasurable. A growing body of literature supports an association between religious and spiritual beliefs and behaviors and recovery from alcohol addiction. This project is an investigation of this association. The goal is to offer some …

Health Promotion And Cancer Screening Of Arab Americans, Lamyaa Alyaba

Dissertations

Introduction: Although Arab Americans represent one of the fastest-growing populations in the U.S., there is very little health data about their preventive health habits and health-promoting lifestyle, including cancer screening. Purpose: the purpose of this study is to examine the relationship between personal factors, health-promoting behaviors, and cancer-screening behaviors of Arab Americans while controlling for acculturation. Design: Pender's Health Promotion Model was the conceptual framework for the study. a cross-sectional correlational design explored the relationship between the study variables utilizing an online-based survey to collect data from Arab Americans. Multimodal recruitment was used to recruit a convenience sample of 287 …

Pediatric Providers' Perceptions Of Their Role In Early Detection Of Postpartum Depression, Laura Aime De La Pena

Dissertations

The birth of a child is usually a happy occasion in a woman's life. It is also often a time of overwhelming anxiety, stress and hormonal changes. Postpartum depression (PPD) could occur during the first year of childbirth in approximately 10-20% of mothers (Waldrop, Ledford, Perry, & Beeber, 2017). PPD is the most common maternal health problem within the first year after childbirth (the American College of Obstetricians and Gynecologists, 2018). Recognition of mothers who are at risk for PPD allows health professionals to initiate care that can prevent further problems for the mother, infant, and the rest of their …

Vigilance Of Certified Registered Nurse Anesthetists, Timothy Finn

Dissertations

Vigilance of certified registered nurse anesthetists (CRNAs) is an integral component of the care they provide patients under general anesthetic. the practice of CRNas is important as the official seal of the American Association of Nurse Anesthetists (AANA). on the seal, Morpheus, the god of dreams, is shown holding the Lamp of Learning, by the light of which he keeps vigil (Hirter & Van Nest, 1995). as the patients remain unconscious under general anesthesia, CRNas remain the patients' eyes and ears remains responsive to their needs. the CRNa must remain attentive to the patient's needs by continuously monitoring the patient …