Medicine and Health Sciences Commons^™

Delirium In Long Term Care Rehabilitation Residents: A Correlational Retrospective Study, Rebecca Lerma-Kjonegaard

Dissertations

Abstract Background: Delirium is associated with devastating outcomes, cognitive loss,

decreased function and an increase risk of mortality which affects patients and places a heavy burden on family and the healthcare system. The purpose of this study was to describe the relationship between select demographics, clinical characteristics, CHART- DEL-derived delirium diagnosis and ICD-10 coded discharge delirium diagnoses among Long Term Care (LTC) rehabilitation residents.

Method: A retrospective correlational design from174 LTC rehabilitation residents age 65 years or older using EMR and hard copy charts. The setting was a Southern California community hospital-based 100-bed LTC. Abstracted data included demographic characteristics (age, …

Adult Postoperative Open-Heart Patients: Anemia And 30-Day Hospital Readmission, Lindsey Ryan

Dissertations

Background. In 2013 alone, more than 4% (3.9 million) of patients discharged from a hospital were readmitted. Anemia following a surgical procedure is associated with early hospital readmission.

Purpose/Aims. The following were specific aims of this dissertation:

• Aim 1. To develop an operational definition of the term condition-based maintenance as applied to health care and discuss the applicability and effectiveness of condition-based maintenance within health care.
• Aim 2. To identify the number of adult patients undergoing elective open-heart surgery with preoperative anemia.
• Aim 3. To examine the relationship between preoperative anemia, sociodemographics, and 30-day hospital readmission rates among postoperative open-heart …

Patient’S Utilization Of Health Information Technologies For Disease Self-Management, Mahmoud Hamzeh Altawalbih

Dissertations

Background: The rapid growth of Health Information Technologies (HITs) provides

patients with greater opportunity to take control over their health. HITs utilization has

been proven to be a critical component of disease self-management and can result in

positive outcomes. Its widespread adoption and utilization is still relatively low among

patients with chronic disease. It is important to understand the factors that may impact

HITs utilization, such as the perceived Task-Technology Fit (TTF). A very limited

number of studies have examined the relationship between HITs utilization and the

perceived fit between task and technology in the context of TTF theory.

Aims/ …

Nurse Family Member Perceptions Of Patient Death And Nursing Care After Withdrawal Of Life-Sustaining Treatment, Deena Drake

Dissertations

Purpose/Aims: This pilot study explored nurse family member perceptions of nursing care and patient quality of death and dying during and after withdrawal of life-sustaining treatment within Intensive Care Units (ICU).

Rationale: Past research that examined physician, nurse, and family member experiences of End-of-Life (EOL) care within the ICU found significant differences between the three groups.

Background: Approximately 500,000 people die within an ICU each year in the United States. End-of-Life and Palliative Care programs focused primarily on physician interventions to improve quality of EOL care have had little impact on family member perceptions of quality of care or patient …

Early Identification And Intervention In Patients With Atrial Fibrillation Using An Implantable Cardiac Monitor To Significantly Improve Guideline-Based Anticoagulation Therapy In An Outpatient Cardiology Clinic, Lisa Alvarez

Dissertations

The purpose of this research was to (a) examine the demographics of patients receiving care in an outpatient cardiology clinic, (b) describe the relationship between the atrial fibrillation (AF) and other variables (e.g., BMI), (c) examine the frequency and the length of time to AF diagnosis in patients implanted with an implantable cardiac monitoring (ICM) device, (d) observe provider patterns of treatment with oral anticoagulants (OACs), and (e) investigate documented considerations to either diagnose or rule out OSA in a group of outpatient AF patients in a cardiology clinic.

Background: AF is largely undiagnosed but can cause major morbidity and …

Validation Of A Scale To Measure Phonological And Morphological Knowledge And Skill Of Speech-Language Pathologists And Elementary Teachers, Susan S. Perry

Dissertations

Phonological and morphological skills are crucial to the process of reading. Speech-language pathologists (SLPs) have received advanced trained in these basic foundations of language and could be an untapped resource in our school systems for teaching beginning reading skills. The purposes of this research were to examine SLPs’ and general education elementary (K-6) teachers’ attitudes toward SLPs taking part in reading instruction, to compare the differences in phonological and morphological knowledge and skill among SLPs and teachers, and to assess the performance of the Revised Basic Language Constructs Surveywhen administered to SLPs and teachers.

Results indicated that, although fewer …

Resilience And Coping In Mothers Of Children With Sickle Cell Disease, Holly Carter

Dissertations

Sickle cell disease (SCD) is a prominent chronic illness in the United States. The Centers for Disease Control and Prevention (2016) estimated that one child out of every 365 African-American births will have SCD, affecting approximately 100,000 Americans. Supporting and promoting the integrity of the family and its’ members when a child has SCD is important for each family member’s well-being. Specific family characteristics, such as resilience and coping are important to understand because they can mitigate stress and create positive family outcomes (Brown et al., 1993; Cousino & Hazen, 2013; Hildenbrand, Barakat, Alderfer, & Marsac, 2015; O’Hanlon, Camic, & …

Attitudes Of New Graduate Rns Regarding Their Readiness For Practice Before And After Hospital Orientation, Diane Young

Dissertations

The acuity level of patients continues to increase making it more vital than ever that new graduate Registered Nurses (RNs) be prepared to give safe, quality care when leaving their hospital’s orientation program (Spector et al., 2015). Today, new graduate RNs need orientation programs that will ensure a smooth transition into nursing practice. This involves the ability to apply higher-level knowledge and skills in everyday practice situations, thereby, maintaining quality care (Henderson, Ossenberg, & Tyler, 2015).

The purpose of this study was to identify differences between new graduate RNs’ opinions on readiness for practice, as measured by the Casey-Fink Readiness …

Mississippi Registered Nurse Perceptions When Communicating With Limited-English-Speaking And Non-English-Speaking Patients, Mary Pipper Widdig

Dissertations

Communication serves as the foundation for safe and effective healthcare practice. Effective nurse-patient communication is the cornerstone of the nurse-patient relationship and is vital for the delivery of safe and effective healthcare. Research has shown patients who are communication impaired are at a greater risk of medical error and poorer health outcomes. A review of the literature revealed various nurse perceptions of barriers when providing care for limited-English-speaking patients and non-English-speaking patients. LEP and NEP patients also identified similar perceived barriers when receiving care. Both nurses and patients revealed a distrust for interpreters and interpreter services. The literature review revealed …

Simulation As Replacement For Traditional Clinical In Pre-Licensure Nursing Education: Outcomes Of Different Ratios Of Replacement Time For Traditional Clinical With Simulation, Tiffany Zyniewicz

Dissertations

The use of simulation in nursing education has grown over the last 30 years. The National Council of State Boards of Nursing National Simulation Study indicated that up to 50% of traditional clinical hours can be replaced with simulation at a 1:1 replacement ratio and produce the same outcomes. A review of the literature indicated that there is no standard replacement ratio for simulation time to traditional clinical time being used in pre-licensure nursing education in the United States. The purpose of this study was to explore the outcomes of utilizing a 1:1 simulation-to-traditional clinical time replacement ratio and a …

Exploring The Homeless Persons Perception Of Living In A Long-Term Care Facility, Janice Woods

Dissertations

Objective:The purpose of this study was to explore the lived experiences of homeless persons admitted to a nursing home facility. Originally, the study was to explore their understanding of and their experience with advance health care planning; coincidently, the participants were more open to their experience of living in a long-term care facility.

Method:A convenience sample of 13 participants (12 male, 1 female) at four long-term care facilities in Southern California were interviewed about their perception of advanced health care planning, including the physician’s orders for life sustaining treatment (POLST); a consent form required in all nursing homes. …

The Use Of Clinical Decision Support To Improve Nursing Practice, Kathleen Klimpel

Dissertations

Healthcare information technology is solidly entrenched in most acute care hospitals but the need to demonstrate its positive impact on patient outcomes persists. Clinical decision support (CDS) is an informatics tool that is highly customizable to promote patient improvement activities. Despite its high potential, studies have had mixed results regarding the impact of CDS and it has not been widely studied in the realm of nursing practice. One aim of this dissertation was to analyze the concept of CDS in order to inform the examination of the relationships between CDS implementation and nursing interventions. The determining factors of nurses use …

Older Adults’ Implementation Of Discharge Instructions Following An Acute Care Hospital Stay, Brenda Miller

Dissertations

Discharge instructions are a self-care guide for patients after discharge from an acute care hospitalization. The discharge process starts on admission to the hospital and continues until discharged. Many patients rely on informal caregivers to provide support after a discharge. However, it is often unclear whether the patients or caregivers completely understand instructions provided during the discharge process. Key concepts related to how discharge instructions were implemented following discharge to home have been understudied from the patient’s and informal caregivers’ perspectives. Developing effective discharge instructions based on study findings may assist in reducing 30-day hospital readmission rates.
This study was …

The Role Of Plasmids And Clones In The Emergence Of Carbapenem Resistant Enterobacteriaceae In The United Arab Emirates, Shaimaa Fekry Mahmoud Mouftah Ali

Dissertations

Resistance to carbapenems, the ultimate beta-lactam antibiotics used to treat life-threatening Gram-negative infections associates with very high mortality. Consequently, carbapenem-resistant Enterobacteriaceae (CRE), which are usually multi- or extremely drug-resistant, is considered a critical pathogen. To help to control their spread, we investigated the molecular epidemiology of CRE in the United Arab Emirates (UAE) and its neighboring countries. CRE isolated in the UAE were screened for IncX3 incompatibility type plasmids carrying carbapenemases. The complete sequence of the IncX3 plasmids identified was established. Thirty CRE carried blaNDM-1, blaNDM-4, blaNDM-5, blaNDM-7, blaOXA-181, and blaKPC-2 on IncX3 plasmids. …

Impact Of Leadership Styles On The Performance Of Virtual Teams In The Uae Government Sector: Assessment Of Transactional And Transformational Leadership Styles, Nama Salmeen Mabrouk Omar Al Ameri

Dissertations

The widespread availability of computers and the presence of ubiquitous internet has motivated organizations to acknowledge the potential role of virtual teams in reducing the cost of operations, increasing firm productivity, and creating flexible work environments. Consequently, most global firms are running their operations using multiple experts located remotely in different parts of the world (virtual teams) to plan, design, and implement projects and tasks. However, virtual teams face many challenges resulting from a lack of face-to-face contact. Based on existing relevant literature, this study contributes a unique insight into how some challenges surrounding virtual team performance might be addressed. …

Perioperative Antimicrobial Prophylaxis In Vascular Surgery: A Quality Assessment And Improvement Project, Brian Torres

Dissertations

Introduction: Prophylactic antimicrobial selection and administration for the prevention of surgical site infections in vascular surgery is a recommended best practice. Non-adherence to published guidelines on the selection and administration of antimicrobials has been observed and may lead to reduced efficacy of antimicrobial prophylaxis.

Methods: An observational, descriptive design was used to study clinician knowledge and behavior and included a retrospective patient record review and provider knowledge survey. A clinical education intervention targeting providers responsible for the selection and administration of antimicrobial prophylaxis was conducted. A repeat patient record review and knowledge survey was completed following the education intervention.

Results: …

How Professional Physical Therapist Education Programs Develop Cultural Competence Within Their Students: An Exploratory Concurrent Mixed Methods Study, Dustin E. Domingo

Dissertations

Purpose: The purpose of this exploratory concurrent mixed methods study was to describe experiences that shape the factors of cultural intelligence (CQ) as perceived by students of professional physical therapist education programs. In addition, it was the purpose of this study to determine whether any particular factor of cultural intelligence influenced one’s overall cultural competence according to the cultural competence continuum by Cross et al. (1989).

Methodology: Students in a professional physical therapist education program completed a questionnaire, which included Likert scale questions, open ended questions, and a 37-item self-assessment based on the expanded cultural intelligence scale by Van Dyne …

G.I. Jane Fem Etran Goes Corporate: An Exploration Of Post-9/11 Female Combat Veterans Transitioning To A Civilian Career, Tumona Austin

Dissertations

Purpose: The purpose of this multiple-case study was to explore the experiences of post- 9/11 female combat veterans transitioning from military service to civilian careers, using the Schlossberg transition model factors of situation, self, social support, and strategies.

Methodology: This multiple-case study identified and interviewed post-9/11 female combat veterans transitioning from active-duty to civilian career. Respondents were purposively chosen based on specific criteria and expert panel recommendations.

Findings: Examination of case-study interview data and artifacts from the 3 post-9/11 female combat veterans indicated nine major findings:

1. The factor of situation clearly outweighed the other Schlossberg factors in impact.

2. …

Identifying Potential Predictors Of Health Literacy And Steps Taken To Pursue Kidney Transplant Among African-Americans On Dialysis, Stacy Skelton

Dissertations

The dissertation attempts to address the disparity seen in all transplant centers today, the low number of African-American end-stage renal disease(ESRD) patients pursing kidney transplant as renal replacement therapy. Currently, there are two renal replacement options, dialysis or a kidney transplant. Research has shown that kidney transplant provides the best health care outcomes in terms of quality of life and decrease mortality. While African-Americans carry the burden of the disease by being four times more likely to have ESRD they only represent 1/3 of the kidney transplants done in the United States. There have been three attempts to increase access …

Physician Stress: Is The Electronic Health Record To Blame?, Zack Ward

Dissertations

The purpose of this study was to explore the potential relationship between Family Medicine physician burnout and the electronic health record. To do so, this study utilized the Copenhagen Burnout Inventory to assess burnout among physicians, along with specific questions regarding usage of the electronic health record and measurement of physician perceptions of the electronic health record. Members of the Kentucky Academy of Family Physicians were sent two separate invitations to participate in the study twice over a one-month period via email.

The study yielded no significant differences in Family Medicine physician demographics and their degree of burnout, or the …

A Collaborative Perspectives Approach For Understanding Effective Care Coordination In Autism Spectrum Disorder, Rachel Severs

Dissertations

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that causes significant impairment in social and communication areas. The severity of the disorder can often result in a substantial degree and amount of service access and expenditures relating to a child’s needs. This study examined the experiences of how family caregivers and service providers of children with ASD view service delivery using a basic qualitative research design. For the study, 10 participants (five family caregivers and five service providers) were enrolled and interviewed. Interview data were collected and coded to produce a qualitative analysis of the experiences of these individuals who …

Redefining Burnout: Exploring Common Conceptualizations And The Neurophysiology Of Chronic Stress To Establish An Integrated Allostatic Model, Danny A. Guzzi

Dissertations

Burnout is a widely researched stress-related phenomenon associated with numerous adverse outcomes for employees and organizations. Unfortunately, burnout is not well understood and research to this point has been flawed due to a lack of consensus on the definition, dimensionality, and context of the construct. Prevalent conceptualizations of burnout have been criticized for being arbitrarily developed without solid theoretical foundation and for failing to clearly distinguish burnout from depression or other work-related conditions such as compassion fatigue, secondary traumatization, and vicarious traumatization. The current project first examines relevant literature to identify commonalities among prevalent burnout conceptualizations. Then relevant stress research …

The Influence Of Stressful Life Events On The Development Of Type 2 Diabetes, Joshua Minks

Dissertations

This study examined the relationship between distress and the development of Type 2 diabetes mellitus (T2DM) in the presence of established risk factors. Distress secondary to mental health disparities, stressful life events, and work conditions has been shown to promote insulin resistance and the development of T2DM.

Subjects (N=79) diagnosed with T2DM within the previous six months were recruited from SSM Health Centers and VA Medical Centers in the greater St. Louis area. They completed the Recent Life Changes Questionnaire, ENRICHD Social Support Instrument, and a demographic survey and analyses were conducted to determine differences between the veteran …

Human Trafficking Identification Among Nurse Practitioner Students During Objective Structured Clinical Examinations, Zoe Onyun

Dissertations

Problem: Human trafficking (HT) is a significant worldwide and domestic issue affecting all ages, races, and genders resulting in over 40 million victims globally. Nurse practitioners (NP) often unknowingly come into contact with victims of HT, however, few NP’s have had formal education on the topic and may fail to recognize signs and risk factors. The purpose of this study was to initiate HT training for NP students.

Methods: A quality improvement (QI) initiative for a university college of nursing (CON) utilizing a prospective, observational, descriptive, cohort design. A plan-do-study-act (PDSA) methodology was implemented. A written case study given …

The Lived Experiences Of Parenting Children With Food Allergies: A Phenomenological Study, Anne Zavell

Dissertations

This phenomenological study focuses on five mothers' experiences of the phenomenon of living with a diagnosed food allergy in the family. Attention is given to the contexts or situations that have typically influenced or affected their experiences, including the impact of the diagnoses, travel and restaurants, friendships, sibling relationships, and anxiety. There is a major emphasis on these mothers' experiences advocating for the needs of their children in schools, including their strategies, concerns, and frustrations. Policies related to food allergies are reviewed from the contemporary and historical perspectives, with recommendations for policy change. The lived experiences of food allergy mothers …

The Impact Of Perceived Organisational Justice On Organisational Citizenship Behaviour In The Context Of Mergers, Fatima Ahmed Abdulla Al Nabhani

Dissertations

Scholars have relied on various approaches and methods to explain why organisations enter into a merger relationship, and how organisational initiatives impact employees' work outcomes. However, minimal attention has been directed towards the study of the relationship between Organisational Justice (OJ) and Organisational Citizenship Behaviour (OCB) in the post-merger period. The objective of this study was to examine how Organisational Justice affects Organisational Citizenship Behaviour in the context of mergers in the UAE. The study relied on a quantitative research method, social exchange mechanisms, and organisational justice theory to achieve the intended objectives. A total of 15 hypotheses were identified …

The Lived Experience Of Spiritual Well-Being Amongst Informal Caregivers Of Persons With Dementia On Palliative Care Living At Home, Michael Baumgardner

Dissertations

Title. The Lived Experience of Spiritual Well-Being Amongst Informal Caregivers of Persons with Dementia on Palliative Care Living at Home.

Purpose.This study explored the lived experience of spiritual well-being amongst informal caregivers of a person with dementia who were living at home and enrolled in palliative care.

Background. Patients with dementia comprise the third leading diagnosis in palliative care patients and many receive informal care from family members. Palliative care improves quality of life in patients and their informal caregivers. However, little is known about spiritual well-being in the setting of caregiving of persons with dementia on palliative care. …

Adventist Healthcare: A Qualitative Study Of 19th Century Founding Governing Principles In 21st Century Adventist Hospitals, Cesiah Yareth Pimentel Melendez

Dissertations

Problem and Purpose

Founding values and principles can help organizations stay focused on fulfilling their mission. This is especially true in faith-based organizations that seek to continue their founding principles as a governing commitment to their core identity. This study identified Adventist healthcare founding principles in Ellen G. White's early health visions and explored how Adventist healthcare leaders perceived these principles as governing principles applied to current Adventist healthcare practices.

Conceptual Framework and Research Design

Two metaphors and three areas of literature review guided my approach of this qualitative study of Adventist healthcare founding principles. My first metaphor of DNA …

Journey With Autism: Successful Educational And Social Interventions From A Single Case Study, Kwame M. De Jonge-Moore

Dissertations

Problem

Statistics indicate that Autism Spectrum Disorder (ASD) is on the increase in America and worldwide (Xu, Strathearn, Liu, & Bao, 2018; Baio et al., 2018). Autism spectrum disorder can impair an individual’s ability to engage in neurotypical behavior, which has the potential to increase their vulnerability to being shunned and bullied. This makes autism a major societal concern with significant costs to the individual, their family, private/public health insurance, state financial aid programs, and to the nation. This present study was undertaken to determine, in the opinions of those connected to the case, whether the interventions engaged in this …

Psychiatric Patients’ Perception Of Involvement In The Plan Of Care, Jaspal Kaur Gill

Dissertations

Background: There is an increased need to actively engage and involve patients in their care planning in healthcare facilities including psychiatric facilities (Wills, Riefer, Schauer, & del Vecchio, 2011). There has been a growing interest in patient-centered care and patients’ involvement in their plan of care as it leads to positive healthcare outcomes and increased patient satisfaction. However, there is a lack of research on how psychiatric patients perceive their involvement in the care planning while they are admitted to an inpatient psychiatric facility.

Aim: The aim of this qualitative phenomenological research study was to explore patients’ perception …