Lived Experience After Surgery Among Hispanic Adults, Kimberly Sanchez

Dissertations

Background: In 2010, more than 51.4 million procedures were performed in hospitals in the United States. Almost half of all patients had a surgical procedure prior to their hospital discharge and over 80% of patients experienced acute pain after surgery. When acute pain persists for two or more months after surgery, chronic pain develops, costing the United States up to $635 billion annually. Hispanics, in particular, disproportionately experience disparities in pain treatment as they are less likely to receive analgesics. Routine pain assessments conducted using instruments may be inaccurately capturing the pain experience of Hispanic adults. No research has …

Patient Outcomes Associated With Delayed Rapid Response System Activation: A Retrospective Comparative Study, Ricardo Padilla

Dissertations

Purpose: The purpose of the dissertation study was to determine the difference in survival and length of stay (LOS) between patients who experienced a delay in Rapid Response System (RRS) activation and those patients who had no delay.

Rationale: There is evidence to support that the RRS is often not activated in a timely manner potentially leading to negative patient outcomes.

Background: Delaying treatment for in-hospital clinical deterioration has been associated with Serious Adverse Events (SAEs), including increased mortality, protracted LOS during hospitalization, and significant increased financial costs. The RRS was created as a hospital-wide approach to prevent SAEs; however, …

Women's Decision-Making For Subsequent Pregnancy After A Cesarean Delivery, Melinda Dixon

Dissertations

The purpose of this study is to generate a theory of the decision making process for women as they choose a birth option after a previous Cesarean delivery. The research method of choice when little is known about the phenomena is qualitative research. A qualitative approach was used to generate a substantive theory of decision making for women deciding subsequent pregnancy birth mode after a previous Cesarean delivery. The classical grounded theory methodology including sampling plan, recruitment, data collection and analysis outlined in Glaser and Strauss (1967) guided this study. Twelve study participants with a history of one previous Cesarean …

The Effectiveness Of An Ambulatory Care Health System Redesign On Patient Engagement, Healthcare Utilization, And Clinical Indicators, Nancy Johansen Madsen

Dissertations

Diabetes is a lifelong debilitating and deadly chronic disease affecting nearly one out of every eleven Americans. This public health problem costs $245 billion annually in the United States. Long term research trials have shown that diabetes complications can be prevented with good glycemic control, but it is difficult for patients to maintain control without much support from their healthcare team. U.S. healthcare remains fragmented. With the passage of the Affordable Care Act, there are opportunities to redesign health care delivery to minimize fragmentation and improve patient outcomes. The aim of this study is to determine if a redesigned care …

Predicting Decision-Making In Relation To Health-Risk Behavior In College Freshmen, Anne Bijumon Luckose

Dissertations

Method/Measurements: A cross-sectional correlational design explored the relationships between decision-making, health-risk behaviors and social support systems in college freshmen. The aims of the study were: 1) to explore the relationship between decision-making and health-risk behaviors among college freshmen; 2) to determine whether or not family support and social support jointly predict decision-making among college freshmen; and 3) to ascertain whether or not the effect of family support on decision-making is different for male and female college freshmen. Measurement was collected at one time-point and participants in this study completed on-line questionnaires through a web-based online survey software application with measures …

Behavioral Symptom Clusters, Inflammation, And Quality Of Life In Chronic Low Back Pain Patients, Anitha Saravanan

Dissertations

Chronic low back pain (CLBP) is a prevalent condition, often involving an inflammatory process. Those with CLBP frequently experience behavioral symptoms, including depressed mood, fatigue, and sleep disturbance, which may exacerbate pain and reduce quality of life (QOL). The purpose of this study was to identify behavioral symptom clusters (depressive mood, fatigue, poor sleep) in individuals with CLBP, and to determine whether there are differences in pain, QOL and inflammation (plasma IL-6) based on cluster membership. CLBP patients (N=69; age = 56±13 years) completed measures of pain, depressive mood, fatigue, sleep, and QOL. Blood was obtained for IL-6 measurement. LCA …

Fwer Controlling Procedures In Simultaneous And Selective Inference, Li Yu

Dissertations

With increasing complexity of research objectives in clinical trials, a variety of relatively complex and less intuitive multiple testing procedures (MTPs) have been developed and applied in clinical data analysis. In order to make testing strategies more explicit and intuitive to communicate with non-statisticians, several flexible and powerful graphical approaches have recently been introduced in the literature for developing and visualizing newer MTPs. Nevertheless, some theoretical as well as methodological issues still remain to be fully addressed. This dissertation addresses several important issues arising in graphical approaches and related selective inference problems. It consists of three parts.

In the first …

Functionalized Carbon Nanotubes In Hydrophobic Drug Delivery, Kun Chen

Dissertations

The direct incorporation of carboxylated carbon nanotubes (f-CNTs) into hydrophobic drug particles during their formation via anti-solvent precipitation is presented. The approach is tested using two drugs namely antifungal agent Griseofulvin (GF) and antibiotic Sulfamethoxazole (SMZ) that have very different aqueous solubility. It is observed that the f-CNTs dispersed in the water serve as nucleating sites for crystallization and are readily incorporated into the drug particles without altering crystal structure or other properties. The results show that the hydrophilic f-CNTs dramatically enhance dissolution rate for both drugs. The increased degree of functionalization leads to higher hydrophilicity and therefore faster dissolution …

Nurse Expectations As Compared To Perceived Reality, Kathryn Mckelvy

Dissertations

Burnout and turnover in nursing have been well documented in nursing literature, but little is known about a nurse’s expectations of the profession compared to their perceived reality of the profession. Do these expectations meet the reality of the workplace, and does this cause the nurse to make a career change? What factors influence a nurse to leave the profession, job-hop, or return to school to further their education? The rate of nurse turnover is an ongoing issue with a lack of research regarding the foundation of nurse expectations compared to the realities of the profession.

The purpose of this …

Self-Care Vs. Self-Sacrifice In Medical-Surgical Nursing Culture: A Critical Ethnography, Elise Jordan Juergens

Dissertations

The critical ethnography research examines need prioritization culture among medical-surgical nurses. Grove, Burns, and Gray (2013) define the problem statement as an explicit identification of the research need. Literature search yields scarce ethnographic research on the nursing population as a culture-sharing group, and no qualitative research exists regarding medical-surgical nurses’ self-need prioritization. The purpose of this critical ethnography is to observe medical-surgical nursing culture, related to personal need prioritization, as reflected by behavior and dialogue.

Qualitative research methodology is appropriate where statistical data is not. Research motivation involves seeking insight and sociocultural understanding. Critical ethnography is the chosen qualitative research …

Male Nurse Practitioners' Views On Nursing Education As A Career Option: An Inductive Qualitative Content Analysis, James Mcdavid

Dissertations

As the nursing shortage continues, the demand for new nurses will increase. In 2015, nursing schools in the United States turned away 62,361 qualified applicants in the baccalaureate and graduate nursing programs (Fang, Li, Arietti, & Trautman, 2016). The number of funded, vacant nursing faculty positions increased from 6.9% in 2014 to 7.1% in 2015 (Fang et al., 2016). One idea to help with the nursing faculty shortage is to recruit male RNs into nurse faculty positions. Males count for 10.6% of nurses in the United States (U.S. Bureau of Labor Statistics, 2016). However, men only count for 5.5% of …

Administrative Barriers To Compliance With The 2010 Ncaa Policy On Concussion Management, Tyler Norman

Dissertations

Concussions and concussion management in sport have become a polarizing public health issue. The best concussion assessment practices and “return-to-play” guidelines have been debated in both the scientific arena and in the media. At risk is the health of the athletes when proper diagnosis and treatment are not accurate for this potentially devastating injury.

Recent research estimates that approximately 1.6 – 3.8 million sport-related concussions occur each year in the United States (Brady, 2011), which can lead to chronic disease, swelling of the brain, cognitive impairment, chronic headaches, mood disorders, depression, blurred vision, double vision, cranial hemorrhaging and death if …

Concussion In Student Athletes: Prevention, Assessment, And Recovery, Miriam A. Carroll-Alfano

Dissertations

The research presented in this study examines concussion among athletes from the perspectives of prevention, assessment, and recovery. The first study examines concussion education for high school athletes by surveying 157 collegiate athletes, who primarily attended high school in Illinois and Indiana, about the previous concussion education, including whether they received mandated education, the methods and providers of education, and their ability to name a variety of concussion symptoms. This study finds that despite legislative mandates in these states, 20% of student-athletes continue to report not receiving concussion education in high school, with females more likely to report not receiving …

Photoreception And Eye Regeneration Mechanisms In Planarians, Taylor R. Birkholz

Dissertations

Although humans lack the ability to regenerate complete organs and limbs following amputation or injury, there are many other species (both vertebrates and invertebrates) that can. Significant advances have been made in understanding the genetic mechanisms that regulate organ regeneration in these species, including regeneration of eye tissues such as the lens and retina. Planarians are an established historical model used to study regeneration due to their ability to regenerate any organ, including the eye. With recent advances in molecular genetic analyses, planarians are now an emerging model for the specific study of eye regeneration mechanisms. Furthermore, regeneration of the …

The Meaning Of A Family History Of Colorectal Cancer In Black Families In The United States, Cassandra Loggins

Dissertations

The purpose of this study is to understand the meaning of a family history of colorectal cancer (CRC) for first-degree relatives of Blacks diagnosed with CRC. Even though CRC is more preventable than other cancers because of effective screening tests for prevention and early detection, Blacks experience a disproportionate burden of CRC compared to other groups. Interventions to increase CRC screening among Blacks have not produced a significant reduction in CRC disparity. Underutilization of CRC screening and low perceived risk of CRC are major factors contributing to CRC disparity. The informing methodological approach employed in this study was hermeneutic phenomenology, …

Eye Examination:Satisfying A Quality Care Measure In Diabetes, Meera Shekar

Dissertations

Abstract

Purpose: Diabetic retinopathy (DR), a microvascular complication occurs in patients with poorly controlled diabetes mellitus (DM). A known risk of increased visual impairment associated with DM occurs in patients when the glycosylated hemoglobin level (HbA1c) increases over 7.0%. Therefore, an annual retinal assessment as a quality care measure in diabetes management is necessary. The conducted study aimed to evaluate the documentation of an annual eye exam in all patients with DM in a private family practice clinic and to investigate any possible association between HbA1c level.

Method: This quality improvement study included a retrospective medical record review in …

Finding Hope In Chaos: The Development Of A Tool To Identify Key Factors That College Students Use To Effectively Deal With Adversity, Joetta Harlow Kelly

Dissertations

The purpose of this study is to identify techniques that could be developed into a resource for counselors and other professionals who assist college students in dealing effectively with adversity. In a series of four surveys, 200 people were asked to participate. These included professional counselors and ministers both on and off campus, as well as directors in Student Affairs, such as those in student support services and student life. To accomplish this, questionnaires were developed to identify and allow for tabulation of the counseling techniques most commonly used for students dealing with adversity by those working with college students. …

Evaluating The Kentucky Association Of Extension 4-H Agents Annual Conference Using The Re-Aim Framework, Michael Elijah Wilson

Dissertations

The Reach, Effectiveness, Adoption, Implementation, and Maintenance (REAIM) evaluation framework, as first introduced by Glasgow, Vogt, and Boles (1999), offers a straightforward method for evaluating Extension related programs. In this study, the RE-AIM framework is used to evaluate the Kentucky Association of 4-H Extension Agents (KAE4-HA) annual conference by examining pre-existing organizational data and records that include the results from KAE4-HA post-conference surveys that had never been reviewed as part of a comprehensive program evaluation.

This dissertation is divided into five chapters. Chapter I provides an overview of the study. Chapter II reviews the history of Extension in Kentucky, program …

The Impact Of Emotional Intelligence And Affective Behavior On Paramedic Student Field Internship Success, Jim Lambert

Dissertations

Purpose: The purpose of this correlational study was to examine the relationship between emotional intelligence (EI) scores, as defined by Bradberry and Greaves (2009) and paramedic student success during the field internship phase of their education as determined by the California Paramedic Field Internship Major Evaluation (FE) Rating Criteria.

Methodology: This quantitative, nonexperimental, correlational study utilized data collected from the Emotional Intelligence Appraisal—Me Edition and the California Paramedic FE reports provided by paramedic preceptors in the field. Data were collected from 30 paramedic interns from 3 paramedic programs in Southern California and analyzed using the Pearson product moment …

Career Coaching: A Study Of Veterans Health Administration (Vha) Leaders', Jerelyn Dugas

Dissertations

Purpose: The purpose of this qualitative multiple case study was to explore and describe the impact of career coaching on the career performance growth and retention as perceived by healthcare’s emerging leaders who participated in selected coaching program institutes for a minimum of 1 year at VHA hospitals in Southern California.

Methodology: The researcher selected a qualitative multiple case study to explore and describe VHA leaders’ perceived impact of coaching on their career performance growth and retention. Further, the researcher conducted semi-structured, interviews with 15 participants to gain a better understanding of the lived experiences of the participants at the …

Indirect & Displaced Aggression: The Role Of Comparison Based Traits And Cognitive Vulnerabilities, Niki M. Knight

Dissertations

The present study explored the relationships of contingent self-esteem, dispositional envy, and two cognitive vulnerabilities (i.e., anger rumination and fear of negative evaluation) to indirect aggression (IA) and displaced aggression (DA) in a college student sample (N = 346). Despite the theoretical relevance of these personality and cognitive factors to aggression, there is little empirical evidence linking them to the perpetration of IA and DA. Bivariate correlations and hierarchical multiple regression were used to test the utility of these constructs in accounting for unique variance in IA and DA and to assess the potential role of participant gender. Participants …

Qualitative Analogue Study On Student Therapist’S Reactions To Client Suicidality, Cynthia A. Beevers

Dissertations

Suicidal clients are a reality for both professional and student therapists providing counseling (Chemtob et al., 1988; Dexter-Mazza & Freeman, 2003; Goodman, 1995; Howard, 2000; Jacobson, Ting, Sanders, & Harrington, 2004; Kleespies, Penk, & Forsyth, 1993; Kleespies, Smith, & Becker, 1990; Mackelprang, Karle, & Cash, 2014; McAdams & Foster, 2000). Previous research has investigated the experiences of professional therapists working with suicidal clients, but little is known about student therapists’ experiences with suicidal clients. Only two studies were found investigating the experiences of student therapists working with suicidal clients (Kleespies et al., 1993; Kleespies et al., 1990). However, in the …

Training Pediatric Primary Care Providers In Behavior Management Strategies, Kate Burger

Dissertations

Childhood mental health disorders are a significant public health concern in the United States. It is estimated that every year 13 to 20% of children living in the United States experience a mental health disorder (National Research Council and Institute of Medicine, 2009). Despite the clear need for mental health care, less than half (45.6%) of children with one or more emotional, behavioral, or developmental conditions receive treatment from a mental health professional (The National Survey of Children's Health, 2007). There is growing evidence that integrating mental health services into pediatric primary care can result in increased treatment access as …

Primary Care Physician Delivered Brief Behavioral Intervention For Adult Obesity And Associated Health Conditions, Julia C. Huston

Dissertations

Obesity is a chronic health condition with prevalence rates that have continued to rise steadily over the past 30 years to the point that it has now been declared a global epidemic and a serious public health concern. Obesity is associated with significant physical and economic costs, primarily resulting from co-occurring health conditions that increase the risk of morbidity including type II diabetes, hypertension, dyslipidemia, stroke, coronary heart disease, and respiratory problems. Despite the dissemination of several obesity treatments, including pharmacotherapy, lifestyle modification, and bariatric surgery, the prevalence and severity of obesity continues to rise. Federal guidelines recommend the use …

Demonstrating Functional Analytic Psychotherapy As An Independent Variable In Efficacy Research: A New Measure Of Treatment Fidelity, Lindsey E. Knott

Dissertations

Functional Analytic Psychotherapy (FAP) is a contextual behavior therapy that takes an in session, in vivo focus to improve client outcomes. This in vivo (IV) focus is distinctive of FAP and involves the therapist utilization of contingencies in session to decrease problematic response classes and increase more adaptive response classes (i.e., a differential reinforcement procedure). This contingent responding is proposed to be FAP’s mechanism of action leading to client change. FAP efficacy research mainly consists of small n single-case studies or group designs combing FAP with another CBT intervention. Maitland & Gaynor (2012) offered recommendations for increasing FAP efficacy research, …

Beta-Testing Of An Interactive Multimedia Computer Program Of Exposure Therapy For Ptsd, Marie C. Barrett

Dissertations

Posttraumatic Stress Disorder (PTSD) results in significant impairment for the individual and substantial costs to society. Research indicates that cognitive behavioral psychotherapy (CBT) is the most effective treatment for PTSD and that among CBT treatments, exposure therapy is the treatment technique with the strongest evidence to recommend it for PTSD treatment. Computerized programs that deliver evidenced-based treatments offer a potential solution to barriers that prevent individuals from accessing and completing treatment. The present study evaluates the clinical and practical functionality of a computer-based program designed for the treatment of PTSD. Results indicate that completion of the program is associated with …

Incidence Of Head Injury Among Synchronized Skaters: Rates, Risks, And Behaviors, Gretchen L. Mohney

Dissertations

Data regarding risk and rates for head injury and concussion specific to the sport of synchronized skating is absent from literature. This study investigated the rate and risk for head injury and concussion as a function of team level, identified behaviors to include education, neurocognitive baseline screening and protective equipment utilization, and the implementation of return to sport protocols.

An anonymous cross-sectional survey was implemented at the 2018 U.S. Synchronized Skating Championships. Participants were female members of a qualifying team, ages 13 and older, at the intermediate participation level and higher. The survey response rate was 42% (520/1232). Among the …

Bariatric Surgery Regain And Long-Term Weight Loss Among Women: Self-Efficacy, Social Support And Health Promotion Lifestyle Behaviors, Raelene Z. Brooks

Dissertations

Although bariatric surgery appears to produce success in a short period of time immediately after surgery, weight regain over time in this population cannot be ignored. Understanding the relationship between potential psychosocial predicting post-surgical variables influencing bariatric surgery may prevent long-term weight regain. The purpose of this research is to examine self-efficacy, social support, and lifestyle habits and their relationship to long term weight loss and regain in women post bariatric surgery. Weight regain is observed as early as 18 months to 2 years after bariatric surgery. Patients face challenges sustaining the dramatic lifestyle changes required to ensure positive long-term …

Optimizing The Involvement Of Women With Opioid Use Disorder In The Care Of Their Infants Experiencing Neonatal Abstinence Syndrome, Rebecca Boedeker

Dissertations

The incidence of opioid use disorder (OUD) has grown to epidemic proportions. Infants exposed to opioids inutero are likely to experience withdrawal symptoms during the hours and days immediately following birth, known as Neonatal Abstinence Syndrome (NAS). Research indicates maximizing non-pharmacologic, supportive management decreases Neonatal Intensive Care Unit (NICU) admissions, the length of stay, and the severity of NAS. The purpose of this project is to evaluate the effects of an antepartum consult designed to prepare mothers with OUD to participate in this nonpharmacologic care. The Women and Infants Substance Help (WISH) Center delivers prenatal care for women with OUD. …

Traumatic Brain Injuries: A Telehealth Alternative For Veterans, Jessica Dickman

Dissertations

Problem: Traumatic Brain Injuries (TBI) are known as the signature wound of veterans serving in Operation Enduring Freedom (OEF) and the Operation Iraqi Freedom (OIF). After the initial TBI diagnosis, outpatient TBI follow-up rates are reported to be approximately 9% less in the Veteran Healthcare Administration (VA) system when compared to the private sector. The purpose of this quality initiative was to decrease the rate of missed appointments among OEF/OIF veterans using a telehealth alternative.

Methods: The Plan-Do-Study-Act (PDSA) method was used to implement a consistent process for the telehealth visit option. A retrospective medical record review over the same …